There is no let up. Patients keep arriving putting pressure on a system running at over-capacity.
The cubicles here at the emergency department in Warrington were full hours ago.
New arrivals wait in whatever space is left.
Liam Ball is typical. He was admitted this morning with bruising to his chest after he was in a car crash.
It’s late afternoon now and he’s still waiting in the nurses’ station for a bed on a ward.
For the medics the day blurs into a constant rush making sure everyone gets treatment, eventually.
Lead nurse in urgent and emergency care, Ali Crawford, says it’s been like this for a long time now.
She said: “What we’ve seen over the last hour is two trauma calls, we’ve had very sick patients in cardiac arrest and we’ve also had two COVID positives standby…so that’s typical of what we’re seeing now and what we’ve seen over the last couple of months.”
What’s happening in Warrington is just a snapshot of the stresses weighing down on one emergency department.
But it’s a similar picture in many other places across the country.
In a cubicle, waiting patiently, we see Ben Aston. He arrived with chest pain hours ago.
He came here because he couldn’t get an appointment with his GP.
Mr Aston said: “I understand there’s difficult situations going on with COVID and things like that, patients being socially distanced and you can’t have family sitting in the waiting rooms so you’re more or less on your own.
“It is hard, I mean it is a very, very, busy environment as you can see as you’ve been walking around… it’s just a case of ‘I’m seen when I’m seen’, really, I am in pain but unfortunately I just have to wait to be seen when I’m seen.”
Increasingly, when one part of the NHS isn’t coping, it’s accident and emergency that takes the strain.
Dr James Wallace, clinical director for urgent and emergency medicine care, says it is a sign of the times.
He said: “There is a large amount that traditionally could have been seen in primary care, but at the same time, we are seeing a lot of things that could also have been seen in secondary care, or if they’d had their routine investigations…surgery.”
The latest data from the NHS shows waiting times from A&E to a ward are now longer ever.
And it’s particularly bad in Warrington. The average patient waiting eight hours and eight minutes, which is 70% longer than the national average.
The pressures of winter and what feels like an endless pandemic are now acute, according to Dr Mark Forrest, the associate medical director for unplanned care.
He said: “We always say if you become overwhelmed, if a resource is overwhelming – declare a major incident. It almost feels like we’re always right on the edge of a major incident.
“So you might say, why don’t you declare one? Well, the reality is we’d be doing it every day, and what actually changes because we’re already using all our escalation methods, we’re using ever resource we possibly can.”
Elsewhere the pressure is just as great. On this ward they are seeing an uptick in respiratory illnesses now lockdown is over, but consultant and respiratory clinical lead Mithun Murthy says coronavirus is still there and it’s causing problems.
He said: “There’s a very difficult mix of COVID still going on, new variants coming which keeps us on our toes, and our immense winter pressures mixed in with other respiratory illnesses. So yeah, it’s a really hard place to be right now.”
No one knows here what will happen over the next few weeks and months. But as winter begins it’s clear, the health care system is already creaking.