article: None of the four nations is achieving any of its three key targets for A&E, cancer or routine treatments, such as knee and hip replacements. All have developed plans and strategies to deal with the common challenges - rising demand, squeezes on funding and the ageing population. But each has found this winter to be particularly difficult. Spending: £2,057 per person Key fact: Just one hospital trust hit the four-hour A&E target in the first week of January. The system: The NHS is split between providers of services, known as NHS trusts, and commissioners, working for clinical commissioning groups. Social care, covering care homes and help in the home, is organised by councils and is means-tested. The story so far: The first week of January was the most difficult since the four-hour target was introduced in 2004. The proportion of patients being treated or discharged in time fell below 78%, with nearly half of hospitals declaring major alerts because of a shortage of beds. An estimated one in five patients ended up facing long delays for a bed after an emergency admission - double the normal rate - while ambulance crews reported problems handing over patients to A&E staff. It comes after a gradual increase in pressures in recent years. The winters have been getting progressively worst, while the 62-day target for cancer treatment to begin following an urgent GP referral has been missed for 11 months in a row. The number of people on hospital waiting lists for a routine operation has also been rising. NHS bosses set out a five-year vision for the NHS, which involved a greater emphasis on keeping people well in the community. But savings also have to be made - there is a £22bn target for 2020. This has led to the development of 44 local plans to overhaul services - some of which involve closing hospitals and cutting staff. Spending: £2,125 per person Key fact: 63% of A&E patients were seen in four hours over the Christmas period. The system: There are five integrated health and care boards that run hospitals, community services and social care. The over-75s get free care in their own home if they have high needs. The story so far: Northern Ireland has some of the worst performance figures in the UK. During the Christmas period, the number of patients seen in four hours in A&E departments dropped to 63%. Exactly the same proportion started their cancer treatment within 62 days, according to the latest statistics, while the numbers waiting longer than they should for a routine operation have almost doubled in the past four years. In response to the growing pressures, ministers have already set out a new vision for the health service, which they acknowledged was at "breaking point". A 10-year plan was published in the autumn, which called for greater investment in general practice as a way of coping with the rising demands on hospitals. The plan was widely criticised for its lack of detail and costings. It did not mention hospital closures, but there is a general
summary: No matter where you live in the UK, you will find local NHS services are under immense pressure.