Health leaders have warned that the NHS is “on course for a very difficult winter”, with one in 10 hospital trusts in England hitting capacity on at least one day last week and not having a single bed to spare.

Meanwhile, the latest performance statistics released by NHS England show there were 2.04 million attendances last month – fewer than the 2.08 million seen in October.

But more people had to wait longer, with 258 patients waiting more than 12 hours from decision to admit them, while 54,373 were forced to wait longer than four hours.

Just 87.6% of patients were seen within the four-hour target – the lowest proportion since March.

An NHS spokesman said staff saw 1,000 more people within four hours in A&E every day in November compared to last year, while a growing proportion of people were receiving same day emergency care – preventing the need for an overnight stay.

But Labour’s shadow health secretary Jonathan Ashworth said the statistics were “hugely concerning figures that don’t bode well for the difficult months ahead”.

Commenting on data relating to the first week of December, Dame Donna Kinnair, acting chief executive at the Royal College of Nursing (RCN), said: “The cold weather is only just beginning to bite, yet it seems NHS performance dipped to a worrying level for mild temperatures last week.

“One in 10 hospital trusts in England hit capacity on at least one day in just the first week of December, and had not a single bed to spare.

“Two were at 100% capacity every day. And because the reporting system doesn’t allow trusts to record more than 100% bed occupancy, these figures often mask large numbers of patients on trolleys and chairs waiting for a bed to become available.”

Miriam Deakin, director of policy and strategy at NHS Providers, 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.

“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.”

She said ambulances brought nearly 97,500 patients into A&E in the first week of December, warning it was “concerning to see these levels this early in winter”.

Patients at A&Es in England waiting over four hours between decision to admit and admission(PA Graphics)

Niall Dickson, chief executive of the NHS Confederation – which represents organisations across the healthcare sector, said the figures were “deeply troubling”.

He said: “Hospitals are now having to operate at unsafe levels – several are at full bed capacity and over a third are operating at 97% or above bed occupancy.

“A&E departments are struggling too, with even fewer patients able to be seen within four hours.

“On the front line, staff are under incredible pressure, treating more patients than ever. But they cannot work miracles.

“The cold, hard reality is that the NHS cannot keep pace with demand. These figures suggest we could be heading for one of the bleakest winters yet.

“The long-term plan for England is expected next week. Its message must be focused on new services in the community which will relieve overstretched hospitals

“Patients deserve to be treated at the right time and in the right place and that is not currently happening.”

Mr Ashworth added: “While Government remains paralysed by Brexit infighting, the NHS is struggling as a result of years of underfunding, cuts and staffing shortages.

“Rather than their self-interest, Tory ministers must start prioritising patients’ interests by outlining proposals for the NHS this winter.

“It would be totally unforgivable if patients suffered another winter crisis like the ones we’ve seen in recent years.

“Patients will expect the imminent NHS plan to have a clear and credible solution to chronic understaffing and a road map for restoring performance that has deteriorated so unacceptably in recent years.”

An NHS spokesman said: “NHS staff continue to work hard to deal with increased demand across the board, seeing 1,000 more people within four hours in A&E every day in November compared to last year.

“A growing proportion of people are getting same day emergency care which prevents the need for an overnight stay, and hospitals have freed up an additional 742 beds by working closely with councils to help more people return home with the right care in place.

“As the colder weather begins to set in, it’s vital that the NHS and local authorities continue to work together to help people stay well and out of hospital wherever possible, and the public can also help the NHS staff by making sure they have their free NHS flu jab if eligible, and by using NHS 111 as their first port of call for non-emergencies.”