Ambulances have missed their target for responding to the most life-threatening calls for a whole year, new data shows.
Crews are meant to reach patients who have had cardiac arrests or are not breathing - so-called Red 1 calls - within eight minutes.
But performance data from NHS England for May showed for the 12th month in a row the 75% target has been missed.
The target for Red 2 calls, for other life-threatening cases such as strokes, has not been met since January 2014.
During May, 70.5% of Red 1 calls were met in eight minutes and for Red 2 calls it was 65%.
NHS England blamed the problem on the rising number of calls - there have been nearly 11m in the past year, an increase of 7% on the previous year.
The figures from NHS England also showed the health service was struggling on a number of other fronts.
Targets for A&E, cancer care and routine operations have also been missed, while delays discharging patients from hospital have reached record levels.
Matthew Swindells, of NHS England, said the figures showed the frontline was under "intense pressure", but added on a number of measures performance had improved on the previous month.
He said accessing social care services run by councils remained a major issue in tackling the delays discharging patients from hospital.