Nearly half of all patients attending Forth Valley Royal Hospital's emergency department last month had to wait longer than the target four hours to be treated, members of the NHS health board have heard.
NHS Forth Valley chief executive Cathie Cowan told members of the health board that the problems in the ED are "a barometer" of the huge pressures that the whole system is under.
The day she addressed the board (Tuesday) the health service had 122 delayed discharges, including 47 in FVRH itself. However, in addition to those 47 delayed discharges, 61 were also waiting to be transferred into a community health facility or social care.
"You can begin to see that we have nearly three to four of our wards with patients who shouldn't be in those beds - they should be somewhere else to meet their needs. When you think that we've only got 12 wards, that's exceptional pressure on the site."
The effect of delayed discharge is particularly acute in Forth Valley which has only one hospital.
While the Scottish Government standard expects 95 per cent of patients to be treated within four-hours, July so far has seen just 51.8 per cent of those attending the Larbert hospital's emergency department hitting that target.
Once again, Ms Cowan began her report with an apology to the people of Forth Valley for the delays and acknowledging that the hospital is still putting five beds in four-bed bays and still using treatment rooms.
She said: "I am sorry. I acknowledge this is less than ideal for patients and staff and we continue to work with all our colleagues to try and help reduce that demand on capacity."
She also acknowledged that Forth Valley is also failing to hit targets that should see nearly all patients with suspected cancer waiting no longer than two months for treatment to start.
The Scottish Government's standard states that 95% of eligible patients should wait a maximum of 62 days from urgent suspicion of cancer referral to first cancer treatment.
In Forth Valley, just 70.4 per cent of patients were seen within that timescale.
Ms Cowan said that the management, staff and health and social care partners are all doing all they can to improve the situation and she paid tribute to the teams working "very hard to identify things that might make the difference to increase capacity or reduce demand".
That work includes meeting patients at the "front door" to see if they could be redirected elsewhere - "to a more suitable location to meet there needs".
One of the areas that "continue to be fragile", Ms Cowan said was 'out of hours' which currently has a number of vacancies.
However, she said recruitment is ongoing and they are "making good progress" in filling those posts and looking at alternatives, including working with the Scottish Ambulance Service to use advanced paramedics.
Dr Andrew Murray, NHS Forth Valley's medical director, said that management were responding to the "inexorable crisis that we face".
He said it was particularly important that the staff can see the senior leadership team meeting daily to address the problems of capacity, working with colleagues in social care and also the Scottish Government to find solutions.
"Capacity means flow and it means people getting into the right place and that's what we've been focused on," he said.
"But the numbers tell the story and unfortunately because of that pressure, we have not found a transformative way to improve our system."
Ms Cowan added that the challenges of Covid were also still present and she praised the efforts of the staff working under constant pressure.
She said: "The teams are working flat out and I absolutely applaud every one of them. When I put out a call last night to say the department had 70 patients, everybody stepped up.
"We may not have all the solutions but that mutual support is extremely helpful and I want to put that on record."
The board heard that while there were undoubted pressures on unscheduled services, the hospital was doing well when it came to planned care.
CT scanning waiting times are also greatly improving, thanks to a mobile scanner that is currently in FVRH grounds.
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