New figures have laid bare the continuing struggle to admit ambulance patients into many hospitals in Wales.
Swansea Bay University Health Board has taken action to speed up unscheduled care admissions but time and time again ambulances are stuck outside.
In June this year there were 721 occasions when it took more than an hour for ambulances to discharge their patients - mainly to Morriston Hospital - compared to 351 in June, 2018.
These figures fluctuate from month to month but the year-on-year comparisons make uncomfortable reading at present considering just how often ambulance crews cannot get away as quickly as they would like.
Paramedics lost the equivalent of 99 days in June while stuck outside the health board's hospitals for more than 15 minutes, which is the target time to offload patients through the front door.
Tracy Myhill, the health board's chief executive, made it clear in May that she wanted to see improvements.
"We have probably got four or five months to get to a significantly better place for the winter," she said.
She was not present at the latest board meeting on July 25 where chief operating officer Chris White said there were signs of progress.
The pressures on our emergency workers:
"There are some green shoots starting to come through but we are not yet where want to be," he said.
A report before the health board said a meeting had taken place involving Mrs Myhill, Welsh Ambulance Service Trust chief executive Jason Killens and chief ambulance services commissioner Stephen Harrhy, and that action was agreed.
And an admissions' review is taking place to see if other hospitals in Swansea Bay and further west can take some of Morriston Hospital's incoming patients.
Aneurin Bevan University Health Board, in south east Wales, had 629 one-hour ambulance handovers in May compared to 239 in May, 2018.
There were 284 one-hour ambulance handovers at Hywel Dda University Health Board last month compared to 158 in June 2018.
And the situation had improved for Betsi Cadwaladr University Health Board in north Wales where the 687 one-hour handovers from June 2018 had come down to 447 last month.
Not all health boards approached by the Local Democracy Reporter Service provided up-to-date figures.
There are many factors which affect the admission, treatment, and discharge of unscheduled care patients, including the complexity and severity of their condition and emergency department attendance numbers.
Another issue is when medically-fit patients are stuck in their beds, for example when there is no package of care waiting for them at home or no care home place available.
There were 172 "bed-blocking" patients on average in Swansea Bay University Health Board's hospitals in June.
Speaking after the July 25 board meeting Mr White said all patients were assessed on arrival but that some less serious cases had to stay in or return to their ambulance.
“We know this can be very distressing for patients and their families but some of the factors which contribute to this are beyond our control," he said.
“So far this summer we have been unusually busy with demand for unscheduled care sometimes exceeding what we experienced in the winter.
“There is no single reason for this. However, we can say that we have seen a large number of acute cases coming in by ambulance and a higher level of walk-in patients than we would normally expect at this time of year.
“Some of these patients need beds for further investigation and treatment.
“But availability of beds throughout the hospital has been and continues to be very challenging due to delayed transfers of care."
Mr White added: "Other long-term patients may find their circumstances have changed while they are in hospital and they are no longer able to return to their former accommodation.
“Some patients may be awaiting a place for rehabilitation or return to a district hospital."
Health board staff, he said, liaised with councils, the Welsh Ambulance Service, and charities to ensure that patients were moved on where appropriate.
Mr White also said alternative care pathways were being discussed with ambulance chiefs to avoid hospital admissions in the first place.
He added: “We can also confirm that during busy periods with ambulances waiting outside, special arrangements are in place in the emergency department to ensure an ambulance can be freed up and dispatched to an emergency call."
