Sheila is the 120th emergency patient to be seen by the Royal Preston Hospital in a day.

And it is only two o'clock in the afternoon.

She has ongoing issues with her spine and needs chronic pain management.

Not far from Sheila is Muriel Hargreaves. Muriel tells me she is 88 and a half years old.

The half she says is important. Muriel has been admitted to hospital with high blood pressure. It is giving her problems with her heart.

She says: "It's a certain problem that I'm having with my heart. They've not named it yet because they've not come to a final conclusion.

"But they're doing everything possible to get to the bottom before…before I go home."

Muriel has been here for more than 24 hours. She should be in a bed on a ward but there is no space.

That means all the investigations to find out what is wrong with her have to be carried out in the emergency department.

It is not ideal but it is the only way to make sure she receives the same care and treatment.

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Samantha Wright is the emergency department nurse who is looking after Muriel.

'Not missing out on care'

She tells me: "She's not missing out on any care at all. Normally, the investigations that are carried out on the ward, ie the speciality that she's under, would normally review her on the ward and put a plan in place.

"But unfortunately due to there being no beds in medicine which Muriel requires at the moment... all those investigations have happened here in the emergency department."

Andy Curran is a consultant in emergency medicine and he began his career here at the Royal Preston Hospital 25 years ago.

One of the most challenging winters

In that time he has seen many difficult winters. But this is one of his most challenging.

"Each time that we think things can't get any harder they seem to do, and the patients that have been coming through have been coming through in increasing numbers," he said.

Mr Curran told me the patients who were coming in were much sicker because they had delayed treatment.

These patients, he said, were "going up and up".

Eleven-year-old Katrina Ward is typical of the patients who are presenting later. She has suspected appendicitis and has been in pain for the last month.

She came into hospital when she fell sick at school this morning.

"I was going to school," Katrina said. "But it was already painful before I went, it was just like a normal morning, and I got to school and it got really painful so I decided to call my mum."

Plans for extra hospital capacity

On the hospital grounds, construction for one of the regional Nightingale surge hubs is continuing.

It will provide extra capacity in case of a surge in Omicron admissions.

That surge did not materialise in numbers that could overwhelm the NHS and the prime minister has lifted Plan B restrictions because of the falling COVID infections.

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Kevin McGee, chief executive of the trust which manages the Royal Preston Hospital, says the hub is an important safety net should there be another wave.

"The Nightingale surgery if we don't use that, I would say that is success, it's a facility should it be needed. It's an insurance policy, and it's the right thing to do. So we are planning for the worst, but clearly hoping for the best."

Planning for a pandemic-resistant future makes sense but for patients like Muriel the present matters just as much.