Recent months have seen significant strain on West Midlands Ambulance Service (WMAS), with warnings that patients are being put at increasing risk because of lack of availability of crews to attend incidents.
The situation has largely been caused by delays in handing patients over to hospitals across the West Midlands – with thousands of patients left waiting sitting in ambulances for space in a hospital.
The capacity in hospitals has in turn been hit by a lack of community care places to discharge healthy patients and free up bed space.
The situation has been stark at a number of the region's hospitals, including Royal Shrewsbury and Princess Royal in Telford, but ambulance bosses have singled out the Manor for praise, saying it "stood out" as coping well with the pressures.
Mark Docherty, director of clinical commissioning and strategic development at WMAS, told a meeting of the trust's board of directors that the number of people waiting for over an hour to be handed over to hospital had topped 41,000 so far this financial year.
He said: "In the year to date we have 41,000 over one-hour delays. I have looked back to when I initially raised concern about handover delays and I had written to NHS England and we had 68.
"I never thought we would get to a situation where we have more than 41,000, it is truly dreadful."
The figures reveal that there have been 98 instances where patients have waited for more than 10 hours in an ambulance.
December alone saw 38 patients having to wait for more than 10 hours to be handed over to hospitals – nine in Telford, five at Shrewsbury, 10 at Heartlands and six at New Queen Elizabeth Hospital.
Mr Docherty said: "In December alone we had 38 patients waiting over ten hours, most in the back of ambulances, most in sub zero temperatures, it does not bear thinking about how dangerous that is for patients."
He said they were doing "everything possible" to reduce pressure on hospitals by reducing the number of people taken unnecessarily to A&E units – although he said this was largely dependent on access to alternative help, which may not be available 24 hours a day.
Board chairman Professor Ian Cumming raised the situation at Walsall Manor and said: "I do not believe Walsall Manor has got less pressure from us, I do not believe they have got more beds than other hospitals so is there something Walsall are doing right that we could see elsewhere?"
Mr Docherty said: "They have the attitude and culture of doing it.
"They own the problem, they own the patient, they see it as their issue that they get to the patients quickly."
He added: "I hold Walsall up as an exemplar of what can be achieved. They just have a vision that is very compelling – you just think if we could get that across the system."
Meanwhile WMAS has revealed plans to build a new ambulance station in Dudley under plans to replace six "ageing" sites across the region. A hub that will become the country's biggest is already being built in Oldbury.