NHS leaders in England say the problems caused by the funding squeeze are greater than ever, with hospitals struggling to cope with record levels of emergency admissions and unions threatening fresh strike action in the new year over pay curbs.

There were more than 111,000 emergency admissions to hospitals in the last week and A&E departments saw 440,428 patients, up more than 24,000 on the same week last year, despite relatively low levels of flu and winter vomiting.

More than 10,000 patients had to wait longer than four hours for a bed once a decision was made to admit them to hospital from A&E. The figure for the same period last year was fewer than 4,000.

Doctors said the service was struggling to cope as managers were told to concentrate more next year on improving public health, streamlining primary care and mental health services and retaining their staff, instead of using more expensive options such as recruiting abroad and using agency workers.

Barbara Hakin, national director of commissioning operations at NHS England, said staff were doing a brilliant job and services remained robust. “The NHS’s waiting times for urgent treatment are among the best for any major country that measures them,” she said. “Looking ahead, we need to transform the NHS so it is better able to cope with demand. We have set out how we plan to drive this forward next year, allocating additional NHS funding to every part of the country.”

“As we come into the holiday period, it is important people continue to look after themselves and nip problems in the bud. They should ensure they have proper medication, get their flu jab if they have not done so, and get advice from their pharmacist.”

Mark Porter, chair of the British Medical Association council, said:“These figures confirm just how much pressure the NHS is under. Staff are working flat out but the system is really struggling to cope with the sheer number of patients coming through the door

. “Growing pressure on services throughout the year means hospitals have no spare capacity to deal with the winter spike in demand. So patients are enduring delays in their treatment, and the NHS finds itself running just to stand still.”

The continuing problems for A&E came as NHS leaders issued formal planning guidance on priorities from April following their settling this week of funding allocations of the £101.7bn national budget.

The total represents a 1.6% increase in real terms, taking into account the near £2bn extra announced by George Osborne earlier this month. Specialised services such as the cancer drugs fund and primary care get the most eyecatching rises.

Costs of new treatments for a number of other conditions, including hepatitis C, are likely to add to the financial pressures. The real-terms rise is slightly more than the 1.4% England’s NHS got last year but it is by no means certain that the £700m extra found to help cope with the current A&E crisis will be repeated. Of the £1.96bn provided by the chancellor earlier this month, £1.5bn will go on frontline services, the rest on developing new ways of providing out-of-hospital care, with financial incentives given to experiments such as having on-site pharmacists or mental health specialists working alongside GPs.

NHS leaders say they want to keep viable smaller hospitals, but endorse an approach advocated in a recent review commissioned by the government which suggested, among other things, allowing a single private or public organisation to operate chains of hospitals across wide geographical areas, standardising clinical pathways and cutting back-office and procurement costs. A separate NHS review to shake up A&E and other parts of urgent care is still under way.

Simon Stevens, NHS England’s chief executive, said a growing and ageing population meant the financial challenge facing the service was “as great as it has ever been”.

Health unions announced further strike action for 29 January as their employers insisted they could not afford to pay any more than this year’s 1% for those not on increments. Those that were had had the equivalent to a 3.4% rise on average. A similar approach will be taken next year as the government continues the pay squeeze.

Ambulance workers belonging to the GMB in England and Northern Ireland are threatening a 48-hour strike from midday on 29 January, saying there will be talks with management over cover for “critical” calls. Unison’s health service members in England will walk out for 12 hours from 9am on 29 January, then work only contracted hours and paid overtime before a 24-hour strike on 24 February. Other unions have yet to detail their plans.

Christine McAnea, chair of the joint NHS trade unions, said: “NHS workers, as ever, are putting the safety of patients first by not taking industrial action over the Christmas and New Year periods, when staffing levels are already stretched, because of their concerns over patient safety. But the government and NHS employers are showing a total disregard for patient safety by refusing to enter into any meaningful negotiations to try and resolve this dispute.

“We have no option but to escalate the industrial action by taking longer strikes. “NHS workers are being treated worse than any other part of the public sector. They have had their pay frozen or held down for five years.”