The crisis gripping Norfolk's health and care system is set to worsen, senior officials have warned.
James Bullion, director of social care at Norfolk County Council, said that the pressures facing hospitals and care operators are not set to peak until later this winter.
Nationally, the NHS is already in the midst of its biggest crisis in a generation, with doctors warning that the situation is costing lives.
The health service was already under extreme pressure - the result of long-standing problems - but Covid, flu and now strike action by staff in some areas have all worsened the situation.
At Norfolk's hospitals, there have been long queues of ambulances waiting to hand over 999 patients, with delays of up to 12 hours reported.
A big part of the problem is the difficulty in getting patients out of wards - to free up space for new admissions - because related issues in the care sector mean support arrangements cannot be made, even for those healthy enough to leave hospital.
Mr Bullion said action was being taken to try to improve the situation, and urged more of the county's care providers to get involved in easing the crisis.
It comes as the government launched a national initiative to help move hospital patients into care homes. The NHS is being given £250m to buy thousands of spaces in the homes.
Mr Bullion said the winter pressures this year were the most challenging he had faced - even worse than last year.
"What we didn't face last year was Covid and flu at the same time and I am not sure we have yet reached a peak of Covid here in Norfolk," he added.
"We always tend to be a couple of weeks behind the national situation, so I think there will be a further rise in Norfolk.
"I really would encourage people to put on a mask to protect the vulnerable."
PLEA FOR HELP
The pressure comes at a time when the need for social care among Norfolk's increasingly elderly population is increasing.
But with more than 100 social worker vacancies and staff sickness due to influenza and Covid, Mr Bullion said ensuring they get that care has been difficult.
In recent days, across Norfolk's three hospitals - the Norfolk and Norwich University Hospital, James Paget University Hospital in Gorleston and the Queen Elizabeth Hospital in King's Lynn - there have been about 600 patients who were medically fit to leave but had not been discharged.
In around 150 of those cases it was because patients were waiting to be discharged to residential care, housing with care schemes or to their own homes.
And Mr Bullion called on care providers - of both residential and home care - which could provide places or support to contact the council.
He said: "I would urge providers to take on staff to expand and grow in line with the demand and to talk to the council to help us get through this crisis.
"We will do whatever we can to with care homes to get through this. We very much see them as allies and partners."
STANDARDS CHALLENGE
However, one of the issues in Norfolk has been the standards in the county's care homes.
Only 69pc of the county's care homes are rated as good or outstanding by the Care Quality Commission - well below the average for England and the East of England.
The council has stopped placing people in homes rated as inadequate, but is placing them in those homes which require improvement, if the authority is confident from quality assurance checks that they are appropriate.
The Conservative-controlled council has also made 44 housing with care flats available for temporary use by people with social care needs who are medically fit to be discharged from hospital, but not well enough to go home.
GOLDEN HELLOS
The authority has tried to tackle the lack of social workers with a recruitment campaign and 'golden hellos' of £2,000.
And it has increased the fees it pays care providers so they can pay home support care workers more - to better compete with other professions.
The money is coming from the government's Adult Social Care Discharge Fund.
Bill Borrett, the council's cabinet member for adult social care, said: "The workforce of the social care sector provide care for many of the most vulnerable in our society, and we recognise the challenge that providers have faced in recruiting and retaining staff.
“Care workers providing support in home settings are vital to the whole healthcare system, enabling individuals to live at home for as long as possible.
"This means people can be discharged from hospital more quickly, or stay living in their own homes for longer.
"By recruiting and retaining more staff in these roles, the whole system will feel the benefits."
LONG TERM SOLUTION
While much of the focus has been on hospitals, Mr Bullion said the pressures were also having a knock-on effect on getting support in place for other vulnerable people.
Even before the winter pressures kicked in, there were 1,700 people waiting for an assessment of their care needs.
And Mr Bullion said a long-term solution would only come about if the issue is tackled nationally - with more investment in social care to recruit and retain workers.
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