Deputy Political Editor Anushka Asthana summarises the report
In one part of the country, the number of "duplicate" 999 calls - where people are not asking for an ambulance but trying to find out where their ambulance is - rose five-fold; in another deaths were attributed to a "lack of resource"; in a third paramedics were urged to divert patients away from emergency care, wherever possible.
Those are just some of the admissions of hospital trusts across England, in hundreds of pages of board papers scrutinised by ITV News, which paint a bleak picture of just how stretched the NHS became at the peak of the Winter crisis.
The documents also reveal soaring staff turnover rates - as rising numbers of ambulance workers walk away from their jobs and trusts struggle to recruit replacements. And they reveal how delays in handing over to emergency departments have halved the number of patients being seen in each shift.
The revelations, which come a day after Rishi Sunak launched his government's recovery plan for emergency care, were contained in documents released by ambulance trusts over the past few days.
Now Rachel Harrison - national secretary of the GMB Union - has written to the chair of parliament's health select committee, Steve Brine, to urge him to consider the new information in his inquiry into ambulance delays and strikes.
In a letter shared exclusively with ITV News, Ms Harrison listed some of the most shocking revelations from the board documents warning: "Ambulance services are in a state of crisis. Turnover rates are unsustainable.
"No seriously ill patient should be forced to travel to an accident and emergency department in a taxi. Patient safety is at risk under the status quo."
Ms Harrison also highlighted the comments by South Central Ambulance Service that the erosion of ambulance workers' real pay was a significant factor in the large number of vacancies, while another trust said it prevented them from being competitive in retaining staff.
She also pointed out that a number of trusts made clear that ambulance workers had ensured deals were in place to cover emergency care on strike days - with some praising unions for ensuring that patient safety was not compromised.
Some of the examples within the papers are:
West Midlands Ambulance Service, who reveal the number of 999-calls which are "duplicates" ("with patients asking 'where is our ambulance', not 'I need one'"), has risen from 5 to 25%. They also say the number of patients seen by paramedics has halved (with sources saying they have dropped from 6/7 per day to 2/3). And - like many others - they talk about rising turnover - with the number of paramedics leaving each month going from 15 to over 25.
WMAS board members warn that the turnover levels are “reaching our limit to recruit new paramedics, reducing turnover will be of paramount importance if the current clinical model is to be sustained let alone the challenge of increasing capacity further by 7%".
Documents linked to the North West Ambulance Service warn of concerns about current long waits and "potential patient deaths which were attributed to a lack of resource". They highlight five patient deaths in which they concluded the Trust contributed in some way - again pointing to a lack of resource.
In the North East - papers referred to staff being asked to consider "alternative care pathways, wherever possible, rather than taking patients to emergency departments". They said this was to minimise pressure on Emergency departments and minimise handover delays - with one hospital taking an hour on average to handover. The target is 15 minutes.
Mathew Hulbert described waiting 11 hours for an ambulance to arrive for his elderly mother as 'distressing'
Speaking to ITV News, Mathew Hulbert, said his mother last year waited around 11 hours between first calling for an ambulance and one arriving to give treatment.
Mr Hulbert's mother injured her ribs during a fall at her Leicestershire home and died in hospital due to a sepsis infection, two days after being admitted.
He said he made "three or four calls" to ambulance call handlers, describing the conversations as "difficult".
"Well it’s just distressing. I mean my mum was 78, she was quite frail, she’d fallen, we weren’t able to move her and I just wanted to get across to the call handlers that this was the situation," he said.
"And although yes she was breathing and so I appreciate you know it wasn’t a category one absolute emergency the fact is she was clearly not well. And she was clearly not well because she died two days later."
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However, sources at several trusts have told me that things have dramatically improved in the past two weeks.
Yesterday, NHS England announced plans to introduce 800 more ambulances, 5,000 more sustainable hospital beds and a £1bn fund as part of a two year delivery plan.
The prime minister said: "Cutting NHS waiting times is one of my five priorities. Urgent and emergency care is facing serious challenges but we have an ambitious and credible plan to fix it.
"It will take time to get there but our plan will cut long waiting times by increasing the number of ambulances, staff and beds - stopping the bottlenecks outside A&E and making sure patients are seen and discharged quickly."
The health secretary, Steve Barclay, added: "Every day of every week, tens of thousands of people receive safe, high quality urgent and emergency care.
"However, with the NHS under unprecedented pressure from high Covid and flu cases and the backlog from the pandemic, too many people are waiting too long in A&E or for ambulances."
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