Elderly patients were left in the cold on ambulance trolleys and others had their dignity affected due to the "extreme pressure" on a hospital.

Health inspectors carried out an unannounced visit to Crosshouse Hospital, in Kilmarnock, East Ayrshire, to examine the quality and effectiveness of elderly care at the hospital.

A total of 14 areas of improvement have been outlined for NHS Ayrshire and Arran (NHSAA) act on after the publication of the damning report.

The hospital and its staff are being placed under "extreme pressure" due to the number of patients and as a result this has had a direct impact on all aspects of care, according to the report.

Inspectors observed one patient on a trolley next to the nursing station in the admissions unit as there were no cubicles or rooms available in the department.

Two frail patients, one of whom had dementia, were also left on ambulance trolleys in the reception area of the combined assessment unit waiting to be admitted.

The report stated the area was cold and patients had to be provided with blankets by the ambulance crews.

It added: "We were told that staff are frustrated at not being able to deliver the care that they would like due to capacity and flow issues within the hospital."

Some patients were cared for in single rooms or single sex bays with en suite facilities but because of capacity issues other were also being cared for in treatment rooms and relatives' rooms.

In the treatment rooms there was access to buzzers, oxygen and other medical equipment but there were no toilet or shower facilities in the rooms.

This meant patients had to use the nearest bathroom, which was already allocated to six other patients.

It also emerged relatives' rooms used as extra patient rooms within wards had not been risk assessed for or properly equipped with oxygen, other medical equipment or patient buzzers.

The report said: "This raises safety, and dignity and respect issues. Additionally, the risk assessments for these rooms had been in place since 2014.

"We asked for the risk assessment to be updated and submitted to us; we received a copy of this following our inspection.

"The combined assessment unit was under extreme pressure due to the volume of admissions on the first day of inspection."

It added: "These pressures have also had an impact on the quality of documentation as staff do not always have time to complete it.

"A senior charge nurse stated that she felt there was good team working, although staff often worked late and missed meal breaks.

"Whilst we do not underestimate the significant operational issues affecting the hospital, NHS Ayrshire and Arran has a duty to maintain the safety, and dignity and respect of those patients under its care."

Claire Sweeney, interim director of quality assurance for Healthcare Improvement Scotland, said: "During our inspection we observed many positive interactions between staff and patients.

"However, throughout the inspection it became clear that the hospital was under extreme pressure from the number of patients and that this has had a direct effect on all aspects of care that we observed.

"While we do not underestimate the significant operational issues affecting the hospital, NHS Ayrshire & Arran has a duty to ensure that the care provided to patients under its care is appropriate."

NHSAA nurse director professor Hazel Borland said the organisation is "committed to the provision of high standards" to ensure patients receive safe and dignified care.

She added: "Our teams have a strong focus on ensuring that improvements are made to deliver the best possible care across health and social care services.

"Many areas highlighted by the visiting team were part of our ongoing improvement work and this has been reflected in our action plan.

"We are pleased that the inspection team observed and have reflected the positive feedback received from patients and carers about the standard of care, respect, dignity and compassion they were experiencing during their time in University Hospital Crosshouse."