A record number of people were left waiting at least four hours from the decision to admit to admission in A&E, NHS England figures show.
The number waiting reached a peak of 150,922 in October, up from 131,861 the previous month.
More than 30% of people had to wait over four hours to be seen in A&E in October, including 45% of people attending Major A&Es (excluding minor injuries units and specialist centres).
The operational standard is that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours, but this has not been met nationally since 2015.
The number of people waiting more than 12 hours in A&E departments in England from a decision to admit to actually being admitted has also risen to a new record high.
New NHS England data shows that 43,792 people waited longer than 12 hours in October, up 34% from 32,776 in September and the highest number in records going back to August 2010.
It comes as the number of people in England waiting to start routine hospital treatment has risen to a new record high.
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A total of 7.1 million people were waiting to start treatment at the end of September, NHS England said.
This is up from 7.0 million in August and is the highest number since records began in August 2007.
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Meanwhile, 401,537 people have been waiting longer than a year to start hospital treatment, up from 387,257 at the end of August and equivalent to around one in 18 people on the entire waiting list.
Very long waits of more than two years have fallen slightly, while the number of people waiting 18 months for treatment has dropped by almost 60% in one year, NHS England said.
The rate cancer patients in England saw a specialist within two weeks of seeing their GP has also slumped to an all time low.
Data shows 251,977 urgent cancer referrals were made by GPs in September, but only 72.6% were seen within the two week timeframe.
It also showed that nearly 6,000 cancer referral patients waited more than two months to be seen by a specialist.
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Ambulance waiting times were also a long way outside their targets, with the average response time to people with life-threatening injuries outside London clocking in at nine minutes 56 seconds, almost three minutes over the target time of seven minutes.
Figures also revealed the number of people in England waiting longer than six weeks for a key diagnostic test has risen to the highest level in two years.
Some 463,930 patients – 29.8% of the total – had been waiting longer than six weeks for one of 15 standard tests in September, including MRI scans, non-obstetric ultrasound or gastroscopies.
This is up from 461,400 the previous month and the highest number since August 2020 when 472,517 patients had been waiting longer than six weeks.
Analysis
The figures are stark. There is no other way to say it.
Even gains made in previous months are reversing or slowing down.
And the worrying thing is as it gets busier we are still nowhere near peak winter.
Covid, flu and A&E attendances are driving the pressure according to the NHS.
They say last month was exceptionally busy and that is reflected in the record waiting times right across the board from ambulance attendances, A&E waiting times and trolley waits.
There are more people going into hospital than leaving. The lack of social care provision is why.
So as winter really starts to bite that pressure and those waiting times are only going to rise to more record highs.
Add to the mix the impending nurses strike. We don’t know when or how many days but any operations, procedures and appointments that have to be cancelled will have to be rescheduled.
And that, again, means lists grow. And it is not just nurses who are taking industrial action.
The unions for non-clinical staff who work in hospitals, the army of people that make these buildings work, are balloting their members too.
NHS medical director Professor Sir Stephen Powis said: “There is no doubt October has been a challenging month for staff, who are now facing a tripledemic of Covid, flu and record pressure on emergency services with more people attending A&E or requiring the most urgent ambulance callout than any other October.
“Pressure on emergency services remains high as a result of more than 13,000 beds taken up each day by people who no longer need to be in hospital.
“But staff have kept their foot on the accelerator to get the backlog down, with 18-month waiters down by three-fifths on last year.
“We have always said the overall waiting list would rise as more patients come forward, and, with pressures on staff set to increase over the winter months, the NHS has a plan – including a new falls service, 24/7 war rooms, and extra beds and call handlers.”
The synagogue killer, Jihad al Shamie, radicalised himself after searching online for videos of the Islamic State terror group, according to a friend.
The man, Qas, said al Shamie “started using [encrypted messaging app] Telegram and searching for ISIS videos.
“Once, he even tried to show me one at the shisha lounge. I told him to go away and asked how he even got access to that content, and he said it was through Telegram. After that, I didn’t see him for a long time until I heard what had happened.”
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1:43
Who was the Manchester synagogue attacker?
Another friend, Asim, told Sky News he met al Shamie through their shared interest in computers. He said he noticed a difference in al Shamie a year ago.
Asim said al Shamie “changed a bit, I felt his thoughts were a bit too radical for me. He was a nice guy, very quiet and softly-spoken. I was shocked about what he did.
“He started asking me for money – not small amounts, but thousands,” Asim explained.
“When I refused, he became angry. I’d never seen that side of him before.”
Earlier this year, al Shamie was working as a call handler for the RAC motoring organisation.
He was employed through an agency as a part-time temp from December to the end of March, when he was no longer needed.
Last year, al Shamie had money problems and was subject to a government debt relief order, which meant that his debts would be paid off in a year if he agreed to certain restrictions.
Money appeared to be one of many problems.
A former friend of al Shamie described how he became increasingly withdrawn and “in his own world” after a steroid addiction had led to heavier drug use. They said his behaviour became strange and unpredictable.
“I once noticed on his phone that he had several notifications from dating apps, which confused me because I knew he was married,” the friend said.
“You could be having a normal conversation with him, and suddenly he would flip and start ranting. I eventually blocked him.”
Image: Police and forensics officers near Heaton Park Hebrew synagogue. Pic: PA
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4:10
Synagogue security guard on moment attack unfolded
Multiple marriages and ‘obsessed’ with dating app
It’s believed the terrorist married several wives in Islamic wedding ceremonies, one of them even before he split up from the mother of his young child.
He reportedly became obsessed with an Islamic dating app, and sent abusive messages to an ex-girlfriend, hit her and told her to dress more conservatively during their brief on-off relationship.
The woman, who was 18 at the time, told the Manchester Evening News: “He used to say ‘I want you to be dedicated to the cause’, and he used to sit there and make me watch videos, like extreme videos, that I had no interest in.
“I am Muslim and of course I love to learn more, but this stuff were things that I have been raised to not agree with. He used to always say I was taught the wrong way and I wasn’t taught right. He was basically just trying to groom me into what he thought.”
She said he would message girls on his Muzmatch – now Muzz – dating app, using false names such as Valentino and Ahmed.
“He kept getting banned because of his speech and what he was sending,” she said.
“There were times when he would send me videos of him with other girls, and the girls were quite young.”
‘Rape fantasies’
The woman said al Shamie told her he had “rape fantasies”, and that he “used to say weird stuff, it was just insane. I can’t believe I stayed as long as I did”.
His marriage collapsed after he secretly wed an NHS nurse, a widow, who had converted to Islam.
A neighbour, Geoff Halliwell, who cleaned the family’s windows for many years at their home in Prestwich, told Sky News al Shamie had lived there with his wife and young child, but he believed left six months earlier.
Mr Halliwell said: “There was the mother and three lads, but one moved away. We’re talking about the eldest, he had a wife and kid, but she moved out some time ago.
“There was no sign of radicalisation, nothing like that. We never talked politics. Just ‘good morning, how are you? Lovely day, isn’t it?’
“He was fine, the whole thing has come out of the blue. He was a smashing lad to talk to, so were the other two lads.”
Mr Halliwell said the father left the family home about 10 years ago, but sometimes visited.
He thought he had moved to France because sometimes he turned up in a French-registered car.
Faraj al Shamie, a trauma surgeon who has worked for the International Committee of the Red Cross in Africa, condemned his son’s attack on the synagogue.
Image: Faraj al Shamie spoke of the family’s ‘deep shock and sorrow’ at his son’s actions
He said in a statement: “The al Shamie family in the UK and abroad strongly condemns this heinous act, which targeted peaceful, innocent civilians. We fully distance ourselves from this attack and express our deep shock and sorrow over what has happened.”
But, two years ago, on 7 October, he praised the actions of Hamas terrorists for their attack on Israel in which 1,200 were killed and 251 taken back to Gaza as hostages.
Al Shamie wrote on Facebook: “The scenes broadcast by the Al-Aqsa Martyrs Brigades of a group of fighters storming an Israeli army camp using simple means, namely balloons and motorcycles, prove beyond a shadow of a doubt that Israel will not remain.”
Additional reporting by Shakir Ahmed, specialist producer and Rebecca Spencer, crime producer
Author Dame Jilly Cooper has died, her publisher has said.
“It is with great sadness that we announce the death of Dame Jilly Cooper, DBE who died on Sunday morning, after a fall, at the age of 88,” a statement said.
The Queen paid tribute to Dame Jilly, calling her a “legend” who was a “wonderfully witty and compassionate friend”.
The best-selling author was renowned for her raunchy, so-called “bonkbuster” novels, which portrayed the scandals and sex lives of wealthy country social circles, including Rivals, Riders and Polo.
She was praised for her blend of risqué storylines and critique of Britain’s class system, personified by showjumping lothario Rupert Campbell-Black.
Her children Felix and Emily said: “Mum was the shining light in all of our lives. Her love for all of her family and friends knew no bounds.
“Her unexpected death has come as a complete shock.
“We are so proud of everything she achieved in her life and can’t begin to imagine life without her infectious smile and laughter all around us.”
Image: Jilly Cooper met Queen Camilla during a reception at Clarence House in March this year. Pic: PA
Image: Jilly Cooper and daughter Emily. Pic: PA
Dame Jilly was propelled to commercial success in the 1980s, and sold 11 million copies of her books during her more than fifty-year career.
Last year, Rivals was adapted into a successful TV series, which she worked on as an executive producer.
Image: Jilly Cooper found fame in the 1980s. Pic: Nikki English/ANL/Shutterstock
Tributes to author who created ‘a whole new genre’
Dame Jilly was a long-standing friend of the Queen.
In a statement released by Buckingham Palace, she said: “I was so saddened to learn of Dame Jilly’s death last night.
“Very few writers get to be a legend in their own lifetime but Jilly was one, creating a whole new genre of literature and making it her own through a career that spanned over five decades.
“In person she was a wonderfully witty and compassionate friend to me and so many – and it was a particular pleasure to see her just a few weeks ago at my Queen’s Reading Room Festival where she was, as ever, a star of the show.
“I join my husband the King in sending our thoughts and sympathies to all her family.
“And may her hereafter be filled with impossibly handsome men and devoted dogs.”
The author’s many fans included former prime minister Rishi Sunak, who said the books offered “escapism”.
Image: Jilly Cooper with cast members from Rivals in 2024. Pic: Hogan Media/Shutterstock
‘Dame Jilly defined culture’
Her agent Felicity Blunt said: “The privilege of my career has been working with a woman who has defined culture, writing and conversation since she was first published over fifty years ago.”
She added: “You wouldn’t expect books categorised as bonkbusters to have so emphatically stood the test of time, but Jilly wrote with acuity and insight about all things – class, sex, marriage, rivalry, grief and fertility.”
The executive producers of the Disney+ adaptation, Rivals, said they are “broken-hearted” and “her legacy will endure”.
Dominic Treadwell-Collins and Alex Lamb added: “Jilly was and always will be one of the world’s greatest storytellers, and it has been the most incredible honour to have been able to work with her to adapt her incredible novels for television.”
As tributes rolled in on Monday, TV presenter Kirsty Allsopp wrote on X: “I know 88 is a good age, but this is very sad news.
“A British institution, funny, enthusiastic and self-deprecating, we don’t see enough of it these days.”
Her publisher Bill Scott-Kerr said: “Jilly may have worn her influence lightly, but she was a true trailblazer.
“As a journalist she went where others feared to tread, and as a novelist she did likewise.
“With a winning combination of glorious storytelling, wicked social commentary and deft, lacerating characterisation, she dissected the behaviour, bad mostly, of the English upper middle classes with the sharpest of scalpels.”
Image: Author Jilly Cooper with two stars of a mini TV series based on her book Riders. Pic: PA
Image: Pic: PA
The ‘unholy terror’
Born in Essex in 1937, Jilly Cooper came from a Yorkshire family known for newspaper publishing and politics.
Her writing career began in 1956 as a junior reporter on the Middlesex Independent, covering everything from parties to football.
Image: Aidan Turner played the character Declan O’Hara in Rivals. Pic: PA
She had said she was known as the “unholy terror” at school, and was sacked from 22 jobs before finding her way into book publishing.
Dame Jilly started writing stories for women’s magazines in 1968, and found her break in 1969 when The Sunday Times published a story on being an ”undomesticated” homemaker. It gave rise to a column that lasted over 13 years.
In 2019 she won the inaugural Comedy Women in Print lifetime achievement award, and in 2024 was made a dame for her services to literature and charity.
A security guard who helped barricade the doors during the Manchester synagogue attack has told Sky News he thought “we are all going to die” – as he watched two of his friends get struck by what’s believed to be a police bullet.
Ivor Rosenberg was a working volunteer security guard on the morning Jihad al Shamie, 35, launched his attack on the Heaton Park Hebrew Congregation Synagogue in Crumpsall.
He described first confronting al Shamie outside the synagogue some minutes earlier, thinking “he’s up to no good” – after he told different people conflicting stories about how he was looking for his car and a pub.
“He looked at me and said ‘what are you looking at?’,” Mr Rosenberg told Sky News.
“I just said, ‘I don’t know’… he said ‘you’re very brave inside the fence’… and he walked away.”
Image: Jihad al Shamie at the scene
Mr Rosenberg said he started walking back up the stairs towards the synagogue when he heard “an almighty bang”.
“I turned around and I saw the car smashed into the wall of the gate,” he said.
He described Alan Levy, the synagogue chairman, managing to lock the main door as he ran straight to the office and dialled 999.
“I was screaming at them – ‘we’re under attack, we’re under attack!’,” he said.
“I could hear him banging on the doors, trying to get in – threatening to kill everyone.”
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1:43
Who was the Manchester synagogue attacker?
Mr Rosenberg said he looked out of the window and saw al Shamie banging on the synagogue door with a “large knife”.
“I was terrified,” he said.
After running to get chairs to put up against the synagogue door, he described holding the doors shut with a group of nine or 10 others from the synagogue.
It was then that he saw a bullet come through the door – hitting two of his friends.
After the police initially opened fire on al Shamie, Mr Rosenberg said he saw him trying to get up.
“I screamed – he’s getting up again,” he said.
“I stood back and we could hear a shot.
“Yoni – who was standing just a couple of feet away from me – dropped down to the ground.”
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1:35
Shapps: My father-in-law was at synagogue attack
Yoni Finlay is currently recovering in hospital. He is one of two men that Greater Manchester Police believe they accidentally struck with gunfire while trying to shoot al Shamie.
The other is Adrian Daulby, 53, who died from his injuries.
Melvin Cravitz, 66, who was among those who helped to prevent al Shamie from entering the synagogue, also died.
Mr Rosenberg described seeing a “bullet hole” in the door – and believes the same bullet hit both Mr Finlay and Mr Daulby, who was also behind the door with him at the time.
Image: Adrian Daulby. Pic: Family handout // Melvin Cravitz.
Pic: Greater Manchester Police
He said at first he believed Mr Finlay, a friend of his for many years, was intentionally ducking to avoid the gunfire. He then quickly realised he had been injured.
“He said ‘I’ve been hit’. I think the bullet came through him and hit Mr Daulby. I thought ‘we’re all going to die’ for a minute. It was terrifying,” Mr Rosenberg said.
“I took my jacket off and cradled Yoni’s head. It was very, very scary.”
Mr Rosenberg said both of the men were “heroes” – and has had updates that Mr Finlay is continuing to recover in hospital.
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2:41
‘Brave men saved community from harm’
Two other men also remain in hospital with serious injuries – a security guard with car-impact injuries and a community worker with stab wounds.
Mr Rosenberg said that he is still struggling to come to terms with what happened that day.
“I’m okay until someone asks me how I’m doing – then it’s hard,” he said.
Four people arrested on suspicion of preparing terrorist acts remain in custody after police were granted a further five days to question them on Saturday.