The daily struggle to discharge patients

"The A&E department is full," says Edna Panambo, the sister in charge at the Royal Liverpool Hospital for the day.

"There's no capacity. We are actually overflowing in A&E. So there is a problem. Ambulances will be queuing up."

It is 09:00 and she points to a screen that shows a row of red dots. Each one represents a patient who has been waiting more than four hours, breaching government targets. One patient has been there for 18 hours. Many of them are elderly and many are waiting for beds elsewhere in the hospital.

Asked if she's frustrated, she responds: "Yes to be honest with you. That is an honest answer. All of us are frustrated."

Upstairs in the hospital, senior staff are trying to free up beds for the new patients. They have more than 100 who are ready to go home, but they can't be discharged because the care they need at home isn't in place.

Alyson Constantine is the deputy operations manager leading the meeting.

"This is happening almost every day. Surgery can't start this morning until we have identified a bed for somebody to then return to after theatre. And then down in our emergency department there are patients who've been medically seen and need to be admitted but can't be admitted because there is no bed for them to go to yet."

Camille Furnell, 77, was admitted to the Royal on 31 May after a fall.

Medically, she's ready to go home, but she's been waiting 72 days to be discharged. Social workers assessed her in June, but so far they haven't been able to find a home care company willing to provide the support she needs four times a day. In July, one of the country's largest home care providers withdrew from contracts with the local authority, claiming the fees were too low.

Unable to cope on her own, it means Miss Furnell remains on a hospital ward.

"I'm a very independent person," she says. "They should do more to get people back into the community."

On the acute stroke ward, Dr Paul Fitzsimmons is talking to an 86-year-old patient who will go home today. But he's been waiting on the specialist ward whilst care has been arranged, because it was the only bed available.

"Essentially it is a very expensive residential care home bed… He isn't the problem it's our system that is preventing us from discharging people appropriately. Which means that the acute patients who really do have a need for these beds are being delayed downstairs in the A&E department and so aren't getting to the wards that they need to be on quite as quickly."

'We don't have the services to cope'

Liverpool's hospitals and the city council are working together to try to improve the situation, that includes putting in rehabilitation beds that can act as a stepping stone between hospital and home.

But the man who runs social care in the city admits they are struggling. "We are seeing more people with high demands in terms of their health and their well-being," says adult social care director Samih Kalakeche.

"People are living longer which is great. We celebrate it. But we don't have the services out there to cope with that number."

In 2010, the council spent £222m a year on adult care, by next year that figure will have fallen to £130 million, despite the growing number of older people needing help.

In Liverpool, the extra 2% the government allowed local authorities to put on council tax this year, specifically for social care, raised less than £3m.

With more cuts to his budget on the way, Mr Kalakeche believes the care system is at breaking point. "And that's what keeps me awake at night. I go home every night thinking what are we going to do next?"