Patients going to accident and emergency departments in winter brace themselves for the worst. They expect to wait for care, and understand when the two

or three-hour delay for the doctor's time stretches into four or five hours.

But that's winter. A season which brings exhausting complications for the NHS, with 'flu outbreaks and broken bones from slips and falls.

But yesterday the Argus revealed hospitals in Sussex were facing the same kinds of pressures which stretched them in winter - now, in mid-summer.

NHS specialists say they are puzzled why the increase has occurred at this time of year.

What they do know is the lack of nursing and residential care home places in the community, where patients can go once their treatment has finished, is almost the worst they have seen it.

Limited care home places has a knock-on effect across a hospital. If there are no free beds in the hospital itself because they are taken up by people waiting to be discharged, patients coming through accident and emergency have to wait longer for admission.

And people waiting for a care home place find themselves at risk of a relapse or infections, sometimes becoming sicker instead of better.

Brighton Health Care NHS Trust, which runs four hospitals, has acknowledged its patients have been facing "horrendous" waits in accident and emergency.

In Eastbourne and Worthing hospitals are also running to full capacity. For the NHS, there seems to have been little respite since the winter months subsided.

Perhaps now, more than ever, the NHS and social services are determined to work together to ease the all-round impact of a lack of nursing and residential accommodation.

Brighton Health Care chief executive Stuart Welling said: "This is a collective problem through all the agencies. We have to find a way around this and we have got to resolve it."

This week the Government unveiled its National Plan for the NHS, hailed as the greatest step forward since the system was introduced in 1948.

The Government pledged a £900 million investment in intermediate care (accommodation between hospitals and people's homes) and new trusts to bring health and social services together.

Alan Randall, chief executive of Eastbourne Hospitals NHS Trust, said his organisation now paid social services to help provide some care home accommodation for the first four weeks after patients were discharged.

"We are seeing more or less the equivalent of one ward lost because of delayed discharges. The answer is to fund more alternatives to admissions and half-way accommodation for patients who are recovering but are not yet ready to go home."

The National Plan says: "In future, older people must not be left to find their own way around the system or left in a hospital bed when rehabilitation or supported care is what they need. They must receive the right care at the right time in the right place."

Changes will include rapid-response teams of nurses, social workers, therapists and GPs providing emergency care for people at home and preventing unnecessary hospital admissions. But Robyn Clayton, director of Age Concern in West Sussex, is dubious about promises of cash injections and a new era of care for older patients.

She said: "This battle has been going on for 30 years. The problem is not the lack of beds. It's the lack of funds."

Trevor Richards, chief officer of community health councils representing Worthing and Mid Sussex, said improvements in medical procedures meant there were now more people being cared for in the system.

"These things take a long time to set up. And my guess is it will be a long time before we see the benefits of changes."

Brighton and Hove Council's social care budgets are under grave financial pressure. The council predicts it will be £1.6 million overspent in community care by the end of the financial year.

Ian Long, assistant director for adult services, said there were still general staff shortages. He said there was a need to get better at getting into schools and promoting the care industry as a career.

He added: "Closer work between the NHS and Social Services is about making the best use of scarce resources."