Both Dr Vassili Crispi and paramedic Simon Day paint a picture of a service at breaking point.

Mr Day said a typical shift for an ambulance service worker would be to pick up a patient, take them to hospital - and wait in the car park for hours.

Dr Crispi said that during one of his recent shifts, his A&E department was filled with more than 150 patients.

The waiting time to be admitted to A&E was three hours, for patients to be seen by a doctor 12 hours, and to be admitted to a ward more than 24 hours.

He said they were having to choose who to take to surgery first - between a burst appendix, a bowel that had perforated or an obstructed bowel.

"We are tired," Dr Crispi said. "The service we are able to provide is very stretched and we are having to firefight - deciding which patients are going to receive the most important care.

"It is very difficult... heartbreaking."

Mr Day, who as well as being a paramedic is a branch official for the West Midlands branch of the GMB union said: "Day-to-day now we experience delays at hospital.

"Regardless of what our trust attempts to do, or what hospitals attempt to do, nothing seems to work, nothing seems to relieve the pressures on the doors when you turn up at A&E.

"Month on month, week on week, we experience worse delays than the month or week before and there just seems to be no let-up."

He said a number of studies had shown a correlation between delays and the increased risk to patients, and that was something they had to face daily.

"Ambulance service staff are very conscious that the increasing delays they face have the potential to cause significant harm to their patients," he said.

"It's always there at the back of their minds."

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Dr Crispi, who is co-chair of the Yorkshire junior doctors' committee for the British Medical Association, said he believed there had been around 500 avoidable deaths during the winter crisis.

"I treat patients in corridors at A&E, still sat in a chair. We have had a number of patients who are well enough not to need a chair or a bed, so are lying on the floor.

"It is very difficult and very heartbreaking, especially when you are having to have very difficult conversations about prognosis or what emergency treatment they might need, in a corridor, with strangers listening.

"There is no privacy and no dignity for patients - this is not the way we want to practice medicine."

Both men support health care workers' strike action and say the government must engage in pay discussions.

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Mr Day said: "As pressures increase.... as it becomes more frustrating, more hopeless, more demoralising, the fact that your pay is being constantly outstripped by your bills doesn't help

"It doesn't provide resilience and people are leaving - and then you have that spiral of a worsening situation because there are less people to respond to those patients, there are less people to clear ambulances or to man wards or provide care for patients and the spiral continues.

"Pay is important because it has a definite and undisputable correlation with recruitment and retention.

"The strikes tomorrow could have been prevented yesterday, had the government had meaningful discussions - about the importance of pay to staff retention, staff recruitment and the impact that has on existing staff within the health service - with the trade unions, which they chose not to do."

'Skyrocketing burnout'

And Dr Crispi railed against the perceived suggestion from some quarters that since NHS staff numbers had actually increased, they may simply need to work harder.

"We do not have the capacity or the strength," he said.

"We are all working on extremely busy rotas, the rates of burnout have been skyrocketing amongst my colleagues... We do not have the emotional or physical capacity to continue to working at this rate.

"We have showed incredible risk and responsibility, which is not matched by our pay. We cannot deliver any more than we are already.

"We simply can't work any harder."

Mr Day added: "I do believe, although our members were balloted for pay, the reason they put the cross in the box was for their patients - because they share the frustrations that patients experience when they can't get an ambulance because we are parked outside hospital, or they can't get into hospital because there aren't the staff."

And he hit out at a bill due before parliament next week that will mean unions representing key workers will have to agree to minimum levels of safety and service when their members go on strike.

He said striking workers already agreed to "life and limb" coverage when out on industrial action, for patients experiencing things like heart attacks, strokes or sepsis.

"If we take away, or make more difficult, the ability for ambulance service staff and health service staff to strike, who is going to stand up for the patients? Because it seems to me, from the past two years, clearly the government aren't going to, and I believe firmly, we have come to this point of action because it's the staff of the health service that are standing up for their patients - and pay is a crucial part of that."

Dr Crispi said simply: "If the government really cared for the NHS, it must listen to the unions."