Bed-blocking in Birmingham is at crisis levels with 'the equivalent of a hospital full' of people awaiting discharge, and work towards achieving NHS plan targets badly hit.
The scale of Birmingham's problems was revealed just before the government's announcement of£250m social care funding to help manage winter pressures across England.
The Commission for Health Improvement has also highlighted the 'severe pressure' on the city's social care arrangements in its report on Birmingham Heartlands and Solihull trust, which it said was the dominating factor in its review. The pressure is felt by staff who cannot attend training and by patients enduring long waits in accident and emergency because of bed shortages.
Around 350 people are currently awaiting discharge from the city's hospitals, a Birmingham health authority spokesperson confirmed, with the figure 'rising each month'. 'The knock-on effect is that We are adrift on waiting targets and that sort of thing.'
Nearly£7m, mostly from social services, was injected during the summer to try to resolve the crisis - when delayed discharges reached 400. The council and the NHS each put in a further£400,000 in September.
Council leader Albert Bore last week wrote to health minister Jacqui Smith warning that it was 'not in a financially robust position to meet any unplanned expenditure' on winter pressures.
But as the government announced that new social care cash would be channelled direct to social services departments, a senior NHS source attacked Birmingham social services for ignoring the effects of its budget decisions on the NHS.
'Social services didn't put enough money in. They put in what they could afford rather than what was needed. They didn't think what the consequences were. They looked at the city council budget in isolation, not at the implications on the NHS.'
Birmingham Heartlands and Solihull trust chief executive Mark Goldman said there were around 100 people waiting for discharge at his trust, 'possibly more'.
'We are trying not to turn this into an embattled position between health and social services, ' he said.
The trust is implementing a series of measures to try to cope, including demand management, shortening lengths of stay and collaboration with primary care over step-down facilities.
The problem 'never really went away' despite a dip after the summer cash injection, Mr Goldman said. 'Calculations differed according to who provided the figures, on whether it was going to be enough to deal with the number of patients accumulating and the backlog as well.'
Another senior NHS manager said: 'We have got the equivalent of a hospital full of delayed discharges.
The current situation can't continue without significantly damaging performance against the NHS plan. In England's second city, that would be a tragedy.'
The solution was to create 'better rehabilitation and community care facilities' for older people, he said.
A Birmingham city council spokesperson said not all the delays were due to lack of care funding: 'A couple of weeks ago, there were 300 people awaiting discharge from hospital.Of those, about 180 were waiting for social services care packages. The rest are for all sorts of different reasons.'
The city council had set a social services budget 7 per cent bigger than its standard spending assessment, but was still heading for a£4.3m deficit, he said.
Though social services deficits and bed-blocking were problems across the country, he said 'Birmingham is the biggest local authority - if There is ever an issue, then Birmingham's got it bigger'.