Four in 10 hospitals declared major alert amid mounting pressure
More than four in 10 hospitals in England declared a major alert in the first week of the year as the health service came under increasing pressure.
Some 65 out of 152 trusts raised the alarm as bed shortages intensified and A&E departments became overwhelmed.
Overall, NHS hospitals issued 222 serious alerts in six days, saying they were experiencing major pressures.
The data from NHS England, which covers the period up to last Sunday, shows the overall number of alerts was around six times higher than the previous six days.
There were 222 operational pressure alerts at either level 3 or 4 across the six days to January 8, compared with 34 from December 28 to January 2.
Overall, 59 NHS trusts across the week reported they were at level 3 on at least one day, while six reported level 4 at least once during the week - meaning patient safety was at risk.
In total, 25 trusts declared major alerts every day between January 3 and 8.
The number of major alerts - previously called red and black alerts - is the highest of the winter.
The figures come as trusts confirmed to the Press Association that they have cancelled operations and procedures to ease pressure.
The John Radcliffe in Oxford confirmed it had cancelled all non-urgent planned operations and admissions on Friday and Monday.
Around 20 procedures have been cancelled at Northern Lincolnshire and Goole NHS Foundation Trust while planned procedures have also been postponed at Leicester's Hospitals, although the trust declined to say how many.
NHS bosses have warned that the flu peak has not yet hit the NHS.
Prime Minister Theresa May acknowledged the system was under pressure.
The six trusts that issued a level 4 were University Hospitals Bristol NHS Foundation Trust, North Bristol NHS Trust, Royal Liverpool and Broadgreen University Hospitals NHS Trust, University Hospitals of Leicester NHS Trust, University Hospitals of North Midlands NHS Trust and Southport and Ormskirk Hospital NHS Trust.
Mrs May told a press conference at 10 Downing Street: "I recognise, and we have acknowledged, that the NHS is under pressure.
"We always see increased pressures in the NHS over the winter period. That's why in preparing for the winter period this time, £400 million was put in to ensure that winter-preparedness."
On Thursday, she said there had been a "small number" of incidents of unacceptable practice in NHS trusts, while Health Secretary Jeremy Hunt said there were problems in "one or two" areas.
An NHS England spokesman warned that the flu season peak would heap further pressure on overstretched hospitals.
He said: "A&E visits were higher last week than the week before, but emergency hospital admissions moderated slightly. The number of OPEL 3 and 4 days increased, compared with the previous week, but the number of A&E diverts fell. Norovirus is 77% higher than last year, but the flu peak is probably still to come."
So far, eight flu deaths have been confirmed in the first week of January, with 32 so far this winter.
Figures from the Royal College of Emergency Medicine (RCEM) show that only 74% of patients at 60 trusts it monitors were seen within four hours in A&E, against a 95% target.
Performance is at its worst level in the two years the annual project has run and comes despite a rise in available beds.
Chris Moulton, from the RCEM, said: "It was an incredibly hard week in a very difficult winter. It is probably the most challenging it has been for 15 years."
Shadow health secretary Jonathan Ashworth said: "This crisis is only getting worse and with the cold weather due to set in, there will be deep concerns over the next days and weeks.
"The response of Theresa May to this NHS crisis has been one of incompetence and denial.
"The Prime Minister needs to explain if she considers today's figures as 'small' or whether she considers the numbers of ambulances being diverted from A&E as acceptable?"
Official NHS guidance says level 3 is when the local health and social care system "is experiencing major pressures compromising patient flow and continues to increase".
Level 4, the most serious, shows that pressure "continues to escalate, leaving organisations unable to deliver comprehensive care. There is increased potential for patient care and safety to be compromised".
The data showed that from January 2 to 8, there were 39 occasions when A&E departments closed their doors to patients, known as A&E diverts, down slightly on the previous week.
The Royal Surrey Hospital in Guildford, which serves some of Mr Hunt's constituents, confirmed it had been forced to turn a gym into a place to put extra beds as it became overwhelmed with patients.
A statement said: "The hospital has been incredibly busy and as such, the decision was taken to use a gym space on one of our wards to provide additional temporary bed capacity."
It said the situation had eased by Tuesday and it was in a "positive bed position".
Using a combination of data, the BBC calculated that one in five patients admitted as an emergency last week experienced a delay of at least four hours for a bed - twice the rate over the past year.
Almost one in four patients waited over four hours to be seen in A&E, and in some places it reached nearly half.
More than a quarter of ambulances arriving at A&E units waited longer than 30 minutes to hand over patients to A&E staff - twice as long as they should.
NHS Providers chief executive Chris Hopson said: "Daily attendances at A&E last week were consistently above 50,000. Bed occupancy rates - at or around 95% throughout the week - remained unacceptably high."
He said, thanks to the hard work of staff, "the majority of trusts are managing to keep their heads above water - just".
Liberal Democrat health spokesman Norman Lamb said: " There is now an avalanche of bad news showing hospitals are struggling to cope.
"How much more will it take for this Government to see sense and provide emergency funding for the NHS?"
Mark Porter, chairman of the British Medical Association's council, said: "It is extremely concerning that this many trusts in one week raised the alarm to say they can't cope, and it shows the scale of the crisis in our NHS at the moment.
"It's astonishing that, following a week in which alerts were six times higher than the last, the Government has chosen to play down the pressure that services are under."
Mark Holland, from the Society for Acute Medicine, said: "So far this winter we have not seen exceptional winter conditions to put undue pressure on the NHS, unseasonably mild weather and no evidence of a flu epidemic so far.
"Hence we conclude that our services are unable to cope with the conditions of a normal winter. The Government must now accept that the NHS cannot cope with a normal winter.
"When will the Prime Minister accept that we have a crisis on our hands? With the current cold snap about to bite, one would anticipate that nothing is going to improve very quickly.
"We must accept that we now face a national emergency in the NHS in England."