Queen's Hospital A&E is the "number one risk" facing the trust that runs it, its chief executive has said.
The Romford site's emergency department has seen record demand in recent months, with a lack of space meaning patients are increasingly being cared for in the corridors.
Matthew Trainer, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) chief executive, told this paper it is the "number one risk" out of the biggest issues facing the trust.
It has left the "eldest and most vulnerable patients facing the longest waits".
Mr Trainer said: "The A&E here is probably the worst designed one I've been in.
"I used to work for the CQC [Care Quality Commission] so I inspected a lot of A&Es, and the Queen's one is particularly poorly designed and particularly crowded.
"NHS England have been to see the A&E here a number of times in the last few years, and they recognise that it's too small and too cramped."
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Although Mr Trainer acknowledged that "everywhere is busier than it used to be", he believes that an increase in population in Havering, the lasting impacts of Covid and a "very tough winter" have compounded to create the intense demand Queen's is now seeing.
An increase in flu and respiratory illnesses in December and January contributed to this, as well as residents not being able to access their GPs as easily as they once could.
"Havering's got the lowest number of GPs per head of population in London, and all of the GPs we have got are seeing more patients than they ever have," Mr Trainer said.
"People still struggle to see their GP or get help outside of hospital so they end up here."
Queen's emergency department has also experienced an "increase in recent years in people coming in because of social problems", according to the chief executive.
While you might not expect people to attend A&E with housing problems, or loneliness, it is something that Queen's staff have reported, particularly over the festive period.
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Mr Trainer said: "What we've certainly in the last few years is more people coming in for reasons that are not just to do with their physical health.
"More mental health, more social issues, more issues with housing.
"Talking to some of our staff over Christmas, they said they saw a lot of people who were very lonely - elderly people living on their own.
"When the weather's been really cold, we had on one night eight homeless people in the atrium [main entrance] who had come in just to get warm," he added.
"And they came in night after night. It was freezing, actually."
These issues have an impact on the hospital beyond bringing more people into A&E, with BHRUT equally coming up against more social problems when sending patients home who are medically fit in order to free up beds for those who need them most.
Homelessness has become "more of an issue" when discharging patients, as has getting the right care package arranged with social care providers.
Despite this, Mr Trainer said the trust is making the "best of a bad situation" - working with Havering Council on the social issues and employing extra nurses and support workers to care for patients in corridors.
He called A&E staff a "fantastic bunch", who work "incredibly hard in some very difficult circumstances".
But the crowding means they often "can't do the job they would like to", and Mr Trainer believes the solution is securing £35 million in funding to provide more space in the department.
"I think it's important that the public knows [why the investment is needed] and our MPs have all been very supportive," he said.
"I don't want to feel like we haven't done enough to try to get that investment."
