Ambulance queues outside Ipswich Hospital are worse than ever before at the end of October, according to chief executive Nick Hulme.
But he remains hopeful that £7m of extra capacity that is coming on stream next month should help it to cope - and stressed the hospital would still be there for people who needed it.
Mr Hulme was reacting after Ipswich Labour councillor Neil MacDonald took a picture of 10 ambulances queuing to unload patients outside the Garrett Anderson Centre at the hospital earlier this week.
He said: "I have no criticism of the hospital over this, but it really does show how serious the health situation is.
"I know they have problems with the shortage of beds and difficulties in being able to discharge patients because of a shortage of places in care homes and lack of home care.
"There needs to be much more support from the government if we are not going to face a real crisis."
Mr Hulme said the queues that the hospital had faced on some days had been worse, for this point in October, than he had ever seen before.
He said: "We are working very hard on a plan that we are planning to implement between next month and the end of March to try to ease things - but yes sometimes the situation we are currently in can give you a sleepless night."
Every patient on an ambulance was checked as soon as they arrived - and priority was given to admitting those who were in the most serious condition.
The hospital had a £7m budget to try to ease winter pressures - and was hoping to set up "hospital wards at home" allowing staff to monitor and treat patients at home if they were fit enough to leave the hospital.
He said: "That could free up 30-40 beds at a time which might not sound like a great number - but would ease pressures on the wards."
People could ease the pressures on the hospital, and especially the A&E department, if they sought advice from a community pharmacist or local GP before going to the hospital.
But he added: "We want people to be confident we are absolutely ready to treat them if they need it - and we are doing a lot of planning and preparation to ensure we are here for them."
Mr Hulme said recruiting staff to help run the "hospital wards at home" scheme was continuing - although other hospital trusts in the area were also looking for similar staff at the same time.
Staff recruitment continued to be a challenge - and that was especially the case in the care sector which is vital for the hospital because that provides support allowing patients to be discharged to their own homes.
He said: "The government is putting £500m into that across the country. I don't know how much of that is coming here but to be honest it would not go a long way.
"So long as people can earn more working on a supermarket till or in a distribution hub than they can from offering care to people in their own homes it will be very difficult."
And he also urged people to help the hospital to help themselves - another wave of Covid was likely in the winter and getting a jab would help to strengthen people's protection against it.
He said: "We are still seeing it in hospital and while it often isn't serious in itself, it does mean we have to treat patients with care to avoid it being spread in hospital."
Comments: Our rules
We want our comments to be a lively and valuable part of our community - a place where readers can debate and engage with the most important local issues. The ability to comment on our stories is a privilege, not a right, however, and that privilege may be withdrawn if it is abused or misused.
Please report any comments that break our rules.
Read the rules here