The latest HSSIB report finds that corridor care has become normalised. The healthcare sector is frustrated and worries that it undermines public trust in the health service.
Temporary care environments, commonly referred to as “corridor care”, are being used across NHS trusts, and there are widespread concerns about normalising their use and the impact on patients and staff.
A report from the Health Services Safety Investigations Body (HSSIB) urges healthcare leaders and NHS Trusts to understand and manage the risks temporary care environments may present to patient safety.
“Until there is a solution to the complex underlying issues related to patient flow, we must recognise that hospitals may have no choice but to use temporary care environments,” said HSSIB senior safety investigator Saskia Fursland.
“By working together with a shared understanding, healthcare leaders and NHS trusts can better understand the use of temporary care environments and their impact on patient safety in a consistent way and systematically address the risks to patient safety,” she added.
The issue of corridor care is a political hot potato that much of the healthcare sector believes is not being taken seriously enough.
As Healthcare Today has repeatedly written, not only is the issue not being alleviated, new corridor care guidance published by NHS England has been criticised. The impact of the issue is being mitigated rather than eliminated.
No seasonal variation
Temporary care environments are spaces not originally designed, staffed or equipped for patient care, such as waiting rooms, corridors, chairs on wards, ambulances outside emergency departments and other hospital areas not designed for inpatient care. They are used when demand exceeds capacity, in an attempt to balance risks across the patient care pathway.
These decisions often compromise the standard and quality of care delivered, which affects patients’ experiences, including the provision of dignity and respect.
The HSSIB points out that it is getting worse rather than better. Over the past few years, demand has usually peaked during the colder months when the NHS experiences winter pressures. Its investigation, however, visited 13 hospitals and had insights from four other hospitals, from August to December last year.
They were all experiencing issues with patient flow, showing there is no longer significant seasonal variation.
The report calls for the adoption of a nationally agreed definition of temporary care environments as well as improved understanding of how and when temporary care environments are used in NHS hospitals. In the absence of an agreed definition and improved data collection of the use of temporary care environments, there is a limited understanding of the safety risks and impact on patients, it concludes.
“We must end the need to use corridors or other temporary spaces. More beds may be the obvious answer, but before saying this is the only solution, we must make reality the desired shift to looking after more people in the community – at or close to home – and prevent as many hospital admissions as possible,” said Daniel Elkeles, chief executive of NHS Providers.
Resigned frustration
The response to the report from the sector has been one of resigned frustration.
“This report is the latest damning evidence of how normalised corridor care has become in emergency departments across the country,” said BMA consultants committee emergency care lead Den Langhor.
“What’s particularly disheartening is how accepted it has become – spelled out in this report that it’s often seen by staff as the ‘least worst’ option. Doctors and their colleagues time and time again prove how innovative and flexible they are in the face of huge challenges, but there is only so much that individual hospitals and staff can do to adapt to keep patients safe,” he added.
His view was echoed by Royal College of Nursing chief nursing officer Lynn Woolsey. “A national safety investigator finding that corridor care is no longer an exception but entirely normalised and all year round is a damning indictment. It means every day vulnerable people are being treated in unsafe and undignified conditions,” she said.
The Health Foundation’s assistant director of policy, Tim Gardner, pointed out that trolley waits in A&E – one measure of the problems in emergency care – are set to have hit record levels last year, with more than 500,000 patients having already waited more than 12 hours for admission to a hospital bed. “Such delays were uncommon before the pandemic, but are now the worst since record-keeping started in 2011. They reflect an NHS exhausted by the pandemic and a decade of underfunding before that,” he said.
And the longer the issue remains, the greater the problems.
“Corridor care risks fundamentally undermining the public’s trust in the health service. We must address issues with patient flow, capacity and take action to reduce the number of people becoming sick enough to need emergency admission in the first place,” said Hilary Williams, clinical vice president at the Royal College of Physicians.
