A&E struggles with growing elderly population
Recent reports have shown many hospital accident and emergency (A&E) departments are in crisis after facing unprecedented demand. Panorama spent seven days in A&E, at the University Hospital of North Tees in Stockton last year and it was busy, but meeting its targets. In January, we returned to try to find out what's putting A&E departments under so much pressure.
In Stockton, we saw A&E staff treating increasing numbers of old people with complex medical needs. But we also saw elderly people arriving, not because they were ill, but because those caring for them could no longer cope.
"It's a lot worse than it was," explains Sharon Webb, a patient process facilitator in A&E. Her job is to help move patients through the department as quickly and efficiently as possible.
"It's a lot busier than it was last year, everybody's under a lot of strain... and sometimes you feel like you're not getting anywhere."
Alan Foster, chief executive at the North Tees and Hartlepool NHS Foundation Trust, told us: "It's not just the winter. No, it's the demand on the health service from a growing elderly population."
'No medical problems'
In the small hours of the morning an elderly patient, George, who is 93 years old, arrives at A&E.
A young friend of his brings him in because, he thinks, George can't look after himself:
"He never goes into the shower. His clothes stink. I try to get him in the shower, he just punches us."
George, who hasn't had an accident or an emergency, has nonetheless become A&E's business. He'll almost certainly need the help of social services but for now it's the NHS that will care for him.
Leanne Johnson, a staff nurse, who's the first to see him says: "No, he doesn't seem to have any medical problems whatsoever… and he's going to end up getting admitted into a hospital bed, probably."
And that's just what happens. Beds throughout the hospital are at a premium.
Quite often a hospital bed that could otherwise be free is occupied by a frail and elderly patient who no longer needs hospital care.
In an acute ward in the hospital is 89-year-old, Jane Abrahams. She has dementia and she was admitted into hospital from her care home.
She was well enough to leave hospital before Christmas but in mid-January she's still here.
"I want to go home," she tells her family.
But because Mrs Abraham's medical and nursing needs have increased she can't go back to the care home where she lived before.
And this is where the hospital can become reliant on the actions of others, social services and families themselves.
Her daughters have been struggling to find a suitable new care home.
Her daughter Terri Cruikshank says: "We are really concerned about my mother. We desperately want her out of here. I feel like there's a big block somewhere between the NHS and then what happens to somebody afterwards."
Her daughters spend hours on the phone and the internet trying to find a suitable new home for their mother. It's unfamiliar and stressful work.
The family think they should have had more help from social services. But the local authority insists that they've done everything that was required of them.
The hospital admits a failure in communication on its part has contributed to the delay in Mrs Abraham being discharged.
More than a quarter of the days that patients spend in hospital, in England, after they are medically fit to leave, are down to arranging social care.
The harder it is to get patients out of hospital, the more the traffic jam tails back to an already overstretched A&E.
Yet staff are still meant to meet the same official waiting time target: treating and then admitting or discharging 95% of their patients within four hours.
Sharon Webb, on the front line in A&E, says: "When you're doing everything you can and you're still not hitting your targets it is very frustrating."
Last year, we saw staff working hard to meet the target and they were succeeding. But now week by week, just like many other hospitals up and down the country, Stockton's failing.
Some staff sounded quite unapologetic. Dr Dave Prosser, a registrar in A&E, says: "If no-one knows how bad the situation is how on earth are we going to get help. If the system is broken we want that to be highlighted."
Alan Foster, who runs the NHS trust, says they don't like failing to meet the four-hour waiting time targets and if they do, it's not for want of trying.
"When a service is under pressure I think that is inevitable but, nevertheless, we do make sure that we have got the staffing that we need in place to make sure that those patients when they come into hospital are not put at risk," he said.
Stockton is officially recognised as a good hospital.
But even this good hospital is labouring under heavy burdens and some of its staff in A&E say they can't take much more.
Nurse Dave Brereton says: "There's times when I feel like halfway through a shift just walking out because the pressure is that much."
Meanwhile, registrar Dr Dave Prosser is worried about whether they can continue to do their job properly with the the increased pressure. His warning is stark.
"We are broken, we have reached our capacity, there's no more to give."
Prof Keith Willetts, who is in charge of NHS acute care in England, says change is needed and reform has already begun.
"We are trying very hard to make sure that the system is coping and I believe the NHS is currently coping, but we have an unsustainable system and it is something that will have to change.
"Because the system demand means that at the moment the model we have to deliver care will increasingly find it difficult to do safe care."
Watch Panorama: Emergency in A&E on BBC One on 2 February at 20:30 GMT or later on the BBC iPlayer.