Statistics show performance against key performance targets in the summer months of 2018 were worse than every winter between 2011 and 2015, further indication of what has been described as “permanent winter” in the health service.

NHS leaders have warned that pressure is only going to grow in the coming months, raising concerns that staff and patients will face even worse conditions this winter than last.

The figures reveal that almost 6.2m people attended an A&E department between July and September, an increase of 250,000 (4.3%) on the same period last year.

Emergency admissions rose even more sharply, up 5.9% year on year, the equivalent of an additional 940 a day across the country.

In total, a record 5.52m people were seen, treated or discharged within the target time of four hours, an increase of 180,000 patients on 2017.

As a percentage however the proportion seen within four hours fell to 89.3%, well short of the target of 95%, a measure the NHS in England has not hit nationwide for over a year.

The number of people on waiting lists for planned operations and procedures also rose to 4.3m, and increase of 200,000 on September 2017.

The percentage treated within 18 weeks fell to 86.7%, well below the target of 92%, and the number of people waiting more than a year soared, up from 1,778 to 3,156.

The quarterly report, compiled by regulator NHS Improvement (NHSI), also revealed a staff shortage of more than 100,000 doctors and nurses, and a combined deficit of £1.2bn.

NHSI forecasts that the deficit at the end of the financial year will be £558m.

The figures come as the government and NHS England finalise details of a long-term plan that will set out how increased funding promised by the prime minister will be spent.

The NHS will receive an annual increase of 3.4% for the next five years, worth an extra £4bn this year rising to £20.5bn by 2023.

NHS leaders and think tanks are sceptical that the increase will be sufficient to improve performance against current targets as well as delivering promised improvements in treatment for cancer and mental health.

Mrs May hopes to unveil the plan next month, tentatively scheduled for some time after the meaningful vote on Brexit on December 11, and the end of the parliamentary term on the 21st.

Ian Dalton, chief executive of NHS Improvement, said: “The NHS is working flat out to ensure record numbers of patients get the care they need. Frontline staff and managers deserve tremendous praise for their heroism.

“But this achievement continues to come at a cost with performance targets not being met nationally and hospitals being unable to balance their books to cover the increased demand on their services.

“The long-term plan is our opportunity to fundamentally redesign how the NHS works so that it can continue to provide high-quality care for patients.”

Siva Anandaciva, Chief Analyst at The King’s Fund said: “Today’s report is a warning that the NHS is heading for another very tough winter, with rising demand for services and staff shortages taking an increasingly heavy toll on patient care.

“As we get closer to the publication of the long-term plan, it is becoming increasingly clear that the new funding will not be enough to address all the pressures facing the service.”

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