A hospital trust has declared a “critical incident” because of the “exceptional” pressure on A&E.

Nottingham University Hospitals Trust (NUH) runs the Queen’s Medical Centre (QMC) and City Hospital and has been on OPEL 4 – previously known as black alert – since Monday morning.

On Wednesday it raised the level further.

Some routine operations have been cancelled as the trust prioritises those who need emergency care.

Health bosses do not want to operate on patients who cannot be guaranteed a bed in which to recover.

Lisa Kelly, NUH chief operating officer, said: “This is following a number of days seeing exceptional pressure across the system, with high numbers of very poorly patients arriving at our emergency department.”

She added they were working closely with health and social care partners and trying to discharge patients in a “timely” manner to free up beds.

Hospital bosses were forced to chant “we can do this” by a senior NHS official in an effort to improve their accident and emergency performance in advance of what doctors have warned will be a tough winter for the NHS.

Hospital trust chief executives say they were left feeling “bullied, patronised and humiliated” by the incident last week at a meeting attended by Jeremy Hunt, the health secretary, and Simon Stevens, the head of the NHS in England.

The leaders of about 60 trusts which NHS national bodies deemed to have the worst record on meeting the politically important four-hour A&E treatment target were called into a meeting held in London on Monday 18 September.

Chief executives present say that they were divided into four regional groups, covering the south and north of England, London, and the Midlands and east of the country, each of which held a separate session with a senior NHS England official.

Paul Watson, NHS England’s regional director for the Midlands and east of England, then encouraged those in the group he was leading to chant “we can do it” as part of a renewed effort to improve their A&E performance. Hunt and Stevens are not thought to have been at that session; nor was Jim Mackie, chief executive of health service regulator NHS Improvement, who jointly convened the meeting with Hunt and Stevens.

One chief executive said: “It was awful – the worst meeting I’ve been at in my entire career. Watson said: ‘Do you want the 40-slide version of our message or the four-word version?’ Everyone wanted the four-word version, obviously.

“He then said ‘I want you to all chant ‘we…can…do…this’. It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.”

According to the Health Service Journal, which revealed what had happened at the meeting, Watson told trust bosses that they were initially chanting too quietly and that they should chant the slogan again but louder, and “take the roof off” with the noise.

At least 100 accident and emergency units will offer reduced levels of service and patients will have to travel further for expert treatment under the biggest shake-up of NHS casualty departments in 40 years.

A new two-tier system of A&E departments is the only way to keep a safe health service which is free at the point of use, officials claim.

Under the system up to 70 of England’s 170 casualty units will be designated as “major emergency centres” which treat the most serious conditions and injuries. The remainder will deal only with less serious injuries.

The plan will also attempt to ease the burden on A&E by keeping patients who do not need emergency treatment away from hospitals.

The reorganisation comes amid fears that this winter will put unprecedented strain on England’s A&E units.

The crisis over the NHS’s new non-emergency 111 telephone service has deepened after a major provider pulled out of two regions and warned that its entire service was “unsustainable”.

NHS Direct won 11 of the 46 contracts to provide the new 111 service, which has been plagued with problems since it went national in April.

But in a major blow to the service, which has been backed by the health secretary Jeremy Hunt,  NHS Direct has said it is “not in a position” to provide services for North Essex and Cornwall and that each of its 11 contracts are not “financially sustainable”.

In two areas – the North West and the West Midlands – NHS Direct has only been able to take between 30 and 40 per cent of the calls it was contracted to handle, with staff unable to cope with demand.

The 111 service was piloted last year and was rolled out nationally in April. After complaints about calls going unanswered and poor advice being given by operators with no medical expertise, NHS chiefs admitted that patients had been “let down” by the service. The phone line has been blamed for heaping pressure on A&E wards. A number of deaths and several serious incidents are being investigated by local health authorities to discover whether failings in the 111 service played a part.