The NHS has yet again failed to hit some of its key performance targets, raising fears that problems are now deeply ingrained and that services are at risk of buckling under the pressure, particularly if colder whether sparks a spike in the number of patients needing medical attention.

Data for November show that, for the sixth month in a row, the standard for the number of the most urgent ambulance calls’ being responded to within eight minutes was missed, coming in at 71.9 percent versus the target of 75 percent. The number of less urgent ‘Red 2’ calls hitting the eight-minute response target was even lower, at just 67.4 percent.

According to the figures, there were 1,874,234 attendances at A&E in November 2015, up 2.4 percent from the same month in 2014. But the number of patients admitted, transferred and discharged from A&E within the four-hour target continued to slip, with 91.3 percent for the period versus the 95 percent target and 93.5 percent a year ago.

The number of diagnostic tests such as CT or MRI scans undertaken was higher than in the preceding 12-month period, but again patients were left waiting longer for them, with 1.6 percent waiting six weeks or longer from referral, missing the standard of 1 percent, which has not been met since November 2013.

Elsewhere, while seven of the eight cancer standards were met, the 85 percent standard for 62 day cancer waiting times was not, with 83.5 percent of patients beginning a first definitive treatment within 62 days from an urgent GP referral.

“The fact that so many targets - not just on A&E waits but also on ambulance response times and waits for cancer treatment - are now routinely being missed every month lays to rest the idea that a few poorly performing Trusts are dragging down the rest,” said Nigel Edwards, chief executive of the Nuffield Trust health think tank. “Failure to meet the targets now seems to have become the norm rather than the exception”.