Measurement, management and elimination of temporary care environments for patients admitted to hospital

Across the NHS, patients are receiving care in spaces that are not designed, staffed or equipped for care delivery such as waiting rooms, corridors, chairs on wards, ambulances outside emergency departments (EDs), and other areas of the hospital not designed for in-patient care. The Royal College of Physicians (RCP) has termed these spaces ‘temporary care environments’ - reflecting a lack of capacity within health and care systems to manage the demand for patients requiring urgent and emergency care.

The RCP is one of many healthcare organisations calling for an end to this unsafe and unacceptable practice that is compromising patient safety and dignity, as well as risking staff burnout/morale. As such, we call on the NHS, the Department of Health and Social Care, and arms-length bodies across the four nations of the UK to:

• formally measure and nationally report the prevalence of care being delivered in temporary care environments all year round
• put systems and processes in place to eliminate corridor care
• support patients and staff when care is delivered in temporary care environments
• adopt a ‘zero tolerance’ approach to this inadequate care.

NHS England’s recent announcement to record data on the use of temporary escalation spaces across all NHS trusts from January 2025 is a welcome step forward. These data must be clearly defined, published as soon as possible, and reported regularly all year round through NHS England monthly performance statistics. These incidents of care are no longer a problem confined to the winter months.

Until appropriate action is taken to eliminate care delivery in these inappropriate spaces, the RCP recognise that clinicians and systems alike need greater support to manage when these incidents occur. As such, the RCP’s statement sets out practical recommendations for hospitals and local healthcare systems, as well as clinicians to manage in these situations.

Hospitals and local healthcare systems should:

• regularly review demand and capacity for in-patient care and assessment.
• develop robust plans to expand in-patient capacity when that capacity is required, using appropriate facilities designed and staffed for in-patient care.
• work with system partners and patients to ensure timely discharge or transfer from the acute hospital when patients are well enough.
• provide operational support to clinicians to ensure timely interventions that maximise patient flow, with a focus on the most vulnerable or unstable patients.

Clinicians should:

• work as multi-professional teams to ensure timely assessment, management and transfer of patients, identifying those most in need of care.
• work with other clinical departments to ensure timely assessment and patient flow, including response to referrals and clinical in reach to other departments e.g. acute medical units and emergency departments.
• prioritise the sickest patients, followed by those who might be discharged and transferred in their regular assessments.
• ensure temporary care environments support patient privacy and dignity if medical photography is required to support rapid virtual review by other clinical departments.
• ensure timely discharge and flow in line with expected discharge and admission times and rates.

Further resources

• RCP Urgent and emergency care winter planning
• Getting It Right First Time (GIRFT) and Society for Acute Medicine Six to help fix: Acute medicine guidance for improving in-hospital flow
• GIRFT and RCP Principles for acute patient care
• GIRFT Further faster: Urgent and emergency care handbook (FutureNHS login required)
• Emergency Care Improvement Support Team (ECIST) resources at https://future.nhs.uk/connect.ti/ECISTnetwork/groupHome (FutureNHS login required)
• Royal College of Emergency Medicine Service design delivery toolkit
• British Geriatrics Society Joining the dots: A blueprint for preventing and managing frailty in older people 
• GIRFT / NHS England indicator tables:
  • Summary Emergency Department Indicator Table (SEDIT)
  • Summary Acute Medicine Indicator Table (SAMIT) and SAMIT 75+ for frailty