The NHS has recorded its worst A&E waiting times in England since current targets began in 2004.
The latest figures show that 83.6% of patients were seen within four hours in October.
That compares to 85.2% in September, and 89.1% in October 2018.
However, attendances rose to 2,170,510 in October, 4.4% up on the same month last year.
There were also 563,079 emergency admissions, a rise of 3.1%.
In addition, there were more than 6,000 extra category 1 ambulance callouts – a rise of 11.2%.
The rate of growth for those over 65 is double that of those under 65, according to data from a sample of trusts.
Older people also tend to spend longer in A&E, NHS England said.
The 95% target in A&E was last met in July 2015.
On a more positive note, almost 175,000 people were seen within two weeks of being referred for an urgent cancer check in September, an increase of 8.9% compared to the same month last year.
And nearly two million diagnostic tests were undertaken in September, an increase of 7% on the previous year.
Patients are being asked to go to their local casualty department only in a genuine emergency.
An NHS spokesperson said: “These figures show that while NHS staff are looking after a markedly higher number of older and sicker patients, a higher number of patients are being seen quickly than a year ago.
“While hospitals will be opening more beds over the coming weeks, the public also have a role to play going into winter, and can help doctors, nurses and other staff by getting their flu jab, and by using the NHS 111 phone or online service as a first port of call for non-emergencies.”
The Society for Acute Medicine said urgent action was needed, warning the system was “imploding”.
Responding to the latest figures, the Nuffield Trust said the next government could be faced with “one of the bleakest winters in the NHS’s history”.
The health think tank added that there were “many months to go until seasonal pressures really hit the NHS”.
Analysing the statistics, it said: “The health service is seeing far more patients, yet one in six is now waiting more than four hours in A&E. If the usual trends continue after Christmas, that would head towards one in five.”
Labour’s shadow health secretary, Jonathan Ashworth, said the NHS was “in crisis” and a “winter of abject misery for patients” was in prospect.
He added: “Our A&Es are overwhelmed, more so than ever. In every community there’s an ever growing queue of people waiting for treatment.
“These figures starkly show why patients desperately need Labour’s £40 billion rescue plan.”
Health Secretary Matt Hancock said the figures showed “just how important it is that we stop Jeremy Corbyn”.
He added: “We are giving the biggest cash boost ever to our NHS, but Corbyn’s chaotic policies will put that at risk.
“With rising demand, and with dedicated staff already working exceptionally hard, the last thing our NHS can afford is Labour’s plans for a four-day week and uncontrolled and unlimited immigration, which would cripple our health service – leaving it understaffed and underfunded.”
The Liberal Democrats’ health spokesperson, Luciana Berger, said: “This is a damning indictment of the Conservatives’ dismal record on the NHS.
“The Liberal Democrats would invest £35bn in our NHS through a penny on income tax and stop Brexit to protect our EU NHS workforce.”
The worst is yet to come this winter – analysis by Ashish Joshi, health correspondent
The figures are bad and they will only get worse. And that is the real worry.
Right now we are in the pre-winter period and already the figures show the worst ever figures since the data was collected.
NHS England says its “staff are looking after a markedly higher number of older and sicker patients”.
That is true. We do have an ageing population that needs more care.
But these figures tell us the NHS is not coping and when the winter really does arrive it will further increase pressure on a struggling health service.
The NHS says “hospitals will be opening more beds over the coming weeks”.
That is fine but its own data shows nearly 5,000 beds were occupied by people who were fit to be discharged.
That is because of a delay in putting together a social care plan for these patients.
The winter is traditionally the most difficult period for the NHS but the summers are also becoming increasingly busy, and that will certainly have affected winter preparations.
Brexit uncertainty will not have helped, but it is not thought to have had a major impact on getting ready for another winter crisis.
And according to NHS Providers, the membership organisation for NHS hospitals, unless there is much greater investment in the health and care system, the coming months will be harder than ever.
Saffron Cordery, deputy chief executive of NHS Providers, said: “Trusts have put winter planning into practice. There is a great deal that has been learned from previous years, but there is absolutely no doubt this winter will be an exceptionally testing time for trusts.”
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