The shocking state of the National Health Service

One interim manager at Dudley's Russells Hall Hospital is being paid as much as £36,000 a month.

Wolverhampton's New Cross Hospital's A&E revamp is going to cost an extra £8 million.

• The same hospital is being fined £180,000 for missing the target for seeing people within four hours.

• Nearly 800 patients in one week were left waiting up to 12 hours to be admitted to A&E in hospitals across the region, many languishing on trolleys.

• A hospital in Stoke has been is using Portakabins as demand surges after the downgrade of scandal-hit Stafford Hospital.

• A 12-hour strike is looming next Thursday as paramedics and other NHS workers walk out in a row over pay.[/breakout]

Across the West Midlands, hospitals are creaking at the seams as demand for accident and emergency care soars.

But bureaucracy and staggering costs are putting the NHS under even greater strain.

In Dudley up to 400 jobs are being axed at the trust that run's Russell's Hall Hospital.

But the Dudley Group of Hospitals is employing an interim operations director, whose management company is being paid between £28,000 and £36,000 each month for his services. Jon Scott is being credited with helping the hospital be one of only a few in the country to meet its four-hour target for seeing people at A&E.

The trust's chief executive, Paula Clark, said the hospital had tried to recruit a full-time operations director but was unable to do so because of a 'national shortage' of people qualified for the post.

Meanwhile, the cost of a new unit at New Cross Hospital has risen £8m to £38m to put in extra space for patients. But in another development, the hospital has now been fined £180,000 for failing to see enough patients within four hours with its chief executive David Loughton warning it was the worst situation he had ever seen.

Figures last night also revealed 779 people waited between four and 12 hours when they went to A&E in the Black Country, Staffordshire, Birmingham and Worcestershire in the week ending January 11.

Although they are dubbed 'trolley waits', bosses said not all patients would have been on trolleys as some would have been able to move around.

The worst in the Black Country was Wolverhampton's New Cross Hospital where 218 patients waited more than four hours. But there were dozens recorded at many other hospitals as well. Elsewhere, patients from scandal-hit Stafford Hospital are now being treated in Stoke, Walsall and Wolverhampton following a costly downgrade.

But demand at Royal Stoke University Hospital is now so high it has had to do a £13.5 million deal with Portakabin to build two new wards with 56 beds and two theatres in record time.

The temporary building company is charged with completing the work within four months to meet 'increasing demand for services' according to the hospital.

And, as the service battles huge winter demand, paramedics and hospital workers will walk out for 12 hours on Thursday at hospitals including Walsall Manor, Sandwell General and New Cross in a strike over pay. The Government is refusing to implement a one per cent pay rise across the board. Negotiations between the Government and trade unions will not resume until Monday.

This week's waiting times are showing an improvement but the NHS is still below its own target of seeing 95 per cent of A&E patients within four hours.

Shadow health secretary Andy Burnham said: "These figures show that hospitals all over England remain at their limits and are sailing dangerously close to the wind."