Thousands of patients endured long ambulance waits and almost 95% of hospital beds were occupied in the first week of the NHS winter, according to new figures.
The first winter pressure situation report published by NHS England also revealed that 11 accident and emergency departments were forced to divert patients away in the seven days to Sunday 3 December.
NHS leaders and opposition politicians said the figures show NHS services are under extreme pressure even before demand is expected to peak over the coming months.
The figures show that, on average, 10,184 patients every day waited for between 30 and 60 minutes in an ambulance before they were seen in hospital, with a daily average of 1,844 waiting more than an hour.
General and acute bed occupancy, a key indicator of capacity, was running at 94.5%. Hospitals consider 85% occupancy a safe level.
There were four flu-related deaths in England during the week.
The figures do show some improvement on the previous week, results for which were held back, when 39 hospitals activated A&E diverts and more than 10,600 people waited up to an hour.
Unlike previous years, NHS England has chosen not to publish total attendance at A&E departments, or the number of hospitals classified as “under pressure” because they have triggered one of the two highest levels of “escalation” in response to demand.
The figures comes as NHS hospital trusts warned that the most extensive winter planning ever undertaken may be undermined, and patients put at risk, by shortages of staff, beds and money.
NHS Providers, which represents hospital, ambulance and mental health trusts, said its members were already severely stretched, with bed occupancy in some trusts running at 98%, and significant delays in transferring patients out of hospital reducing the capacity for new admissions.
Speaking to Sky News at Newham University Hospital, Barts Health chief medical officer Alistair Chesser said local co-operation was helping them cope with demand.
He said: “Winter has definitely arrived, we’ve noticed that. We had 530 attendances here in Newham on Monday, our normal rate is about 430, so you can see that the numbers are going up.
“But we saw 97% of people within four hours yesterday which is a terrific performance by this hospital, so we are coping.”
Labour and the Liberal Democrats said the ambulance figures were evidence of Government underfunding.
Jonathan Ashworth, Labour’s shadow health secretary, said: “Today’s data reveals a stark picture of what lies ahead: a winter of misery for patients and unparalleled pressures on our NHS staff.
“Some Trusts are already completely full with no spare beds – an extremely worrying indicator for what is still to come particularly after NHS Improvement’s explicit warning that ambulance handover delays ‘should not occur’.”
Lib Dem former health minister Norman Lamb said: “These completely unacceptable delays are a long-running problem that the Government is failing to address, and they are getting worse.
“There is no doubt that lives are being lost as a result of these pressures.”
In a statement, NHS England said: “The NHS has prepared for winter this year more intensely than ever before, developing robust plans to manage expected increased pressures, as well as create contingency plans to cover exceptional surges in demand.
“The public can continue to play their part by making sure they have their flu jab and by using local pharmacies and NHS 111 for medical advice, alongside other services.”
A spokesperson for the Department of Health said: “The NHS has more robust plans in place than ever to cope with winter supported by £435m and £1bn funding for the social care system this year.
“The plans include an unprecedented system-wide push for all NHS workers to have the flu jab, aimed at helping to protect patients in hospitals and in the community.”