‘Unsafe and undignified’: RCP describes ‘chaos’ of corridor care and calls for action to alleviate pressure on the hospital front door

In December 2024, emergency department (ED) attendances in England reached 2.3 million. Many of the 54,207 patients waiting longer than 12 hours following a decision to admit in December – the third highest recorded number of patients with waits of this kind - will have received care in temporary environments, such as corridors or chairs.

This is slowing down patient flow through the hospital and having a growing impact on waiting times for planned care. It is predominantly affecting some of the most vulnerable people in society, exacerbating health inequalities and leading to worse patient outcomes. 

RCP clinical vice president Dr John Dean said:

‘Physicians tell us that they are being asked to provide more and more care in corridors and in other temporary environments, such as treating additional patients on wards, over and above agreed numbers. This is unacceptable and must end.

‘As an immediate priority, the NHS must begin publishing data on the number of patients who are receiving care in temporary environments. Later this month, the RCP will publish new guidance to support NHS staff on the management and elimination of temporary care environments for patients admitted to hospital.

‘With just 59.1% of patients being seen within 18 weeks, realistic expectations need to be set to ensure that doctors do not face further burnout in trying to restore this target. Critically, a focus on this standard must not mean that other needed reforms are overlooked. The forthcoming NHS 10-Year Health Plan must take the opportunity to radically transform the way we work: we will only improve performance, outcomes and patient experience with a far more integrated approach to health and care, and the structural reform of outpatient care.

‘More broadly, the NHS should review which winter preparedness measures have made a difference so far – and which have not. The NHS England urgent and emergency care recovery plan has invested over £1 billion in the system – we need to understand what works and what doesn’t, so that we never find ourselves in this situation again.’

The RCP’s 2024 Modern outpatient care guide sets out practical principles for efficient and effective outpatient care and includes template recommendations to support clinical teams.

Crucially, the number of patients staying 14 days or more in hospital because there was not adequate community-based capacity available last month reached 10,979. The greater the number of patients unable to leave hospital, despite being medically well enough to do so, the fewer beds there are for new hospital admissions for new patients coming in who are acutely ill.[1]

Dr Ben Chadwick, RCP regional adviser for Wessex, said:

‘As physicians, we are caring for huge numbers of patients who are staying in surgical and orthopaedic beds because the medical wards are all full. This makes the whole system less efficient – patients stay in hospital for longer, which contributes to longer waiting times in the ED while we try and create capacity within the hospital. This is a recurring theme every year, but this year feels more pressured than previously.’

Dr Mashkur Khan, RCP regional adviser for south London, said:

‘We have patients who are boarding on our wards.[2] Our physiotherapy gym has now been taken over for extra bed spaces and the corridors are full to the brim. Patients are often managed in chairs all day and all night.’

Dr Jacob de Wolff, RCP regional adviser for north west London, said: 

‘It is not uncommon to arrive at 8am in the ED to be greeted by a corridor full of trolleys. Some of these patients will have spent the night there, in bright lights and with no easy access to a bathroom. Even those lucky enough to have their own cubicle will still have had poor and unrefreshing sleep.’

Dr Dean added that, in the longer term, the UK government must recognise social care as an equal partner to the NHS in delivering patient-centred services.

‘This means parity in status, staffing levels, governance and funding, to ensure that health and social care teams can work together effectively and sustainably. Social care roles must be made attractive and competitive through targeted investment – a well-staffed social care system will help to reduce hospital admissions, enhance patient flow and speed up the transfer of care from hospital to community.

‘We are concerned that the timelines for the recently announced independent commission on adult social care are not sufficiently urgent. Patients, their families and the NHS cannot wait another 3 years for much-needed improvement and change. If we want to fix the problems set out in Lord Darzi's report, it is paramount that social care reform takes place at the same time.’

The RCP’s 2023 guidance, Physicians and social care professionals: working together, highlights the importance of effective collaboration between physicians and social care professionals.

In Wales, the cabinet secretary for health and social care told the Senedd this week that seasonal illnesses have placed a significant demand on the NHS, most visibly on the Welsh Ambulance Service, and that the complexity of triaging, assessing and discharging people with acute respiratory infections in critical care and EDs has contributed to longer waiting times for admission, resulting in congested wards and EDs, and in longer ambulance handover delays.

RCP vice president for Wales Dr Hilary Williams said:

‘Patients waiting in corridors is unsafe and undignified. We are in a vicious unproductive circle. The current chaos means that we default to admission and the cycle of crisis continues. Every hour that an older person spends lying on a trolley or sitting in a chair prolongs their stay in hospital. Continuity of care is lost.’  

Dr Sacha Moore, RCP Resident Doctor Committee representative for Wales, said:

‘The past fortnight has been particularly challenging. Far too many patients are being treated in inappropriate settings – many medical patients are staying on a non-medical ward, making continuity of care far more challenging, and ultimately slowing down our ability to get people home. We simply don’t have enough doctors.’[3]

In Northern Ireland, there are intense pressures facing hospitals and ambulance services, with a reported 500 patients unable to be discharged from NI hospitals on Sunday night due to a lack of care packages. The Department of Health said that long-term solutions are needed, including sustained investment and reform of the health sector.

Dr Aidan O’Neill, RCP lead fellow for Northern Ireland, said:

‘As a consultant physician working in acute medicine, my main focus is the care of patients in the very early days of a hospital admission. But instead of spending time on our acute medical unit, the majority of my time is spent in ED side rooms, corridors and waiting rooms. Too many patients, often frail and confused, are examined behind screens that offer little privacy, and even find it difficult to know what time of the day it is, given the lack of windows and natural light. Northern Ireland is already lagging behind the rest of the UK when it comes to our waiting lists and staffing levels; the current flu season and winter pressures have only served to exacerbate a problem which has been present for many years.’