All ambulance services in England are on the highest level of alert and are under “extreme pressure”.

A combination of Covid absences among staff, difficulty caused by the hot weather and ongoing delays in handing over patients to A&E has left ambulance trusts struggling to cope.

All 10 ambulance services confirmed to the PA news agency they were on the highest level of alert after the Health Service Journal (HSJ) first reported they were.

West Midlands Ambulance Service said it had been on the highest level of alert – known as REAP 4 – for a few months, while South Central Ambulance Service said it was also at REAP 4, which means trusts are under “extreme pressure”.

South Central added that it had also declared a critical incident “due to current pressures on our services”.

As a result of the recent warm weather and increased demand, we have decided to step up to Level 4 of Resource Escalation Action Plan

It said in a statement: “We continue to prioritise our response to those patients with life-threatening and serious emergencies but, due to the current levels of pressure we are seeing, there will be delays in responding to other patients with less urgent needs who are assessed as requiring an ambulance response.

“We are experiencing an increasing number of 999 calls into our service, combined with patients calling back if there is a delay in our response to them. As a result, our capacity to take calls is being severely challenged.

“This is combined with the challenges of handing patients over to busy hospitals across our region and a rise in Covid infections, as well as other respiratory illnesses, among both staff and in our communities.

“This week we are also faced with high temperatures across our region which we know will lead to an increase in demand on our service. All of these issues combined are impacting on our ability to respond to patients.”

A North West Ambulance Service spokesman told PA: “As a result of the recent warm weather and increased demand, we have decided to step up to Level 4 of Resource Escalation Action Plan (REAP).

Patients are left for far longer than is safe and lives are being lost as a result

“In moving to REAP Level 4, we will be maximising all available resources, increasing staffing levels in emergency call centres and on the road.

“We urge the public to reserve the 999 service for emergencies only and consider if their GP, pharmacist or 111.nhs.uk could provide them with the medical help they need.”

South East Coast Ambulance Service confirmed to PA it moved to REAP 4 this week.

A London Ambulance Service spokesman said it had moved to REAP 4 “as a result of a sustained demand on both our 999 and 111 services, and with hot weather set to continue over the next few days”.

He added: “The public can support us by only calling 999 in the event of a life-threatening emergency and by taking steps to keep hydrated and stay out of the sun at the hottest periods of the day.”

South Western Ambulance Service NHS Trust also confirmed to PA it was at REAP 4, as did the East Midlands Ambulance Service, the East of England Ambulance Service and the Yorkshire Ambulance Service.

North East Ambulance Service told PA it increased its alert level on Monday.

Donna Hay, strategic commander at the service, said: “As a result of sustained pressure on our service and wider system pressures, as well as anticipated pressure continuing over the next week, including a potential increase in heat-related incidents, we made a decision to increase our operational alert level to four on 11 July.

“The public can continue to support us by only calling 999 in a life-threatening emergency.”

We have a number of staff absences due to a rise in Covid cases as well as additional pressure caused by the current hot weather, which is making things even tougher for our staff and of course the patients they are caring for

Shadow health secretary, Wes Streeting, said: “Twelve years of Conservative mismanagement has left our ambulance service in crisis.

“Patients are left for far longer than is safe and lives are being lost as a result.”

According to HSJ, West Midlands had more than half of its ambulance crews queued outside hospitals at one point on Monday.

A spokesman for the trust said one ambulance crew had to wait 24 hours to hand a patient over.

Meanwhile, the chief executive of an acute trust in the Midlands region told HSJ: “We had a very very challenged night for handovers last night, possibly the worst ever and it is only July.”

Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said: “The NHS ambulance sector is under intense pressure, with all ambulance services operating at the highest level of four within their local resource escalation action plans, normally only ever reserved for major incidents or short-term periods of unusual demand.

“Severe delays in ambulance crews being able to hand over their patients at many hospital emergency departments are having a very significant impact on the ambulance sector’s ability to respond to patients as quickly as we would like to, because our crews and vehicles are stuck outside those hospitals.

“Added to this, we have a number of staff absences due to a rise in Covid cases as well as additional pressure caused by the current hot weather, which is making things even tougher for our staff and of course the patients they are caring for.”

He urged people not to call 999 back to ask about an estimated arrival time unless the patient’s condition has changed.

A spokesperson for NHS England said: “Near record levels of 999 calls, challenges discharging patients to social care settings, increasing Covid cases – leading to more than 20,000 staff absences – and the current heatwave is inevitably having an impact on NHS capacity.

“It, however, remains vital that the public continue to dial 999 in an emergency and use 111 online, or their local pharmacy for other health issues and advice.”