In the new Royal Liverpool Hospital a 78-year-old man is lying on a trolley in a corridor. He's been there for two days, waiting, hoping to be moved into a bed on a ward.
The corridor full of patients on trolleys that he is lying in is a standard part of this hospital's Accident and Emergency department now. Around the corner in the designated A&E department there are scenes of desperation and chaos.
A man who has suffered a suspected stroke hasn't even made it onto a trolley. He's been waiting for 24 hours in the same chair. A woman has been given oxygen while she waits. Another is in so much pain she has decided to retreat to her car as its the most comfortable place for her to lie down.
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These scenes may sound dramatic - and they should do - but they have sadly become normal for hospitals up and down the country as the NHS faces its biggest ever crisis. The situation at the New Royal was recounted by a woman who tried to get her mother seen by a doctor after a serious asthma attack. Having been told to go to A&E, she couldn't believe what she was witnessing.
She said: "There was a woman in the waiting room who was vomiting into bowls, but there were no staff around to help her so other members of the public were helping her to clear it up. We were told by a staff member that there was a 30-hour wait for a bed. He had a big three-page list of all the people who were waiting for a bed."
This is not a situation confined to one hospital. Across the city at Aintree Hospital the situation is just as grim.
Around 15 ambulances can be seen queueing outside the entrance to the hospital's emergency department, with patients being treated inside. Inside the department and some of those paramedics can be seen tending to sick patients on rows of trolleys.
Further inside the A&E area and people are lying on the floor in pain, waiting for hours to see a doctor. One eyewitness in the department at the time described the scene as "soul-destroying."
They added: "All the beds were full and the patients were being treated in the back of ambulances outside. There were loads of people being treated in the literal doorway to A&E and nurses who had time to help had to just jump in when they could.
"People were waiting up to 21 hours just to be seen and there were people lying on the floor, some because they were in that much pain. People were then squeezed into rooms on drips and left. have never seen anything like that. The nurses were absolutely brilliant and a credit to themselves. It was soul-destroying to see these angel nurses doing everything they could, I felt sorry for them because it's not their fault."
Bosses at the Liverpool University Hospitals Trust which runs the Royal and Aintree say the demand on their A&E departments is now "unprecedented."
David Melia, Chief Nurse at the trust added: "Our hospitals are caring for a high number of patients who need to remain in a hospital bed. Patient safety remains our priority and our staff are doing everything possible to provide safe care to our patients. All patients in our emergency departments are triaged on arrival and their care is prioritised according to their clinical needs.
"Staff are present in all areas where patients are being cared for. Patients are reviewed at regular intervals and are appropriately monitored and supported, including offering them food and drink and pain relief if necessary."
He added: “Unless their condition is life-threatening, we are urging people not to attend the Emergency Department. Please use NHS 111 online for advice on the best service for your condition. Local Walk-in and Urgent Treatment Centres are open 7 days a week, even on Bank Holidays and your local pharmacist can provide expert advice on a range of common conditions.”
If the situation in Liverpool's hospitals is critical, the scenes over the water are no better. At Arrowe Park there are now regularly four corridors full of patients waiting on trolleys as the facility's A&E department is overrun.
An emergency clinical support worker in the department laid out the reality. He said: "We are just completely overwhelmed. The A&E has capacity for around 60 patients and we are getting 150 now at any one time. There are four or five corridors with trolleys full of patients because there are no beds, it's just crazy, I have never seen it like this.
"We have patients having heart attacks who we don't have trolleys or beds for, so they are sat waiting in chairs. We are having to ration care, having to decide who gets the next trolley with 20-30 people waiting for it.
"Yesterday there were waits of 30 hours for a hospital bed and nine hours just to see a doctor, there was no space whatsoever in resus."
The hospital has activated its trust capacity protocol for numerous days in a row now, this means staff from other departments can be redeployed to try and help with the chaos in A and E. It's usually reserved for major incidents.
He added: "We used to get a bad couple of weeks over the winter, but this is all the time now, we are in a constant state of crisis management and so many people just want to leave."
This dedicated health worker is set to soon leave the NHS after 17 years, six other staff members from his department will follow him out of the door. He added: "I am sad to be leaving the NHS, I don't want to leave but I can't do it anymore, every shift we are completely overwhelmed. I can't go in anymore. It is like going into a war zone every day."
"When I started this job 17 years ago we never had people waiting on trolleys in corridors, but we have seen it get worse every year over the past decade as with other facilities and centres shut down, the crisis in social care - everything impacts hospitals and their A and E departments in the end."
While Accident and Emergency is the visible frontline of the crisis in our hospitals, the chaos and pressure is felt across departments at all times. A ward doctor working in the same hospital explained the knock on impact.
She said: "The hospital is on full capacity and the patients are really sick. They are transferring so quickly to wards that the patients haven't been seen by senior doctors downstairs.
"The protocol means they can 'board' patients (put a patient in the ward corridor) while awaiting them to be discharged later that day so the bed is free for the sick new patient. Staff sickness is making things worse with various viruses. Medical and nursing numbers are very low so we are run off our feet - the Matrons are being great, helping on the wards at the bedside."
A big part of the problem facing hospitals now is not just about who is coming in, but who is not leaving. The crisis in social care means that many medically fit patients who are unable to leave because they haven't had a care package established or a review with a social worker. This creates the bed blockage behind these enormous waits for beds for those arriving at A and E.
The doctor explains: "Some of these patients have been here for weeks waiting. This could give us an extra ten beds on our ward." She added: "There was an acutely bad flu season a couple of years ago for a few weeks at Christmas and it felt dangerous then. But this has already felt bad for weeks and is continuing with no end in sight and nothing coming from the government."
A Wirral University Teaching Hospital spokesperson said: "As is being experienced nationally we are currently seeing unprecedented demand in the number of patients attending our Emergency Department.
“Staff are working tirelessly to provide the highest standards of care and ensure our sickest patients are seen first. While the safety of patients in the Emergency Department remains a top priority, we do have many patients who no longer need to be in hospital but who require ongoing community support. We are working extremely hard with regional teams, partner organisations and North West Ambulance Service (NWAS) to facilitate the safe transfer of patients in and timely discharge of patients out of our hospitals.
“Staff health and wellbeing remains a top priority especially during times of high demand for our services. The Trust has a lot of support in place for staff such as counselling, health and wellbeing areas, Freedom to Speak Up Guardians, and pastoral teams to support staff with any concerns they may have.
“While we do have robust plans in place to ensure the Trust can deliver all essential services during winter, we would ask patients to only attend the Emergency Department if it is an emergency. If it is not an emergency, there are other more appropriate alternatives such as contacting 111 for advice, visiting a pharmacy or speaking to a GP.”
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