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As the service toils amid ongoing industrial action, medics say socialising over the Yuletide holiday period has added to the spread of seasonal winter influenza, leaving the entire healthcare system at breaking point.

As a result, waiting periods at already overworked A&E departments are further being stretched out, with some now not being assessed for 15 hours.

And patients are being warned to expect even more chaos in January with four more days of strike action in the New Year, as nurses walk out on January 18 and 19, while paramedics again strike on January 11 and 23.

With the crisis deepening amid the surge in new flu cases – as well as winter Covid cases – several NHS Trusts have declared “critical incidents” in recent days.

This effectively means they cannot provide safe levels of care, with some patients waiting 15 hours in overcrowded A&Es.

NHS leaders have warned that this winter may be the “darkest to date” as usual seasonal pressures are “aggravated” by severe outbreaks of flu and strep A, as well as an unprecedented wave of strikes.

And post Christmas, flu is now of particular concern, with admissions for cases at their highest level for five years, with 2,300 patients in hospital with the virus. In addition, Covid-19 infections are also their highest level since October.

On Thursday, an NHS spokesman admitted: “There is no doubt the NHS is under considerable pressure, with the latest figures showing 19 in 20 beds occupied amid rising numbers of flu cases in hospital, on top of record A&E demand, increasing staff absences and over 13,000 patients each day in hospital who are medically fit to be discharged.

“Despite this, staff have been working incredibly hard to prepare for this winter and it is vital that people continue to come forward for care when they need it.”

Saffron Cordery, interim chief executive of NHS Providers told the Daily Express the health service was now facing unprecedented tough times.

“This is a testing time for the NHS. It’s under pressure as never before,” she explained.

“Services and staff are overstretched. We’re seeing the impact of flu and Covid-19 on top of the usual winter challenges.

“There are staff shortages compounded by exhaustion and sickness.”

But on the ground, with an increasing number of trusts declaring ‘critical incidents’ staff say the situation is now at breaking point.

Two ambulance services in the South-west and North-east of England also declared critical incidents due to a rise in 999 calls following the four-day Christmas break.

Such critical incident status allows NHS trusts to take steps such as seeking aid from other services, diverting patients to nearby hospitals and deploying more staff to the frontline.

But this week, hundreds of patients faced painful and long waits for ambulances, with “extreme pressures” linked to a “rebound effect” after paramedics staged a nationwide strike last week.

Calls fell dramatically during the strike as the public heeded warnings to only dial 999 in a life-threatening emergency but doctors said they feared this would create pent-up demand, spilling over into this week.

South Western Ambulance Service told how during one morning this week there were 482 patients waiting for ambulances across the region. Another 106 patients were stuck in the backs of ambulances queueing outside hospitals waiting to be handed over to A&E.

Wayne Darch, the trust’s deputy director of operations, said patients may not get an ambulance if their condition is not life-threatening.

He added: “We are doing all we can to manage these winter pressures and we are sorry that we are unable to respond to some patients as quickly as we would like. We will get to you as soon as we can. Please do not call back simply to ask for an estimated time of arrival of an ambulance. We cannot provide one, and it blocks our lines for other callers.”

On Boxing Day, North East Ambulance Service declared a critical incident for the second time in nine days due to “unprecedented” pressure after the Christmas break.

More than 100 patients were waiting for an ambulance at one stage, while paramedics were facing lengthy handover delays when they arrived at hospital.

Hospitals also reported record numbers of people attending A&E over Christmas.

Gloucestershire Royal Hospital declared a critical incident on Thursday stating that patients were spending an average of 15 hours in its A&E department.

On Tuesday night 186 people were waiting to be seen in A&E.

A message to staff said: “Following the Christmas and Boxing Day holidays we are facing significant pressure that is affecting our ability to deliver patient care.” Several factors included an “increasing number of patients with flu and Covid”.

Surrey and Sussex Healthcare NHS Trust also declared a critical incident, stating: “We are seeing record numbers of people attending A&E, calling NHS 111, accessing GP services and calling 999.”

Sandwell and West Birmingham NHS Trust reported “immense pressure” due to “exceptionally high numbers of patients waiting in our A&E departments”.

The trust said it was calling in more staff to help.

Unions and the government remain at loggerheads over the impending further industrial action but both sides say they want to see an end to the strikes.

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