It is a Saturday night in Melbourne and emergency departments across the city are overwhelmed.
Queues of ambulances are banked up with patients desperate for a bed, while overcrowded waiting rooms look more like peak hour at the airport.
There is barely a spare seat inside as dozens of sick people anxiously wait for hours in uncomfortable chairs to get the urgent medical care they need and, if they are lucky, a bed.
Dan Miles was one of them. He waited at the Austin Hospital for 10 hours with a painful staph infection in his foot.
After visiting his GP, he was struggling to walk, his foot was blowing up and he had not slept for days.
"There were 60 to 100 people in front of me, the corridors were lined with beds, and I just thought to myself 'this is crazy, there are people everywhere'.
"I wasn't in great shape at all by the time I saw the doctor at midnight.
"I needed to have an IV drip but for hours there was nowhere to go to have it."
Dan got a call to return to the hospital on Monday and waited a further six hours.
He said at one point he was about to give up and walk out, when his name was finally called.
In a separate incident, Barry Strahan's 76-year-old mother waited more than 14 hours overnight in the Box Hill Hospital's emergency department waiting room on her birthday, after her GP sent her to hospital with suspected appendicitis.
The emergency department was so busy they were not even able to provide her a bed in the emergency department, despite her abdominal pains.
Mr Strahan said he did not blame the nurses or doctors, because they were "doing the best they can", but said the government should be providing hospitals with more resources.
"I think to have a 76-year-old sitting in a waiting room chair for over 12 hours overnight isn’t the way our health system should be caring for people," he said.
Worst wait times seen in 40 years
The ABC can reveal the number of people abandoning emergency medical care before they have even been seen has doubled in Victoria in the past year, as doctors warn there could be serious consequences.
More than 800 people a day are leaving overcrowded emergency departments across the state, according to three doctors who said the hospital system is past breaking point.
Some patients have told the ABC they were forced to wait more than 12 hours before giving up on getting care.
University of Melbourne emergency medicine professor George Braitberg said the overcrowding in emergency departments was the worst he had seen in his 40-year career.
"When you start to double the number of people who don't wait, you increase the number of people that should have stayed and they have the potential to get sicker," Professor Braitberg said.
"Category three patients are meant to be seen in 30 minutes: we know their wait time is blowing out and they are that group of people they might go home, their clinical condition could get worse, and that is concerning."
In the public hospital system last year, between five and 10 per cent of patients were leaving emergency departments before receiving treatment.
That number has since doubled to between 15 and 20 per cent.
In more than 200 of those hospital beds, patients were ready for discharge, but waiting on the NDIS to approve care plans and disability supports so they could be sent home safely.
Discharge delays of up to 625 days among those NDIS participants meant hundreds of emergency department patients couldn't get access to inpatient care.
The Victorian government said it was working with the NDIS on individual cases to reduce delays in the discharge process.
Nurses leaving stressful roles in droves
The problems are not just in emergency departments but mirrored across the country's health system.
Josh McCallum is a nurse on an acute medical unit for a major Melbourne hospital and he has chosen to speak out because he said the workforce shortage was so bad, patients and staff were suffering.
"When the nurse-to-patient ratio goes down, very basic needs are put to the side – patients are going days without washes and some are not getting their medication on time," he said.
"With winter coming it is only going to get worse, we are dreading what is about to come."
On any given day, more than 2,000 nurses are off work across the state as they struggle to deal with COVID, flu and burnout.
Mr McCallum said some days hospitals were trying to get agencies to fill 50 per cent of nursing shifts and beds that were desperately needed were being closed because there were not enough nurses to staff them.
"On average [on the acute ward] there are four patients per nurse and if there is a nurse not there, that means there are four beds we cannot use in the hospital," he said.
"Compared to three years ago, only about 20 per cent of nurses are still working on my ward, most have gone to less stressful jobs."
Mr McCallum said he and his colleagues were anxious about going to work knowing the workload they would have to take on.
"We have had nurses coming in on shifts bawling their eyes out, when you check what's wrong with them, they were considering self-harm and suicide," he said.
"When I have friends come up to me and say my daughter is thinking about becoming a nurse would you recommend it? I say no – the effort you put into the career is not paid back."
Emergency department pose risk to patients
The state's beleaguered health system has been plagued by problems.
Last week, triple-0 call-takers were forced to resort to pen and paper because of an IT failure prompting a Code Red to be called.
The number of people staying more than 24 hours in emergency also doubled in the past year, according to Victoria's agency for Health Information.
One senior doctor who did not want to be named told the ABC a major Melbourne hospital forced 19 people to wait more than 24 hours for emergency care across two days last month, breaching protocol.
Before that spate of incidents, only four long-stay breaches were reported at the hospital since 2000, painting a concerning picture of the health system under increasing pressure.
Australasian College for Emergency Medicine’s Mya Cubitt said there came a point when it became dangerous for a patient to be in ED.
“After about six hours, the longer [you] spend in an emergency department the more likely you are to die [within] 30 days,” she said.
“The problem is not people turning up at hospital feeling they need healthcare — it is because not enough people are leaving through the backdoor, so no one can get in.”
Dr Cubitt said the health system had become so complex; it was difficult for patients to understand where they were supposed to go with particular problems.
"You can't blame the public for the amount of people coming to ED, or it will deter the wrong people – people like older women who really need help but won't get it because they don't want to be a burden."
More funding, looking after workforce crucial for change
Victorian Health Minister Martin Foley said last month's budget included $12 billion for the health system.
"With COVID and now with pressure from the influenza winter surge we are seeing, with elective surgery comebacks, with deferred care and furloughed staff our system is under pressure like it has never been before," he said.
"Our frontline healthcare professionals are therefore under pressure like they have never been before and they are doing an extraordinary job."
Mr Foley said the government's own data shows that 6.7 per cent of patients did not wait for treatment, compared to 5.3 per cent in January 2020.
This year's Victorian Budget included funding for up to 7,000 new health workers, but it will take time to recruit and train the staff.
Opposition Leader Matthew Guy said it was concerning to see Victorians "lose faith in the health system".
"The government has got to fix the health system crisis and they can't keep blaming everyone else for the health system's problems".
Dr Culpitt said there were short and long-term solutions.
"The biggest problem is the workforce, we don't have enough – in the short term we need to prioritise the scarce resources where we have, to the biggest area of risk," she said.
"Longer-term solutions are building bed capacity, expanding the hospital in the home service and improving pathways to move people through the hospital system, including through rehab, GP practices and preventative health."
In order to retain staff, Mr McCallum said nurses needed to be incentivised, their mental health needed to be looked after and they needed to be paid better.
"We get a 3 per cent pay rise each year, that has not kept up with inflation," he said.
"Nurses have worked so hard over the past two years and essentially we've been rewarded with pay cuts."
Professor Braitberg said hospitals operated at close to 100 per cent capacity even before COVID, therefore expanding capacity should be a priority.
He said it was also crucial to work out why it was becoming harder to get in to see a GP, with those people ending up in ED.
"Unfortunately, this is going to take years rather than weeks or months," he said.
