• NHS England have published the latest monthly performance figures and the first set of weekly winter sitrep data.
• These figures show that performance against the A&E four hour target is the worst in any November since the data collection began. 
• There has been sustained high levels of emergency admissions, with November nearly as high as October and the second highest month on record.
• Demand for ambulances is very high with this week seeing more ambulance arrivals than all the weeks last winter, except Christmas week. However, delays are low compared to last year.
• Trusts have seen 1,000 more people with four hours in A&E every day in November compared to last year.
• The number of super stranded patients has fallen by 10% compared to the same week last year. The number of patients waiting over seven days is also down 5% compared to last year.

Responding to latest monthly performance figures and first set of weekly winter sitrep data, the director of policy and strategy at NHS Providers, Miriam Deakin said:

"Despite the extensive preparations by trusts, today's figures make it very clear that the NHS is on course for a very difficult winter.

"Trusts and their staff are already working at full stretch, but with more patients than ever seeking A&E services in the run up to winter, performance against the four-hour target for November has slipped to its lowest level recorded for that month. However, trusts are seeing 1,000 more people each day in four hours than the same time last year. 

Despite the extensive preparations by trusts, today's figures make it very clear that the NHS is on course for a very difficult winter.

Miriam Deakin    Co-Director of Development and Engagement

 "At the same time trusts are seeing continued high levels of emergency admissions with demand in November similar to the record level seen last month. 

"The pressure in urgent care extends outside the hospital, with ambulances bringing nearly 97,500 patients into A&E in the first week of December – the only week last winter which exceeded this was the traditionally busy Christmas week. It is concerning to see these levels this early in winter.

"It is positive that the measures that trusts and their partners have put in place to reduce the number of patients staying in hospital longer than they need has had an impact with a 10% reduction in the number of patients staying in hospital over 21 days.

NHS providers have worked hard to put preparations into place for winter with more of these measures yet to come into force; however, with the most busy and challenging months of the year still ahead, trusts and their staff are steeling themselves for a challenging winter.

Miriam Deakin    Co-Director of Development and Engagement

 "We should be in no doubt that the dedication of NHS staff has helped to maintain levels of performance across the system against a swell in demand for urgent care. NHS providers have worked hard to put preparations into place for winter with more of these measures yet to come into force; however, with the most busy and challenging months of the year still ahead, trusts and their staff are steeling themselves for a challenging winter."