Supporting clinicians to manage corridor care

Throughout my career as a physician, treating patients in corridors or temporary spaces has gone from being an exceptional circumstance to commonplace. The testimony of health professionals across the NHS confirms these incidents are now far from rare and at times can be harrowing.

In February, the RCP found that four in five physicians had delivered care in these inappropriate environments in the previous month. The Royal College of Nursing similarly reported earlier in the year that this was the case among over 91% of nurses. I’ve experienced these conditions in my own trust, and many of our early-career doctors have known no other reality.

It is unacceptable and unsafe. These spaces often lack access to appropriate equipment to monitor whether patients’ health is deteriorating, or to medications they need, let alone the loss of privacy and dignity. Clinicians don’t want to provide care in these environments but are forced to through a fundamental mismatch between demand and resource.

Our guidance published at the start of the year aims to support NHS staff and healthcare providers to manage this issue. It sets out recommendations for hospitals and local healthcare systems, as well as clinicians, to improve patient flow and reduce care delivery in temporary environments, with the basic principles that should always be observed for patients admitted to hospital.

Regardless of whether care is being delivered in a permanent or temporary location, clinicians should provide clear and frequent assessment and communication, regular mobilisation, access to toilet facilities as well as food and drink, and knowledge of how the patient can alert staff to their needs. In clinical assessments, the most unwell or vulnerable patients should be prioritised, followed by those who might be discharged and transferred in their regular assessments. The time vulnerable patients are in temporary care environments must be minimised first.

The guidance also recognises the huge toll on healthcare staff from providing care in these environments, with doctors telling us of delays to resuscitate patients in A&E due to trolleys blocking access and patients left in a chair or bed in a corridor for more than 72 hours. We recommend that staff should not continually work in these environments and that regular debriefing as well as emotional support for staff are essential.

Much of the national conversation throughout the winter period has been about ‘Why is this happening?’ As clinicians will know, 2024 saw England record its highest levels of emergency department (ED) attendances and we as healthcare professionals are under extreme pressure to admit patients in a timely manner. Insights from our recent member snapshot survey showed that doctors are often unable to discharge patients, and free up beds, due to a lack of social care capacity. The greater the number of patients unable to leave hospital, despite being medically well enough to do so, the fewer beds there are for patients coming into hospital who are acutely ill. These two issues are converging to cause a lack of flow throughout the hospital, with many providers creating temporary care environments to increase capacity.

While the insights from our members confirm what we already knew to be true – that corridor care is commonplace – we need national system-wide data on this practice so we can understand its full extent and take action to eliminate it. This is why the RCP is calling for the number of people being treated in a temporary care environment to be recorded and published all year round. We welcomed NHS England’s commitment to a one-off publication of this data in the Spring as a welcome step forward, but we continue to believe that this data must be published year-round. Corridor care is no longer confined to the winter months alone. Despite the recent news of NHS England being abolished, it is vital that this commitment to the data still stands, and that it is still published.

This data alone will not fix the corridor care crisis, but it will establish a baseline to see whether improvement measures are working and hold the government to account. The systemic issues causing corridor care will take time to solve.

The RCP will keep calling on the government to:

• Publish year-round data on the incidences of corridor care.
• Set out a plan to address the corridor care crisis in the upcoming urgent and emergency care plan.
• Review which winter preparedness measures have made a difference so far, and which have not, as part of the urgent and emergency care plan.
• Staff and resource social care to be an equal partner to the NHS to enable patients to live as independently as possible and clinicians to discharge patients in a timely manner. 

We hope the RCP’s guidance helps to support clinicians so that patients being cared for in temporary environments have access to the same standard of care that is offered to all patients admitted to hospital. We will continue advocating for the government to take the necessary long-term steps now – including across staffing, bed capacity and preventing ill health in the first place – so that we stop finding ourselves in this situation.