The Royal College of Emergency Medicine has warned that the performance of A&E departments across the country is already worse than the lowest level seen in the 2015/16 winter season.

According to the College's Winter Flow Project, which looks at pressures impacting on the emergency care system over the winter period, data collected from 60 sites across the UK shows that performance against the four-hour performance target stands at just 81.51 percent.

Performance is worsening "despite a clear, concerted effort to improve", the College says. The current four-hour wait result - a key indicator of NHS performance - has fallen 3.5 percent since the start of the project and has already dropped under the lowest point in last year's data of 82.10 percent (although it was noted that more Trusts are involved in this year's data scope).

In the nine weeks that data has been collected, the number of acute beds available across has gone up by 1.8 percent, which has helped push down the number of delayed transfers of care by 3.3 percent. But a consequence has been an increase in the number of cancelled elective operations – up by 14 percent since the start of the project, the data show.

"Despite sites making more beds available; allowing fewer patients to experience a delay in their care, four hour performance is still getting worse. This is in addition to an increased number of elective operations having to be cancelled," noted President of the College, Dr Tajek Hassan.

"It is clear that more beds alone is not enough to solve the problems EDs face. More doctors are needed to relieve pressure and provide the best care possible to an ever increasing number of patients with multiple and complex conditions."

Experts believe that this could be the toughest winter facing the NHS yet, because of unprecedented demand and staffing and funding shortages, as well as a lack of investment in social care.

According to the Care Quality Commission's annual State of Care report earlier this year, just 38 percent of urgent and emergency services were rated as 'good' and 5 percent 'outstanding' during its inspection regime, leaving nine percent 'inadequate' and 48 percent in need of improvement.