Hospitals in England continue to miss many of their waiting time targets, official figures for November show.
Ambulances, the 111 phone service and cancer services all missed key targets.
And A&Es only managed to see 91.3% of patients in four hours - the worst performance in November since record-keeping began in 2010.
Meanwhile, the six-week target for diagnostic tests to be done was missed. It is now two years since it was last met.
Significant problems were also being experienced by hospitals in discharging some patients. There were over 153,000 days of delays, the second highest on record. Delays are experienced when there are not the community services available to care for vulnerable patients who are medically fit to leave hospital.
But hospitals did manage to hit their 18-week waiting time target for routine operations, such as hip and knee replacements.
Hospitals have been struggling with many of these targets for the past year or so - and similar challenges are being experienced by the health systems in Scotland, Wales and Northern Ireland.
The November figures released by NHS England showed:
- Ambulances missed their target to answer 75% of the most serious 999 calls in eight minutes - the sixth month in a row it has not been achieved.
- A&E units missed their four-hour target to see, treat or discharge A&E patients - the 14th time in 15 months performance has dropped below 95%.
- At the end of the month, 1.6% of patients had been waiting more than six weeks for diagnostic tests - above the 1% target.
- One of the key cancer targets - the 62-day target for treatment to start - was missed with 83.5% of patients seen in that timeframe, below the 85% target.
- The NHS 111 phone service missed its target to answer 95% of calls within 60 seconds. One in 10 patients waited longer.
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Richard Barker, of NHS England, said the performance needed to be seen in context of the rising number of patients needing care with "particularly large increases" being seen in the numbers getting diagnostic tests, needing ambulances and making calls to the 111 service.
And he added: "We continue to treat more than nine out of 10 A&E patients within four hours, probably the best performance of any major western country."
But Nigel Edwards, chief executive of the Nuffield Trust think-tank, said: "These new figures are particularly worrying given that they only cover November, when the weather was exceptionally mild and winter had not even properly begun - the fact that there have been such dips in performance so early in the season does not leave the health service in a good position to cope with the rest of winter."