A&E waits are growing as the NHS braces for its toughest winter.
Ambulance leaders warned the seasonal crisis has already begun and strikes by junior doctors next month are set to worsen the situation.
In England, 69.7% of patients were seen within four hours in A&Es last month, down from 70.2% in October.
About one in three patients arriving by ambulance last week waited more than 30 minutes to be handed over.
NHS England data reveals 28,498 delays of half an hour or longer were recorded across all hospital trusts in the week to December 10. That was 34% of 84,268 arrivals, up from 25% for the week ending November 26.
The College of Paramedics and the Association of Ambulance Chief Executives said delays are forcing crews to wait outside packed A&Es, unable to take patients off vehicles.
The AACE found in October that delays of 15 minutes or longer reached 237,000, the second-highest volume to date, while delays of an hour or more hit 44,000, doubling in under six months.
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