A&E departments have suffered their worst November performance on record, with the number of patients seen within four hours dropping to 87.6% from 88.8% in November last year, according to performance data released by NHS England.

With 24.4 million attendances to A&E in the last twelve months and 6.25 million emergency admissions to hospital, the pressure on NHS staff continues to increase. In terms of long-term treatment, over 16 million patients started treatment in the last 12 months, which is a 0.6% increase on the previous year.

The statistics show that more than 54,000 people had to wait longer for treatment in 2018 than in 2017, including more than 250 who had to wait for 12 or more hours on a trolley.

“This is deeply troubling,” said Niall Dickson, chief executive of the NHS Confederation.

“Hospitals are now having to operate at unsafe levels - several are at full bed capacity and over a third are operating at 97% or above bed occupancy. A&E departments are struggling too, with even fewer patients able to be seen within four hours.

“On the frontline, staff are under incredible pressure, treating more patients than ever. But they cannot work miracles. The cold, hard reality is that the NHS cannot keep pace with demand. These figures suggest we could be heading for one of the bleakest winters yet.

He went on to note that the long-term plan for England is expected next week. “Its message must be focused on new services in the community which will relieve overstretched hospitals. Patients deserve to be treated at the right time and in the right place and that is not currently happening.”