During early April, the Queen Elizabeth Hospital in Gateshead was "completely bed-blocked" with high numbers of Covid-19 patients and social care issues meaning tens of patients couldn't be sent home from hospital.
Hospital execs told a meeting of the Gateshead Health NHS Trust's board that this meant the hospital was effectively "one in, one out", and bed occupancy was at upwards of 99%. The situation has improved over April, but it remains the case that "delayed discharges" - where a lack of social care provision means otherwise healthy patients can't be sent home - are causing huge issues with the flow of patients through the hospital.
This is a key reason that, in April, more than 130 patients spent over half an hour waiting in an ambulance outside of the hospital's A&E - while over the same month 71 patients were waiting on trolleys in A&E for a bed for more than 12 hours.
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Speaking at the board meeting, chief executive Yvonne Ormston said: "During the pandemic at times we have had one or two of these pressures at a time, but these have come all at once. At one point, we had over 100 Covid-19 patients. We still have around 40 in hospital. That's together with the delayed discharges caused by a lack of domiciliary care - and we know that social care is under huge pressure itself.
"Currently the major issue for the hospital is the flow of patients so we are able to discharge patients and then able to admit those arriving at the front door. On a number of occasions flow has just stopped. In A&E patients have been seen, the decision to admit made, and then it just stops."
Joanne Baxter, the director with responsibility for patient safety, added that in early April, "we were at 99% bed occupancy". She said: "We were basically one in, one out - totally bed-blocked. We nearly had three wards worth of patients who were Covid-19 positive and another three of delayed discharges."
Ms Baxter said the trust was working with the local council to support domiciliary care providers and a new one was set to "come online" next week. However she said: "I'm concerned that we will see an initial flow of patients out of hospital but that will stop when [the new provider] reaches capacity."
The board heard how there was a need to prioritise discharging medically-fit patients from hospital because of the knock-on issues caused. Ms Baxter added: "We need to consider the harm to people stuck in ambulances or on trolleys in A&E."
Board chair Alison Marshall added: "The danger is that, because all NHS organisations are under this sort of pressure, that this becomes seen as business as usual. We simply can't have that."
It is understood there are around 45 medically-fit patients waiting to be discharged from hospital in Gateshead at the moment. This comes as, according to reports submitted to the board, in April there were 71 patients waiting more than 12 hours in A&E a hospital bed - while 132 people spent more than half an hour in an ambulance waiting to be handed-over to A&E.
In early April, staffing pressures also saw one of the QE's wards closed, while a number of emergency beds were made available, with some "day rooms" converted to provide additional space.
Execs are working with leaders from the North East and North Cumbria Integrated Care System on the issue - which continues to affect hospitals around the region. However, along with hospitals run by the North Cumbria Integrated Care NHS Trust, Gateshead is currently one of the hardest hit.
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