Response to RCN report: On the frontline of the UK’s corridor care crisis (Patient Safety Learning, 17 January 2025)

Summary

On the 16 January 2025, the Royal College of Nursing (RCN) published a new report presenting the findings of a survey of nursing staff outlining the extent of corridor care across the UK. This blog sets out Patient Safety Learning’s response to this report.

Content

In a new report this month, On the frontline of the UK’s corridor care crisis, the RCN have set out in stark terms how corridor care has become normalised in the NHS.[1] [2] Documenting the experiences of more than 5,000 nursing staff, the report reveals the widespread issues of corridor care across the UK. It also highlights from a survey of RCN members that:

• Almost 7 in 10 (66.8%) of those surveyed said they were delivering care in over-crowded or unsuitable places.
• More than 9 in 10 (90.8%) of those surveyed said patient safety is being compromised.

Corridor care can broadly be defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In the RCN survey, when asked what inappropriate settings staff had provided care for patients, the main responses were corridors (62.34%), additional bed or chair in a bay (16.12%) and waiting rooms (5.93%). However, 15.31% of respondents also cited other settings, including bathrooms, cloakrooms, chairs in lounges, store cupboards and ward reception areas.

Implications for patient safety

Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate.

But it is not just the physical environment that’s the challenge, it’s also an indication of an organisation that isn’t coping with the demand and capacity being exceeded, in the emergency department and also on the wards. The overspill into corridors is a reflection of that. It is also highly likely that the organisational infrastructure and clinical support services are struggling to cope—for example, getting diagnostic tests and scans. These will take longer, contributing to delays in clinical review and decision making, which in turn could lead to delays in treatment and care.

The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies.

Corridor care also has a particular negative impact on patient dignity and confidentiality. Reflecting of examples of this in practice, in a blog shared on the hub last year a nurse noted that:

“Often, we need to perform an ECG, which involves removing clothes from the upper body. There is supposed to be a room set aside for this, but it is often occupied by someone else in need—a mental health patient, a family member or a woman who has just miscarried. This task then has to be completed in the corridor. The screens we have do not provide any privacy and this leaves patients feeling exposed, vulnerable and cold.

One other example relating to this lack of dignity happened when a patient’s catheter overflowed because it had not been emptied. He was on a narrow trolley with a thin mattress and had become very wet. I simply couldn’t offer him the personal care he needed. There was not enough space, no privacy and no easily accessible hot water. Once I was able to gain support from staff to help me change the patient he had been laying in wet clothes and sheets for the whole morning—four hours. This is basic nursing care that I was not able to perform."[3]

Working in these conditions also has a significant impact on healthcare professionals too, trying to do their best in less than ideal circumstances that are now a daily occurrence. No-one joins a caring profession to continually deliver sub-optimal care that isn’t safe and this adds to the trauma already experienced by patients. Reflecting this, the RCN report included the following response highlighting the impact on one staff member:

“It was cold room with no natural light or access to toilet or shower facilities near by. Temporary measure for no beds in the hospital. Patients felt undervalued and forgotten about. It was out the way of the main ward and felt unsafe. I escalated these concerns nothing was done. I am now in the process of leaving the NHS due to the pressure and culture after a 10 year nursing career. It is fraying at the seam’s and has left me with mental health problems and trauma.”[1]

Normalisation of corridor care

Thirty years ago corridor care was rare, but it is now so normalised that in September last year NHS England published new guidance setting out principles for providing safe and good quality care in what it describes as ‘temporary escalation spaces’ (TES).[4]

The guidance contradicts itself stating that the delivery of care in temporary escalation spaces is not acceptable, but then goes on to say that the principles have been developed to support staff to provide the safest, most effective and highest quality care possible. Reflecting on this from a frontline NHS perspective, a anonymous blog contributor on the hub highlighted various problems with this position, stating that:

“I am unsure which patients are ‘suitable’ for the corridor. I am not aware of anyone who would like to be cared for in an open space, with no privacy or dignity, with no access to emergency equipment or appropriate staffing.”[5]

This guidance has also drawn national criticism in the form of a position statement issued from the Royal College of Emergency Medicine in December 2024, stating that:

“Advice from arm’s length bodies that appear out of touch with what is happening in our departments was always going to be poorly received. Where such spaces are in use it is inevitable that this will be associated with long waits in Emergency Departments. We know that long waits in Emergency Departments are associated with measurable harm to patients. Care will therefore not be safe.”[6]

Further to this guidance, we are also now seeing corridor care become part of workforce planning, with examples of Trusts specifically recruiting nursing roles specifically to carry out shifts in corridors.[7]

A systemic problem

Corridor care is a complex issue that is the result of a range of systemic problems faced by the health and care sector. The roots of this have been considered in a range of previous articles and reports, and recently in a report by the RCN published last summer, Corridor care: unsafe, undignified, unacceptable.[8] [9] [10] 

Factors contributing to there being insufficient capacity in hospitals that are leading to the  persistence and growth of corridor care include:

• Lack of sustainable investment across the health and care system.
• Infrastructure investment, in both new healthcare facilities and essential maintenance for existing buildings, not keeping pace with service requirements.
• Increasing healthcare demand, with an ageing population living for longer in ill health.
• ·Lack of hospital bed capacity, exacerbated by delayed hospital discharges due to a lack of access to appropriate social care.
• Staff shortages, with demand for health and care services outstripping workforce growth.
• Patients waiting longer for diagnostic tests or elective services and becoming more unwell whilst they wait, which could lead to an increase in demand for emergency care.
• Lack of investment in prevention and public health, with worsening wider population health.

Commenting on the winter pressures faced by the NHS, the Health and Social Care Secretary Wes Streeting MP said in the House of Commons this week:

“I want to be clear, I will never accept or tolerate patients being treated in corridors. It is unsafe, undignified, and I am determined to consign it to the history books.”[11]

There is no quick fix to achieve this. It will require system leaders to get to grips with these issues and, supported by evidence and research, put in place plans to address them. If the Government is to realise its ambition to consign corridor care to the history books, this work must be an integral part of the forthcoming 10-Year Health Plan.[12]

Reporting incidences of corridor care

Patient Safety Learning believes that corridor care should be avoided whenever possible. Even in the context of the ongoing immense pressures being faced by the health service, this should not be normalised. In situations where this is unavoidable, there clearly needs to be guidance and safeguards put in place to minimise risks as far as possible. But we do not think this can ever really be characterised as good quality care, which is far removed from the patient and healthcare professional experience of this.

As we have noted, to eliminate corridor care will ultimately depend on long-term action to address its systemic causes. However, we do think there are actions that can be taken now to better understand and respond to the patient safety problems that this raises.

We support the recent calls by an RCN-led coalition on the UK government to commit to transparency on the true extent of the corridor care. It is important that there is regular reporting of incidents of corridor care, and we agree with their recommendation that:

“Mandatory reporting about incidents of care in inappropriate spaces, including TES, must be implemented by the UK government to NHS England, in partnership with local NHS Trusts. This data should be released publicly on a regular basis alongside A&E attendance and waiting time data, forming part of NHS England’s winter situation report data series and monthly performance statistics release.”[13]

We also welcome the recent NHS England announcement that it will begin to report on the number of patients who receive care within temporary escalation spaces from the 25 January onwards.[8]

Capturing the patient safety consequences of corridor care

While it is important incidences of corridor care are regularly recorded, we also need to better understand the patient safety consequences of this and how organisations are mitigating risks to patients and staff. We believe that the NHS needs to give further consideration as to how incidents of avoidable harm, where corridor care is a contributory factor, are captured.

One aspect of this would be looking at how such incidents can be recorded in the Learn from Patient Safety Events (LfPSE) service. LfPSE is the national NHS service for the recording and analysis of patient safety events that occur in healthcare. Trusts can currently see reports of their own data in this, but it would be beneficial if they could also access system-wide findings from this on issues such as corridor care to help them assess risk or engage with others. Consideration also needs to be given to the ease at which staff are be able to record incidents of near misses and incidents in corridor care. If this is an increasingly frequent occurrence, this may become difficult to manage in addition to providing patient care in an overstretched healthcare setting.

We also believe that NHS England should look at how learning and recommendations from investigations related to corridor care at individual healthcare providers under the Patient Safety Incident Response Framework are shared widely for national improvement. If patients’ safety has been compromised by being cared for in unsuitable environments, this must be captured and shared for learning.

We believe that organisations should share how they are mitigating the risks to patient and staff safety. NHS England’s guidance suggests that patient safety considerations should be imperative when using temporary escalation spaces. It states that:

“Local patient safety checklists should be used to ensure the patient is safe to be cared for in this setting. This should include an inclusion and exclusion checklist.”[4]

However, it is not immediately clear what checklists this is referring to, with a localised approach meaning this could vary from organisation to organisation. There does not currently appear to be much evidence on how organisations are responding to this guidance, or shared examples of where this has been implemented well that could be used by others.

Further to this, to ensure we are capturing and acting on the patient safety consequences of corridor care, it is important that:

• Patients, families and carers are invited to and feel able to feedback about their experiences, both at a local and national level, to inform learning and improvement.
• Frontline staff are supported and feel able to report patient safety concerns around corridor care. This requires a wider organisational culture that enables speaking up and demonstrates that the organisation listens to and acts on the findings of incident reports.
• Healthcare managers need to maintain a focus on ensuring patient safety issues relating to corridor care are consistently identified and acted on, despite the enormous pressures the system faces.
• Organisational leaders should maintain a credible and meaningful focus on patient safety as a priority agenda item internally and externally to create the culture and landscape for solutions to be identified and implemented.

However, the above points can only be realised if system leaders, from Integrated Care Boards up to the Department of Health and Social Care, buy into this. This requires honesty and transparency about the scale of corridor care and a commitment to work collaboratively to share practices to minimise the patient safety risks it creates.

Share your views and experiences with us

We would welcome your views on the patient safety concerns raised in this blog.

Are you a patient, or a friend or family member of a patient, who has experienced corridor care? Or perhaps a healthcare professional who has experience of delivering corridor care and would like to share your story?

You can share your views and experiences with us directly by emailing [email protected].

References

1. Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025.
2. Royal College of Nursing. Corridor care: ‘Devastating testimony’ shows patients are coming to harm, 16 January 2025.
3. Anonymous. A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift, Patient Safety Learning, 22 February 2024.
4. NHS England. Principles for providing safe and good quality care in temporary escalation spaces, 16 September 2024.
5. Anonymous. A nurse’s response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces, Patient Safety Learning, 20 September 2024.
6. Royal College of Emergency Medicine. RCEM Position Statement on NHS guidance ‘Principles for providing safe and good quality care in temporary escalation spaces’, 16 December 2024.
7. Lintern S, Wheeler C. Hospital advertises for ‘corridor care’ nurses to ease NHS crisis. The Times, 11 January 2025.
8. Hadden C, Tse J. Corridor care: unsafe, undignified, unacceptable. Royal College of Nursing, 3 June 2024.
9. Wilson H. We shouldn’t get comfortable with corridor ‘care’. The Health Foundation, 14 February 2024.
10. Royal College of Emergency Medicine. The management of emergency department crowding, January 2024.
11. Department of Health and Social Care. Oral statement to Parliament – Health and Social Care Secretary’s statement: winter 2025, 15 January 2025.
12. Department of Health and Social Care. Change NHS: help build a health service fit for the future, 18 November 2024.
13. Royal College of Nursing. Corridor care: RCN-led coalition demands transparency and mandatory reporting, 13 January 2024