By Catherine Jones: ITV News Health Editor
In the A&E unit at Queen Elizabeth Hospital (QEHB) in Birmingham, my interview with the matron is interrupted twice by the loud ringing of the phone which alerts staff to a major trauma heading their way.
Margaret Garbett appears to barely register the tannoy which follows, telling staff they have 11 minutes to prepare.
"RESUS is full, but we'll make the space in time. This is normal." she says.
But all is not "normal" in the QEHB emergency department. Monday was their second busiest day ever. And what's peculiar about that is we're in June.
Usually, at QEHB and hospitals everywhere, May and June provide a breathing space.
There is a lull in the number of complex cases that cause strain over the winter months, before things get busy in July and August when the school holidays creates a spike in children needing treatment for injuries.
But this year, there has been no respite. The numbers arriving at A&E have kept on rising.
Dame Julie Moore, the Chief Executive of the University Hospitals Birmingham NHS Foundation Trust, which runs the QEHB, tells me:
And they need hospital care, according to Vibhore Gupta, the consultant in charge of A&E when I visit.
So it's not necessarily that people are shunning their GP or an out of hours service in favour of a trip to hospital. They are presenting as emergency cases, where only hospital treatment will do.
Joe Harrison, Chief Executive of Milton Keynes NHS Foundation Trust, is coping with the same unusual pattern of demand.
His theory is that people who should have been treated in primary care six months ago weren't and have now become sicker, and that's why they're presenting as emergency cases in June.
Both hospital bosses tell me they're coping, albeit by digging deep, which does impact on their staff and their budgets.
Nationally the picture is difficult to judge, but one barometer of A&E performance is whether units meet the target to deal with 95% of patients within four hours.
The health think tank the King's Fund has plotted the trends. Every year since 2010 the performance for England has consistently met that target between May and November, with a more erratic pattern developing over the winter.
This year the difference is plain to see. The 95% target has been missed throughout May and June until finally just achieving the target by 0.1% last Friday.
Meanwhile the Health Service Journal (HSJ) recently analysed the financial figures of 99 trusts for April.
Two-fifths of them reported higher than planned deficits, in part because they were still experiencing unanticipated "winter pressures" that month.
The HSJ reports Croydon Health Service Trust spent a quarter of a million pounds in April paying for staff to cover beds they'd expected not to need.
The Department of Health told ITV News:
Hospitals managed to avoid the widely predicted "winter crisis" at the start of the year.
But is this a "summer crisis" developing? Or some kind of upward adjustment in demand that will never go away again.
No one at the two hospitals I visited knew the answer. They're just getting on with coping with the consequences.