ROYAL Bolton Hospital has struggled to contend with demands of the ambulance service this winter.

In December, 514 patients who were brought to the accident and emergency department by ambulance waited more than 30 minutes to be handed over.

Out of those, more than half waited longer than an hour.

On Friday, Bolton NHS Foundation Trust chief officer Andy Ennis told NHS Bolton Clinical Commissioning Group public board meeting: "On Friday January 13, 16 ambulances turned up at A&E and waited an average 45 minutes. I rang the North West Ambulance Service and said we needed some support here. Six out of the 16 were not from Bolton and were brought here either out of patient or ambulance choice."

Mr Ennis reported how the hospital struggled to deal with demand due to the small capacity of the A&E department, increase in patients who needed to be admitted and low discharge rate.

He said the 16 ambulances had arrived at the hospital in the space of 90 minutes, and there were approximately 600 visits from the ambulance service a week.

Mr Ennis said the Royal Bolton had the smallest A&E in Greater Manchester with just 12 trolley spaces available for patients.

"But we are also one of the busiest," he said. "We know there is an issue around ambulance handovers, there shouldn't be a single ambulance which waits more than 30 minutes. We have a number waiting substantially longer than that which has a knock-on effect right through the health service.

"It is critical not just to get the ambulance back on the road, but the longer the patient is on the trolley results in increasing their length of stay in hospital."

Over Christmas 50 per cent of patients brought to hospital did not need admitting, but this has since increased to 70 per cent.

Issues have arisen due to lack of available health care professionals in the community available to assess the patients rather than sending them to hospital for treatment.

The trust has begun working with BARDOC, which runs the out of hours GP service, and the North West Ambulance Service to monitor handover times and demand on the A&E department.

Since December, the waiting times had improved to between 30 and 40 minutes, and the hospital is expanding the A&E ward with an extra five trolley spaces to be opened in March.

However, overcrowding in the hospital continues to be an issue.

Mr Ennis reported that on January 26 there were 67 patients who could have been cared for outside of the hospital but had not been discharged.

He added: "You can have the biggest A&E you like, but it won't work unless you address the flow of patients coming through the doors.

"I suggest by 2020, if we do nothing to address this, we will need 40 extra beds in the hospital."