A&E departments have once again failed to hit their waiting time targets, new NHS England figures reveal.
The statistics show the proportion of people seen within four hours in November was 88.4%, against a 95% target.
That is a 2.9% fall compared to the same time in 2015 and represents a seven-month low.
Additionally, only 11 out of 138 NHS trusts with major A&E departments fulfilled their waiting time aim.
of patients were admitted, transferred or discharged within four hours in November
is the target level of patients seen within four hours
the total number of attendances in November 2016
the increase in attendances on the same month last year
The data highlights acute problems with delayed discharges - where patients are medically fit to leave hospital but are stuck in beds due to problems arranging care in the community.
This impacts on A&E as hospitals struggle to find beds for incoming patients.
Days lost to delayed transfers of care totalled 193,680 in November.
This is the third highest number on record, and 26% higher than the figure for November 2015.
Matthew Swindells, NHS England's national director for operations and information, said: "This month's figures show a 42% annual increase in delays in being able to discharge patients as a result of pressures in social care.
"Hospitals report this affects their ability to quickly admit emergency A&E patients, so the NHS is working closely with local councils and community health services to enable older patients to get the support they need after a hospital stay, back at home."
The figures also show trolley waits of over four hours after a decision has been made to admit the patient totalled 52,769, the second highest figure on record, and 54% higher than November 2015.
Trolley waits of over 12 hours totalled 456 - again, the second highest figure on record. This is 93.6% higher than the number for November 2015.
Which were the best and worst performing A&Es in the latest figures?
The figures come just a day after the Health Secretary Jeremy Hunt came under fierce criticism for the increased pressure facing the NHS.
The letter from the RCP said: "Our NHS is underfunded, under doctored and overstretched. Patients are waiting longer on lists, on trolleys, in emergency departments and in their homes for the care they need.
A Department of Health spokesperson said: "Despite the NHS being busier than ever the vast majority of people are seen quickly –208,000 more people attending A&E were seen within the 4 hour standard in the past year compared to the year before.
"The NHS is facing increasing demand from our ageing population, so we are joining up health and social care to make sure patients are not in hospital unnecessarily, supported by an extra £10 billion per year by 2020 to fund the NHS’s own plan to transform services for the future."