'No dignity in this', say staff on stretched A&E

The beep of Dan Crook's emergency pager signals another job and he rushes off to the ambulance arrival bay.

James Oakes is elderly, hypothermic and confused. The paramedics fear sepsis.

"He's a farmer," says Dan. "He's soldiered on for a while but now he's critically ill. We need to get his temperature and oxygen levels up fast."

A patient like James should be seen in the resuscitation bay as well but it's full.

Instead he's assessed and stabilised in the ambulance area. It is only when he is eventually moved into a cubicle that the nurse has time to remove his muddy Wellington boots.

"How long will I be here for?" he asks. His animals need feeding. "I've never been to hospital before and I don't want to stay here long."

Managing the flow through a hospital - that is, freeing up beds by moving on those who are ready to leave - is a vital and challenging task.

Dr Hal Spencer, a medical consultant and chief executive of Chesterfield Royal, says up to 80 beds out of 540 are occupied by patients who are fit to leave but cannot because of issues at home or with social care.

Some of these patients have been admitted even though there is nothing fundamentally wrong - they just have nowhere else safe to return to.

"It makes it very difficult because it means we don't have the capacity to look after people who need care most but when it's 02:00 we end up looking after these people - it's the right thing to do," says Dr Spencer.

The message from Chesterfield's staff is that they are coping, just, and that they are offering safe care.

But they are clear it's nowhere near where it should be and, through no fault of their own, the standard is falling short of what they were trained to provide.