Warning bells are ringing again over the NHS' ability to cope with the expected influx of patients in winter months as reports show A&E departments across England are already failing to keep up.

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

Also, the number of people waiting for more than four hours in A&E overall rose by 30 percent from 2014/15 to 2015/16 as demand outstripped system capacity, raising concerns that the system is on the verge of meltdown.

"The NHS is on its knees and, this winter, areas will implode around the country. There is no reserve left," said Dr Mark Holland, president of the Society for Acute Medicine.

"We coined the phrase eternal winter months ago in relation to increasingly poor performance and this data is clear evidence that is what we are now dealing with. Over the coming weeks and months, if we see a major increase in admissions due to flu or bed closures due to norovirus, we will collapse."

NHS England's most recent monthly NHS performance stats mirror the CQC's findings.

In August, there were 1.9 billion attendances at A&E, marking a rise of 3.6 percent over August 2015, it said, while just 91.0 percent of patients were admitted, transferred or discharged within four hours of arrival, falling well below the 95 percent standard.

Record transfer delays

The data also show 188,340 delayed transfer or care days for the month, compared to 145,093 for the year-ago period – the highest number since monthly data were first collected in August 2010.

Increased A&E attendances and emergency admissions are affecting the ability of a growing number of trusts to meet their performance and financial targets, the CQC noted, but also stressed that this growing number of delayed transfers out of hospital - because of failings in the social care system - is a critical issue.

The Royal College of Emergency Medicine says cuts to social care are having a dramatic effect on emergency departments – "increasing the workload on staff and contributing to Exit Block".

"August saw a record number of delayed days and a third of this is attributable to a lack of social care," noted Dr Taj Hassan, president of the College.

"The report shows how failed systems are having a dramatic impact on secondary care. These failures in the community are showing that this results in Emergency Departments becoming overcrowded due to exit block from lack of access to hospital beds and then patients being delayed from getting back into the community. Exit block overcrowding causes delays to essential treatment in the ED and significantly raises the risk of death".

The RCEM is urging the government to increase its investment both in emergency care as well as social care. "Failure to act now will also more than likely take us past the tipping point for being able to stabilise such fragile emergency systems," Dr Hassan warned.