Louisa Gilbert lies on a bed in an overrun A&E department at Ashford’s William Harvey Hospital, pushed up against a staff desk.

The frail 89-year-old - who has dementia and terminal lung cancer - has been here for more than two days, waiting for a space to become free on a ward.

Nearby, beds filled with patients line the emergency unit’s corridors in scenes likened to a “warzone” by worried relatives.

The images are a damning illustration of the crisis facing the East Kent Hospitals Trust, which for eight straight months has been ranked among the six worst in the country for 12-hour ‘trolley waits’.

And the pressure isn’t easing, with winter set to bite and almost 1,200 patients last month enduring delays of more than half a day for a bed - up from an average of three just five years ago.

But how have things got so bad so quickly, and what is being done to ease the strain on a system at breaking point?

A long-running crisis

A Google search provides some indication of the struggles endured recently by the trust, which runs hospitals in Ashford, Margate, Canterbury, Deal and Dover.

Unwanted headlines include ‘My sick son waited 18 hours in a hard chair’, ‘Patient beds down on own mattress in A&E’ and ‘Corridor-waits the third worst in England’.

This bleak picture of the crisis engulfing East Kent’s emergency departments is supported by monthly statistics published by the NHS.

All trusts are required to record how many people are attending their A&Es, how long they’re waiting to be seen and, if they need to stay in hospital, how long it is before they’re given a bed.

Since the start of this year, an average of 1,151 people a month in East Kent have waited more than 12 hours to be admitted. That’s almost 40 - often very unwell - patients a day.

Among them is great-grandmother Mrs Gilbert, who was taken to the William Harvey by ambulance at about midday on Wednesday after suffering a fall at her Ashford home.

Her daughter, Shelley Ellul, spoke to KentOnline from her mother’s side on Friday morning - almost 48 hours after she had arrived at the hospital.

“She’s been left on a bed next to a desk in the waiting area of the A&E assessment area,” she said.

“All the bays are full and they don’t have a bed on a ward. The corridors are also lined with beds filled with patients - it’s like a warzone, like something you’d see in a third-world country.

“Her sheet had blood on it from where she had grazed herself so I changed it myself.”

Many patients enduring long delays, including Mrs Gilbert, are given treatment while they wait - a practice known as “corridor care” and branded “dehumanising” by leading doctors.

“It’s so degrading to be treated in front of others with no privacy, especially someone my mum’s age,” said Mrs Ellul.

“There’s no dignity at all. It’s heartbreaking to see.”

Mrs Gilbert, who had an infection, was eventually found a bed on a ward at about 5pm on Friday.

Bed-blocking

One of the reasons most cited for causing the long waits is ‘bed-blocking’ - where people well enough to be discharged from hospital can’t be for various reasons.

Across Kent’s four hospital trusts in October, 52 people a day were still on wards despite no longer needing inpatient care.

Of these, more than 60% were waiting for a long-term care package to be put in place so they could return home, such as daily visits to help with dressing and feeding. Others could not be discharged until a suitable care home was found for them.

The knock-on impact is a backlog of patients needing to be admitted, but with no ward space free to accommodate them.

With Kent County Council responsible for the region’s social care, should it be taking more of the blame for the crisis facing our hospitals?

Cllr Dan Watkins, the authority’s cabinet member for adult social care and public health, accepts it has a part to play.

“The problem with beds having patients in them who are medically fit, but without a social care package, is actually a reflection of the fragility of the whole care system in Kent,” he says.

“East Kent is the most challenged region, generally speaking, because we don't have enough quality care providers with the capacity to take on an increasingly elderly population with complex health and care needs.

“The number one reason for that is that we don't have enough skilled workers able to provide that care. Now, there are other reasons as well, but that would be the number one reason.

“It's a complex system, and it's not just the local authority that is causing the challenge, but I absolutely accept our part in fixing the issue.”

Ashford MP Sojan Joseph, who is a former mental health nurse, has seen the issue first-hand, and on a recent visit to the William Harvey noted how many people were waiting to be admitted.

“If the patient flow is happening as it should be, then those patients would have moved into the ward beds,” he told KentOnline.

“There is a big blockage in the system and in social care, with them not being able to move people as quickly as they should.

“It's becoming more and more normal now to care for patients in the corridor, which is not acceptable.”

Ageing population

The older a patient, the more likely they are to be affected by multiple conditions and the longer it takes for them to recover.

East Kent Hospitals is particularly impacted by this as the three districts with the highest average age in the county are all in the geographical area covered by the trust.

In Thanet and Dover, 24% of the population are at least 65 years old, while in Folkestone and Hythe a quarter of all residents are of retirement age.

Elderly people are often more frail and less mobile, which means that a prolonged stay in a hospital bed - rather than moving around their home as normal - can affect their muscles and their long-term ability to walk or do everyday tasks.

This means they can develop more complex care needs by the time they are ready to leave hospital, meaning plans have to be put in place before they are discharged.

A legacy of Covid

Every day in East Kent an average of 38 patients are left waiting at least 12 hours for a bed - more than the total for the whole of 2019 combined (36).

But why has the situation changed so much, and so quickly?

KentOnline spoke recently with the trust’s chief nursing and midwifery officer, Sarah Hayes, outside the William Harvey, having been told its A&E department was too busy for a promised tour to go ahead. The irony was clear to all.

She says a major factor in 12-hour waits soaring in the last five years is the lasting impact of Covid, with many people having grown increasingly unwell during the pandemic as they were unable to access the care they needed.

The cancellation of non-urgent health services meant symptoms weren’t treated as quickly as they normally would be, causing conditions to progress further and become more advanced.

This in turn has meant people arriving at hospital needing more treatment and often with more complex care needs.

“The reality of the situation is that some of the people that are coming into us are sicker,” Ms Hayes said.

“The pandemic meant that lots of people weren’t necessarily able to access healthcare in the same way as they usually would, and their health needs are now greater.

“These are pressures felt across the NHS.”

But there are signs of progress, with fewer than 20 patients in East Kent now waiting less than 78 weeks for a planned procedure - down from 2,400 at the start of the year.

Are long waits unique to East Kent?

Not at all. Since the pandemic there has been a national trend in 12-hour waits increasing, from less than 1,000 a month in 2019 to almost 50,000 a month this year.

But hospitals appear to be coping with the issue with vastly different levels of success.

East Kent is one of the largest trusts in England, with its 25,938 A&E visits last month the 16th highest nationally.

But it consistently finds itself among the country’s five worst for 12-hour waits, and last May even recorded the highest number.

Its November total of 1,121 was the sixth highest in England, and the 14th consecutive month of recording 1,000 or more.

The situation in Medway is also dire, with its 771 last month the 19th highest nationally - despite it only being the 52nd biggest trust by A&E visits.

In contrast, Maidstone and Tunbridge Wells saw 21,694 patients at its emergency units In November, but recorded only 80 waits of 12 hours or more.

There were 276 at Dartford and Gravesham.

Are there targets to hit?

In 2010, the government set a benchmark that at least 95% of patients attending A&E - including urgent care and minir injury units - should be admitted, transferred or discharged within four hours.

Amid the struggles of trusts nationally, this was dropped to 76% in 2022, but is set to rise again next March to 78%.

Last month, 74.1% of emergency patients were dealt with in East Kent within four hours, compared to 74% in Dartford and Gravesham, 77.3% in Medway, and 81.6% in Maidstone and Tunbridge Wells.

But it is in its main A&E departments - at the William Harvey and Margate’s QEQM - that East Kent is struggling most. Last month, just 53.7% of patients passed through these emergency units in four hours or less – almost 12 percentage points lower than any other trust in Kent.

Earlier this year, KentOnline told how one student, Daniel Hebditch, was left in a hard chair in the William Harvey’s A&E unit for 18 hours while suffering acute stomach pain and a fever.

His dad, Tim Hebditch, told KentOnline at the time: “I've worked in healthcare for 30 years and I've never seen anything like it.

“We would have been happy to even have a bed in a corridor for him, but there wasn't one for the 18 hours he was in the A&E waiting room.”

A Department of Health and Social Care spokesperson told KentOnline its aim is for trusts to hit the 95% target by 2030.

Have patient numbers in East Kent increased?

Yes, and quite significantly.

There were 19,439 patients through the doors of emergency units run by East Kent Hospitals in November 2019. Last month there were 25,938 - a 33% increase in just five years.

It’s a trend that’s been seen across the county, with total attendances jumping from 60,087 to 80,181 across the same period.

It means every 32 seconds someone will walk into an A&E department or urgent care centre in Kent, providing some idea of the scale of the challenge facing our hospitals.

Does the East Kent trust need more staff?

It would be reasonable to assume that more doctors and nurses would help tackle the issue, but all the while a shortage of empty beds remains, so does the heart of the crisis.

There are vacancies across the trust’s clinical teams, but staff turnover is the lowest it’s been in two years and continues to improve.

William Harvey nurses were also recently named Team of the Year at the Nursing Times Awards - an indication that staff are doing all they can against the odds.

Criticism of their workplace hurts, although it is accepted scrutiny is part of the job, especially when it comes to people’s health.

Ms Hayes said: “What I see here is people and an organisation who are working really, really hard to get things right in difficult circumstances in a health service where things are really, really busy.

“Of course, it does feel unfair when we talk about the fact that it's East Kent's fault, but equally we know that we need to work to get everything possible right for our patients and we need to be open and honest when we don't get it right.”

What is being done to bring down waiting times?

In March, a three-year expansion of East Kent Hospitals’ main A&E departments in Ashford and Margate was completed at a cost of £30 million.

This winter, a further £11.6 million is being allocated across the NHS in east Kent to avoid unnecessary admissions to hospital.

This will fund extra at-home care packages and use of a scheme led primarily by the ambulance service that ensures patients are assessed before being taken to A&E, so they only attend hospital if they can’t be cared for in the community.

The money will also support the expansion of ‘virtual wards’, which see people receive hospital-level care in their homes, freeing up beds for those who need them most.

Patients are reviewed daily by a clinical team, often over a video call, and can be provided with a range of tests and treatments, including blood tests, medication or fluids through an intravenous drip.

But is the money enough?

At the start of the 2024/25 financial year in April, NHS England told East Kent Hospitals it had to save £49 million over the following 12 months.

In August, the cash-strapped trust reported it had gone £45 million over its originally planned deficit of £72 million in 2023/24, bringing the total overspend in the year to £117 million.

Since then it has been establishing ways, such as its cost-saving measures, to bring that down.

The latest papers show its budget for 2024/25 still expects to meet a planned £88.5 million loss this year.

Ken Rogers, the chairman of the Concern for Health in East Kent (CHEK), has spent years at loggerheads with NHS bosses and is calling for more funding to be provided to the trust.

“Unless the NHS can transform the services in East Kent and have more staff, they're trying to do too many things for too many patients at the same time,” said the five-time cancer patient.

“The reason it's never got any better is because they cannot transform or do the services until they get some investment in East Kent. It is actually quite as simple as that.”

While more beds on wards would help, the trust believes increasing capacity outside of hospitals so people can be treated at home or in the community is as important as having the right number of beds and staff for patients needing acute care.

It says all NHS and social care partners are working together to support patients with complex needs so they can be admitted and discharged at the right time.

Ms Hayes said: “We work together with our social care colleagues, that’s KCC, our primary care colleagues, that’s GPs, ambulance colleagues – we all work together to support patient care.”

Winter is coming

The winter months are traditionally a time of additional pressure for hospitals, with more patients needing to be admitted with illnesses such as Covid and flu.

Last winter, in December and January, the East Kent trust endured its two worst months on record for 12-hour waits, with totals of 1,260 and 1,368 respectively.

The recent scenes at the William Harvey are a worrying indication this added strain will hit hard again.

A trust spokesperson apologised to Mrs Gilbert and all others experiencing long delays, adding: “While we do all we can to ensure all patients receive timely care, our emergency departments are experiencing exceptionally high levels of demand with winter illnesses such as flu and Covid.

“We encourage everybody who is eligible for a flu or Covid vaccination to take the opportunity to protect themselves this winter.”

The trust is also urging people to only turn up at its A&E departments in an emergency, and to contact NHS 111 online or on the phone to find alternative services for non-urgent medical concerns.

Mr Rogers told KentOnline he has serious concerns about what lies ahead in the next few months.

“I know it's probably wrong to say it, but you think hospital services are going to collapse because there's got to be a point when they've just got too many people there and they can't deal with them anymore,” he said.

“When this winter comes now, I think it's going to be probably the worst pressure we've had on the A&E in East Kent for some years.”