Nearly one in three patients arriving at hospitals in England by ambulance last week waited at least 30 minutes to be handed over to A&E teams, new figures show.
More than 11,000 patients – 15% of the total – waited over an hour.
The numbers are higher than at any point last winter, and up on the levels reported for the previous week.
Health chiefs said the NHS is likely to be facing “one of the most brutal winters on record”, with “a perfect storm” of rising virus cases, limited bed capacity and growing demand for emergency care.
Some 23,999 handover delays of half an hour or longer were recorded across all hospital trusts in the seven days to November 27, according to NHS England.
This was 31% of the 77,054 arrivals by ambulance.
The proportion stood at 23% at the beginning of December 2021, before peaking at 27% at the start of April this year.
NHS trusts in England have a target of 95% of all ambulance handovers to be completed with 30 minutes, with 100% to be completed within 60 minutes.
The latest figures are included in the second weekly snapshot of how hospitals are performing this season – and they already suggest that pressures are getting worse.
The proportion of handovers taking at least half an hour is up week-on-week from 29% to 31%, while handovers taking over an hour is up from 13% to 15%.
Some 11,389 ambulance patients waited more than an hour to be passed to A&E teams, compared with 10,020 the previous week.
Professor Sir Stephen Powis, NHS national medical director, said: “These new figures show the NHS is facing a perfect storm, with winter virus cases rapidly increasing alongside ongoing pressures in emergency care and hugely constrained bed capacity.
“We have already said we expect this to be the NHS’s most challenging winter yet, which is why we started preparing earlier than ever before with extensive plans in place to deal with winter boosting bed capacity, including more than 40 control centres to track and manage demand 24/7, which are now live across England.”
Analysis of the data by the PA news agency shows that, among those trusts reporting at least 500 ambulance arrivals last week, the highest proportion of patients waiting over an hour to be handed over was 57% at University Hospitals Plymouth (307 out of 541 patients).
This was followed by University Hospitals of North Midlands at 43% (332 out of 769), Worcestershire Acute Hospitals at 42% (340 out of 802), North Bristol at 42% (259 out of 617), University Hospitals of Leicester at 41% (432 out of 1,050) and Norfolk & Norwich University Hospitals at 41% (280 out of 682).
A handover delay does not always mean a patient has waited in the ambulance.
They may have been moved into an A&E department but staff were not available to complete the handover.
But the rising level of delays reflects the struggle faced by hospitals in England in creating space for new arrivals.
The latest figures also show an average of 13,364 beds per day last week were occupied by people ready to be discharged.
This is up from 13,179 the previous week, and 27% higher than the number in the first week of December 2021.
Patricia Marquis, Royal College of Nursing (RCN) director for England, said: “With more than 13,000 patients a day stuck in hospitals because the community and social care they need to be safely discharged is unavailable, it’s easy to see why health and care is at breaking point.
“Combined with a record 47,000 nurse vacancies across the NHS in England, this is precisely the reason why our members have decided to strike – because the workforce gaps and being underpaid have made care unsafe.”
Up to 100,000 nursing staff will take industrial action in England, Wales and Northern Ireland on December 15 and 20, after voting in favour in a ballot.
Members of the RCN will take action at half of the locations in England where the legal mandate was reached for strikes, plus every NHS employer except one in Wales and throughout Northern Ireland.
Dr Layla McCay, director of policy at the NHS Confederation, the membership organisation representing the healthcare system in England, said: “NHS staff across the country are readying themselves for what is likely to be one of the most brutal winters on record.
“With ambulance handover times increasing and discharge delays showing no sign of waning as over 13,000 people who are medically fit to leave hospital cannot be moved due to the lack of appropriate social care services available to them, the weeks ahead look bleak.
“NHS staff are already exhausted as they head into the darkest winter months, so health service leaders will empathise with those staff who feel they have little option but to go on strike in the coming weeks.
“However, they have been preparing for the forthcoming industrial action for some time and will continue to do all they can to ready their organisations and ensure that as a minimum, urgent, emergency and critical care services will continue on strike days.”