The NHS in England has missed a raft of key targets as experts warn that A&E departments face a "perfect storm" this winter.
The latest figures from NHS England reveal that 93.4% of patients attending emergency departments in September were seen within four hours - against a target of 95%.
The target has only been met once so far this year - in July - and was only met for half of the year last year (six out of 12 months).
The data is often cited as an indicator of the NHS beginning to struggle as it prepares for a busy winter period.
Other key figures show that targets for cancer referrals, ambulance response times and NHS 111 calls were missed in September.
Delays in discharging hospital patients have also reached record levels.
A snapshot taken on the last Thursday of the month showed that more than 5,000 patients were occupying beds, even though they were ready for discharge.
This was the worst level since records began in 2010. Experts have blamed cuts to social care for the so-called "bed-blocking" in NHS hospitals.
Meanwhile, the 62-day wait for cancer treatment from GP referral was hit for 81.5% of patients. The target is 85%. It is the 17th month in a row it has been missed.
The 14-day wait for patients with breast cancer symptoms was hit for 92.7% of patients compared with a target of 93%. It is the third month in a row it has been missed.
Ambulance trusts also continue to miss the target for 75% of critical "Red 1" calls - such as for cardiac arrest - responded to within eight minutes. In September, this was hit for 72.9% of calls, the fourth month in a row it has been missed.
Some 68.9% of "Red 2" immediately life-threatening calls - such as for stroke - were responded to within eight minutes against a target of 75%. This target has not been met by the NHS since January last year.
The proportion of NHS 111 calls answered within 60 seconds was 91.4% against a 95% target. This was the lowest figure for any month of the year so far.
It comes after Dr Mark Holland, the president of the Society for Acute Medicine, warned that A&E units are facing a "perfect storm" which will heap on the pressure in the build-up to winter.
He told Sky News that a lack of staff and possible industrial action by junior doctors were "very, very worrying" at this time of year.
He said: "There is already talk of putting ambulances on divert, of taking patients to other hospitals.
"That intensity is beginning to creep up. Not on a day-to-day consistent basis like last December and January, but it's starting and it feel like it is occurring a wee bit too early.
"The question this winter is how resilient we will be and what will be the tipping point. And that is the unknown factor which is very, very worrying."
He said hospitals have not had the traditional quieter summer period which enables them to catch up after the winter.
"Now, in medical terms, it feels like the summer no longer exists," he said. "It feels as if it is always the winter.
"You have got the perfect storm. You have got junior doctors in dispute with the Government, we cannot recruit into all of our training posts and there are lots of consultant posts unfilled.
"Last winter we were pushed to the brink. All of these things coming together, it only needs one thing to tip over and you will get a domino effect."
A spokesman for NHS England said: "Frontline services are treating more patients than ever, and it's right to say that we need strong primary and social care to help offset the pressures on A&E.
"But it is also worth remembering that, despite the usual flow of negative predictions at this time of year, our services continue to admit or treat and discharge more than nine out of 10 patients within four hours - a higher standard than any major Western nation."
Earlier this week, it emerged that ambulance trusts are able to say they are meeting response times if equipment is nearby to re-start hearts - even if that is useless to the patient.
A Department of Health spokesman said: "The NHS is busier than ever, which is why we're investing the extra £8 billion the NHS asked for.
"This will tackle the underlying challenges to join up care for patients, improve access through seven-day services and do more to prevent illness in the first place."
Shadow health secretary Heidi Alexander said: "These figures show that the NHS is facing breaking point before winter has even started. It is a stark illustration of just how far the NHS has declined under the Tories.
"Unless there is an urgent and significant injection of money into the NHS, then standards of care will be compromised this winter.
"The uncomfortable truth for ministers is that this is a crisis of their own making. The NHS is under pressure as a direct result of decisions they have made.
"They cut older people's care in the home, meaning hospitals have become dangerously full, and cuts to nurse training places have forced hospitals to drain resources hiring expensive agency staff."