An "ongoing" and "extreme" surge in demand is putting healthcare services in Cornwall under severe pressure - forcing NHS bosses to make "challenging choices" to maintain services.
Health bosses in Cornwall and the Isles of Scilly have written an open letter explaining the "complex" factors impacting the region's NHS services.
They say they now have to make changes to reduce the pressure.
What is causing issues?
The letter says: "There’s no single reason for this - it’s a complex mix of factors affecting the whole health and care system.
"These factors include the impact of Covid-19, providing care for our elderly and vulnerable citizens outside of hospital, and an increase in the numbers of people visiting our county for a holiday," it continued.
The sheer volume of people seeking treatment is putting pressure not only on hospitals but also on minor injury units and GP services.
The letter says ambulances queuing outside hospitals has become "the visual representation of the pressures being faced across health and social care".
The Royal Cornwall Hospital is struggling to discharge people due to a lack of social care provision, worsened by care homes having to close due to Covid-19.
The hospital now has 100 patients - the equivalent of five wards - who are well enough to go home but are waiting for care to be provided from other services or relatives to collect them.
Demand on healthcare services in Cornwall
Staff shortages are at their most severe during the summer months.
The letter says: "Health and care organisations are seeing higher levels of sickness in line with the national picture.
"We are in the peak of supporting much needed staff summer leave, plus, there are vacancies. There are significant issues county wide to source affordable accommodation in either the short or long-term. This has compounded availability issues."
What changes are being made?
Health leaders say there are no signs pressure will be reduced in the coming months without making some changes and some elective operations and procedures have already had to be cancelled.
They are taking these steps:
Actively recruiting to vacancies and bringing additional staff into Cornwall and the Isles of Scilly.
Supporting them with accommodation so they can start work quickly.
Deploying clinicians from corporate services back to frontline patient care.
Focussing resources to where we know they will be needed, for example diverting staff from small minor injury units to the larger and busier ones.
Preparing for a further surge at the end of August, in babies and children with respiratory syncytial virus or RSV. This is a common respiratory virus that usually causes mild, cold-like symptoms but can be serious for babies and children. We expect to see significant numbers of children and babies with this condition through until November.
Putting in place arrangements for the COVID-19 booster and flu vaccination programme to protect our population.
Supporting a national drive to reach holidaymakers before they leave home for Cornwall, so they bring the right medicines and know what NHS help is available if needed on their staycation.
What can people do to help?
Choose well - locals and visitors are being encouraged to make use of pharmacies who can give advice and treat conditions such as urinary infections, back pain, gout and insect bites .
Encourage residents and visitors to contact their GP as usual. Your own GP can speak to you by telephone or online, wherever you are. People may need to wait for an appointment.
Go online to or call 111.
Encourage parents to download the free NHS HandiApp which provides advice about common childhood conditions. Most fevers, and coughs can be treated with Calpol, drinking water, and will improve within a week. Call your GP or 111 if your child does not get better, or their condition worsens.
Protect our ambulance service and the NHS by only calling 999 in a genuine, life-threatening emergency, and do not call back for an arrival time.
Encourage families to take their relatives home when they are ready for discharge. Financial support is available in the form of a one-off discharge grant for people who are ready to leave hospital but need a bit of extra care and support to return home. Part of the grant will help ease the current challenges around access to regulated care across Cornwall and Isles of Scilly and support discharge from hospital.