Search the hub

In a blog earlier this year, Patient Safety Learning’s Associate Director Claire Cox looked at how corridor care within the NHS is affecting safety culture and examined its implications for both healthcare professionals and patients. In this new blog, she turns her attention to the associated health and safety risks, questioning whether these are being properly addressed. Claire draws out key areas for consideration and suggests practical measures that can help protect patient safety in such challenging working environments.  In recent years, corridor care has become an unfortunate reality in many NHS hospitals across the UK. With hospitals operating over capacity, patients are often treated in corridors due to a lack of available beds. While this practice may provide temporary relief in overcrowded healthcare settings, it also introduces significant health and safety risks for patients, staff and visitors. What is corridor care? Corridor care is a term used to describe the practice of providing medical attention to patients in hallways or other non-designated clinical areas due to overcrowding or resource shortages. This is typically due to emergency departments being overwhelmed or a shortage of inpatient beds. Corridor care is no longer an exception—it has become the norm in many hospitals. A new report published in January by the Royal College of Nursing illustrated the prevalence of this, sharing the experiences of more than 5,000 nursing staff on corridor care in the UK.[1] [2] In February, the Royal College of Physicians published a snap survey of its members highlighting the prevalence of corridor care, with 78% of respondents having provided care in a temporary environment in the previous month.[3] Key health and safety risks of corridor care When speaking about the impact of corridor care, understandably our initial focus tends to be on its direct impact on the care of the patient and the staff member providing that care. However, a somewhat overlooked aspect of this is how it can impact on the wider health and safety of those working in, or using, healthcare facilities. This can manifest itself in a number of different ways: Infection control risks Corridors lack the necessary infection control measures—for example, hand washing facilities and appropriate waste disposal, including sharps—which increases the risk of hospital-acquired infections, such as MRSA and Clostridium difficile.[4] The inability to maintain appropriate isolation for infectious patients poses a serious public health concern.[5] Delayed emergency response Corridors are not equipped for life-saving interventions in emergencies. Delayed access to equipment, medication and clinical teams in a corridor setting can increase mortality and morbidity.[6] A lack of emergency call bell alarms may incur delays in receiving appropriate emergency help. Swift transfer of unwell patients is often made challenging due to obstacles obstructing a usually clear path. Emergency teams may find it difficult to locate the unwell patient in a corridor as there may be numerous ‘temporary escalation’ areas within the department. Obstruction and fire safety hazards Corridors crowded with trolleys, equipment and patients create obstructions that can impede fire evacuation routes. Fire doors may be left open to accommodate trolleys, compromising compartmentalisation and increasing the spread of fire and smoke. NHS Trusts are legally required under the Regulatory Reform (Fire Safety) Order 2005 to ensure that escape routes remain unobstructed, which is often compromised by corridor care.[7] The London Fire Brigade recently highlighted these issues with their local hospitals, citing concerns about obstruction of fire escape routes, increased fire load in circulation spaces and delayed evacuation times in the event of an emergency.[8] Manual handling and staff safety Healthcare staff face increased manual handling risks while manoeuvring equipment and providing care in narrow corridors. This can lead to musculoskeletal disorders and workplace injuries, further exacerbating staff shortages.[9] The question is, are these risks being addressed? Risk assessments: A key to mitigation While some NHS Trusts have implemented risk assessment templates for corridor care, these are not yet standardised across the system. The Health and Safety Executive (HSE) recommends that risk assessments for corridor care include: infection control protocols fire safety compliance manual handling risk reduction patient privacy and dignity measures emergency response protocols.[9] What about fire safety? Fire safety is one of the most pressing concerns associated with corridor care. Under the Regulatory Reform (Fire Safety) Order 2005, NHS Trusts are required to ensure that: Escape routes remain clear at all times. Adequate fire risk assessments are conducted and updated regularly. Staff are trained in evacuation procedures, especially in high-risk areas like corridors.[7] Are Trusts compliant? While most Trusts have fire risk assessments in place, reports from the Care Quality Commission (CQC) indicate that compliance varies across the country. Some hospitals have been flagged for failing to adequately mitigate the fire risks associated with corridor care.[10] What measures can we take to protect patient safety? The below points offer some practical health and safety measures that can be put in place to help reduce risk: Fire risk management: Regular audits to ensure corridors are not overcrowded and escape routes remain clear. Patient identification and monitoring: Implementing digital systems to track patient location and their condition when placed in corridors. Enhanced infection control: Providing hand hygiene stations and maintaining isolation protocols even in corridor settings. Staff training and awareness: Ensuring staff are trained in dynamic risk assessments and evacuation procedures. Establishing escalation protocols: Creating clear guidelines on when to escalate corridor care situations to prevent patient harm. The need for systemic change Corridor care is a symptom of a healthcare system under immense pressure. While temporary risk mitigation measures can improve safety, long-term solutions require increased capacity, better resource allocation and investment in community-based care to prevent unnecessary admissions. If the current trend continues, addressing health and safety risks associated with corridor care must become a top priority to protect both patients and healthcare staff. Call to action Do you work in healthcare or health and safety? Your expertise can make a real difference! Share your corridor care risk assessments with Patient Safety Learning to help identify risks, prevent harm and improve outcomes for patients. Comment below (sign up first for free) or email [email protected]. References Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Patient Safety Learning. Response to RCN report: On the frontline of the UK’s corridor care crisis, 17 January 2025. Royal College of Physicians. Doctors confirm ‘corridor care’ crisis as 80% forced to treat patients in unsafe spaces, 26 February 2025. National Institute for Health and Care Excellence (NICE). Infection Prevention and Control Quality Standard, 2014. London: NICE. Public Health England. Guidelines on Infection Prevention and Control, 2019. London: PHE. Royal College of Emergency Medicine (RCEM), 2021. Crowding and its Consequences: Policy Brief. London: RCEM. HM Government, 2005. The Regulatory Reform (Fire Safety) Order 2005. London: The Stationery Office. London Fire Brigade. Letter to Trusts to review your Fire Risk Assessments, 17 February 2025. Health and Safety Executive (HSE). Manual Handling Operations Regulations 1992 (as amended), September 2016. London: HSE. Care Quality Commission (CQC). State of Care Report, September 2021. London: CQC. Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox The crisis of corridor care in the NHS: patient safety concerns and incident reporting Response to RCN report: On the frontline of the UK’s corridor care crisis A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift

Overcrowding in hospitals is forcing healthcare professionals to provide care in corridors, waiting rooms, and other unsuitable spaces, compromising patient safety, dignity, and clinical effectiveness. A recent Royal College of Physicians (RCP) survey found that 78% of doctors had delivered care in temporary environments in the past month, with 90% reporting compromised patient privacy, 81% facing physical difficulties, and 75% lacking access to vital equipment. Join the RCP, Royal College of Nursing (RCN), Royal College of Emergency Medicine (RCEM), and Healthwatch for a vital discussion on the impact of corridor care and how to address it. Experts will share real-world experiences, discuss the systemic causes of corridor care, and explore practical solutions to improve patient safety and hospital capacity. This webinar will explore the findings of the survey, share real-world experiences from healthcare professionals, and discuss practical solutions to improve patient safety and hospital capacity. Attendees will have the opportunity to put their questions directly to senior royal college representatives, making this a key opportunity to contribute to the conversation on change. Register

In this blog, Patient Safety Learning’s Associate Director Claire Cox looks at how corridor care within the NHS is affecting safety culture, examining its implications for both healthcare professionals and patients. She underlines the need to understand these dynamics so that we can identify strategies to address causes of corridor care and promote a culture that prioritises safety and high-quality care for all. Corridor care is a term used to describe the practice of providing medical attention to patients in hallways or other non-designated clinical areas due to overcrowding or resource shortages. In the context of the NHS, this phenomenon has become increasingly common due to rising patient demand, workforce challenges and limited bed capacity.[1] While corridor care may seem like a necessary stopgap measure to address acute pressures on healthcare services, it raises significant concerns about patient dignity, privacy and the overall quality of care. We set out these issues in more detail in a blog published earlier this month reflecting on the extent of corridor care in the UK.[2] Corridor care reflects deeper systemic issues within the NHS, including funding constraints, staffing shortages and inefficiencies in patient flow. Its growing prevalence has led to widespread debate about its impact not only on patient outcomes but also on the morale and functioning of healthcare teams. Safety culture An organisational culture that seeks to assign blame when things go wrong makes patient harm more likely to happen again. In our report, A Blueprint for Action, we identify just culture as one of the six foundations of safer care to improve patient safety.[3] A just culture considers wider systemic issues when things go wrong, enabling professionals and those operating in the system to learn without fear of retribution. Just culture aligns with creating a safety culture, where shared values, attitudes and behaviours within an organisation prioritise safety as a fundamental component of its operations. In healthcare, a strong safety culture is critical to minimising risks, preventing harm and ensuring that patients receive the highest standard of care. Published in July 2019, the NHS Patient Safety Strategy identifies a patient safety culture as one of the two core foundations required in working towards its safety vision “to continuously improve patient safety”.[4] Safety culture directly influences how staff respond to pressures, make decisions and balance competing priorities. When safety culture is strong, staff feel empowered to speak up about concerns and systems are in place to mitigate risks. However, practices like corridor care can undermine these principles by creating environments where safety is compromised, staff morale declines and patient outcomes suffer. Corridor care and safety culture: Impact on teams Corridor care significantly affects safety culture among different healthcare teams, including ambulance staff, ward staff and emergency department (ED) staff. These groups must collaborate in high-pressure, resource-limited environments where patient safety is already at risk. However, the dynamics created by corridor care can undermine trust, communication and efficiency, all of which are critical components of a strong safety culture. Ambulance staff Ambulance staff are often the first point of contact for patients entering the healthcare system. When EDs are overcrowded and patients are treated in corridors, ambulance staff may face delays in transferring patients to hospital care. Long ambulance handover delays have been a persistent component of the problems faced by the NHS in recent winters.[5] [6] [7] Prolonged handover times can prevent ambulance crews from responding to new emergencies, creating frustration and moral distress. Corridor care also limits the ability of ambulance staff to provide a full clinical handover, leading to communication breakdowns and potential gaps in patient care. These delays can result in tension between ambulance crews and ED staff, as both teams struggle to manage their workloads under significant pressure. The lack of structured processes during corridor care undermines teamwork and fosters an environment where safety protocols may be bypassed to save time. Emergency department staff ED staff endure the most of corridor care's challenges, as they are tasked with managing patients in overcrowded spaces. The need to oversee patients in hallways stretches resources and divides attention, making it harder to maintain comprehensive monitoring and timely intervention. This environment increases the likelihood of errors and reduces the capacity to provide high-quality care. The presence of patients in corridors can also create role ambiguity and conflict between team members, as the usual boundaries between clinical responsibilities become blurred. For example, junior staff might feel unsupported when managing corridor patients, while senior staff may struggle to oversee all aspects of care effectively. The resulting stress and burnout among ED staff can weaken safety culture by diminishing morale, collaboration and the willingness to speak up about concerns. Ward staff Ward staff are often involved in the downstream effects of corridor care when patients are eventually transferred from ED corridors to inpatient wards. These staff members frequently face increased pressure to admit patients quickly to alleviate ED overcrowding, potentially without adequate preparation or information. This rushed process can compromise continuity of care and increase the risk of adverse outcomes. Many Trusts are now admitting an extra patient onto the wards to alleviate ED pressures, which also has implications for safety, privacy and dignity. Moreover, the systemic strain caused by corridor care can exacerbate existing tensions between ward staff and ED teams. Ward staff may perceive themselves as being unfairly burdened, while ED teams may feel unsupported in their efforts to manage patient flow. This misalignment can erode interdepartmental relationships and hinder the development of a cohesive safety culture. Corridor care and safety culture: Impact on inter-team collaboration Corridor care amplifies the challenges of inter-team communication, trust and collaboration, all of which are essential to maintaining a robust safety culture. When teams operate in silos or perceive themselves as competing for limited resources, it becomes harder to prioritise patient safety as a shared responsibility. The relationship between safety culture and corridor care is deeply intertwined; safety culture can be significantly undermined by the systemic and operational challenges posed by corridor care. Understanding this connection is essential to addressing the negative impact of corridor care on patient safety and team dynamics. This can be seen when considering how core principles associated with safety culture compare with the realities posed by corridor care: Open communication: A strong safety culture relies on clear communication among teams to ensure patient needs are met and risks are minimised. However, in the context of corridor care, chaotic and overcrowded environments can hinder effective communication. Ambulance staff may not have the opportunity to provide thorough handovers, ED staff may miss key patient details in the rush and ward staff may receive incomplete or delayed information about incoming patients. These communication breakdowns increase the risk of errors, undermining safety culture and compromising patient safety. Teamwork and collaboration: Safety culture emphasises collaboration across all levels of healthcare. Corridor care disrupts this by placing teams under excessive strain, leading to interdepartmental tensions. For example, ambulance staff may feel unsupported during prolonged handovers, while ED staff are overwhelmed managing corridor patients. This strain and associated incivility erode trust and reduces the cohesion necessary for a positive safety culture. Proactive risk management: A proactive safety culture involves identifying and mitigating risks before they lead to harm. Corridor care creates environments where risks—such as patient deterioration, falls and inadequate monitoring—are more likely to occur. The lack of resources and time for proactive measures further weakens the ability to uphold safety standards. As well as coming into conflict with some of the core principles of a safety culture, corridor care can also erode this further by: Compromising patient safety: Corridor care forces healthcare professionals to provide care in suboptimal conditions, where monitoring equipment, privacy and basic patient needs are often lacking. This creates a pervasive sense of vulnerability among staff as they are unable to deliver the standard of care they aim to achieve. Over time, this can normalise unsafe practices and dilute an organisation’s safety culture. Increased stress and burnout: Staff operating in these environments experience heightened stress and emotional exhaustion, which can lead to burnout. Burnout can negatively impact engagement, communication and decision making—all critical components of safety culture. Blame culture: In the absence of systemic solutions to corridor care, a culture of blame may develop. Teams or individuals may be scapegoated for adverse outcomes, discouraging the reporting of safety concerns. A blame culture directly contradicts the transparency and learning focus that underpin a strong safety culture. Undermining the opportunity to learn from staff speaking up: In a pressurised environment, staff may not feel that they have the time or confidence that their concerns about unsafe care will be welcomed or listened to. It is important that both healthcare providers and system leaders understand the reality of delivering corridor care and its patient safety consequences. This requires staff to be supported to raise issues through formal reporting systems, contribute to patient safety incident reviews and investigations, and speak up when they need to do so in line with their professional responsibilities. As noted earlier, corridor care often reflects deeper systemic issues, such as funding constraints, staffing shortages and inefficiencies in patient flow due to multifactorial issues outside of the control of an individual organisation. Systemic factors that challenge the ability of healthcare organisations to maintain a robust safety culture can include: Overcrowding in emergency departments—this can be a symptom of wider systemic problems—mental health crisis, an aging population, unaddressed health inequalities, access to primary care, staffing and funding crisis, etc. Insufficient staffing levels and expertise—resulting in compromised care and reduced opportunities for collaboration, communication and oversight with systems in place to review patient acuity and appropriate escalation. Limited resources—preventing the implementation of solutions, such as expanding capacity or improving triage processes, further entrenching corridor care as a stopgap measure. When systemic problems are not addressed, staff may feel disillusioned, which may undermine their commitment to the principles of safety culture. Corridor care and safety culture: What can be done? Maintaining a safety culture is an essential component of keeping patients safe from avoidable harm. In the current circumstances where corridor care is increasingly prevalent in the NHS, this is now more important than ever. This can be supported by: Encouraging open reporting and speaking up: Creating a non-punitive environment for reporting safety concerns allows teams to identify risks associated with corridor care and work collaboratively to address them. Improving communication: Structured handover protocols and enhanced use of digital tools can ensure critical patient information is not lost, even in corridor settings. Fostering interdepartmental collaboration: Training sessions, joint meetings and shared goals can build trust and reduce tensions between ambulance, ED and ward staff. Investing in staff well-being: Providing mental health support and ensuring adequate staffing levels can alleviate burnout, enabling staff to uphold safety principles. At Patient Safety Learning we are clear that corridor care must not become the norm. The negative effects on staff, patients and families can be significant and long lasting. This requires action from healthcare leaders, not only to support real time improvements, but to identify the deep-rooted causes and commit to longer-term solutions. References 1. Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. 2. Patient Safety Learning. Response to RCN report: on the frontline of the UK’s corridor care crisis, 17 January 2025. 3. Patient Safety Learning. The Patient-Safe Future: A Blueprint For Action, 2019. 4. NHS England, The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients, July 2019. 5. Discombe, M. Ambulance handover delays hit record high. Health Service Journal, 9 January 2025. 6. Nuffield Trust. Ambulance handover delays, 25 April 2024. 7. Health Services Safety Investigations Body. Harm caused by delays in transferring patients to the right place of care, 24 August 2023.

In this blog, Patient Safety Learning’s Director Clare Wade reflects on the challenges that growing prevalence of corridor care poses to reporting and acting on patient safety concerns in the NHS. As highlighted by Lord Darzi’s independent investigation into the state of the NHS in September, the health service in the UK is currently facing unsustainable pressure accompanied by a range of critical challenges.[1] One of the most alarming indicators of this pressure is the rise and growing prevalence of 'corridor care'. Corridor care refers to patients receiving treatment in hospital corridors, cupboards and other unsuitable spaces due to bed shortages and overwhelming demand. These are referred to formally by NHS England as ‘temporary escalation spaces’.[2] While this practice aims to provide some level of care amidst resource constraints, it raises significant concerns about patient safety, dignity and quality of care. Recent reports have highlighted how corridor care is becoming increasingly common. In On the frontline of the UK’s corridor care crisis published last month, the Royal College of Nursing (RCN) highlighted from a survey of its members that nearly 70% of nursing staff deliver care in unsuitable spaces such as corridors, and over 90% believe this compromises patient safety.[3] Some hospitals, including Whittington Hospital in North London, have even advertised for 'corridor nurses' to manage patients in these overflow areas, where basic amenities like oxygen and power outlets are hastily installed.[4] Implications for patient safety As we set out in more detail in a blog published last month on the extent of corridor care in the UK,[5] this practice of corridor care poses numerous patient risks, including: Delayed treatment: Patients in corridors often face delays in receiving timely interventions as these areas lack proper infrastructure for urgent care. Inadequate monitoring: Without essential monitoring equipment and privacy, the early detection of patient deterioration is less likely. Compromised infection control: Corridors are high-traffic zones, making it harder to maintain proper hygiene and prevent hospital-acquired infections. The systemic and operational challenges posed by corridor care can also significantly undermine safety culture at an organisation, as set out in more detail in a recent blog by my colleague Claire Cox.[6] Patient safety incident reporting in the NHS In the face of such risks, it is essential that we have robust systems for reporting events or situations that potentially harm, or could harm, patients while they are receiving care. NHS England has recently introduced a new service for recording and analysing patient safety incidents in England. The Learn from Patient Safety Events (LfPSE) service replaces the previous National Reporting and Learning System and is intended to improve patient safety incident reporting in the NHS. Stating how it will do this, NHS England says that when it is fully functional it will: Make it easier for staff across all healthcare settings to record safety events, with automated uploads from local systems to save time and effort, and introduce new tools for non-hospital care where reporting levels have historically been lower. Collect information that is better suited to learning for improvement than what is currently gathered by existing systems. Make data on safety events easier to access, to support local and specialty-specific improvement work. Utilise new technology to support higher quality and more timely data, machine learning, and provide better feedback for staff and organisations.[7] LfPSE has now been rolled out across most of the NHS. However, the way in which this system works, coupled with the conditions created by corridor care, can present significant challenges to reporting and learning from patient safety risks associated with corridor care. Reporting rates At Patient Safety Learning we have heard concerns from frontline staff that significant time pressures can deter them from submitting incident reports. When working in less than ideal conditions such as delivering corridor care, this is further exacerbated. Staff who face significant additional time pressures that accompany monitoring and caring for patients in non-standard spaces can simply have less time and capacity to report incidents. Focus on digital systems LfPSE depends heavily on digital tools for incident reporting. For some organisations this can still be a barrier to their use as they continue to work with outdated IT infrastructure. These infrastructure limitations impact in a range of areas, one of which can be the accessibility and ability to capture incidents comprehensively using the new LfPSE service. This is another issue amplified when working in overcrowded and chaotic environments like corridors, where staff may not have easy access to appropriate IT. Lack of timely feedback Some healthcare staff told us that feedback from LfPSE can be delayed or absent altogether. Without timely insights, the potential for learning and improvement diminishes, and staff may be less likely to report issues if they don’t see evidence of concerns being acted on. Sharing learning Sharing learning from patient safety incidents is a fundamental component of improving patient safety and delivering safe care. However, at Patient Safety Learning we have concerns that LfPSE lacks effective mechanisms for disseminating the learning derived from reported incidents. Currently, LfPSE data is not made readily available for analysis. Trusts can see reports of their own data (which they already have access to) but not system-wide information to help them assess risk or engage with others. This can create a siloed approach where individual trusts or departments may benefit from their data but fail to contribute to a wider culture of safety improvement. For example, in the context of corridor care, incidents such as missed deteriorations or infection outbreaks may provide valuable lessons but, without NHS-wide sharing of this information, other organisations are unable to implement preventive measures. Underrepresentation of corridor care data Many corridor care incidents may be unreported or under-reported, as they often occur in makeshift spaces outside formal wards or departments. This creates a gap in the data and limits the system’s ability to address specific risks associated with such practices. At present, there appears to be no formalised mechanism to capture data from healthcare providers specifically highlighting ‘corridor care’ as a contributory factor to an increased risk of or actual patient harm. NHS England have recently announced that they will now require trusts to report on the number of patients who receive care in ‘temporary escalation spaces’.[4] To date, this data has not been made available so we are unaware of the true frequency of corridor care, where the ‘hot spots’ are or how long patients are being cared for in a corridor/escalation area. Cultural barriers There is a significant body of evidence, ranging from staff survey results to whistleblower testimonies, highlighting the wider problem of the persistence of blame cultures and a fear of speaking up in parts of the NHS.[8] [9] This is particularly true in high-pressure settings like corridors, where staff may feel they are being judged for circumstances beyond their control. Given the significant media focus on this issue, staff may feel reluctant to speak up, fearing a negative response from the trust worried about the reputational impact of reported concerns. Addressing the challenges There are clearly a number of challenges associated with reporting, learning from and acting on patient safety risks and incidents associated with corridor care. Reporting corridor care incidents needs to improve, which could involve introducing specific reporting categories to help identify and address systemic issues more effectively. Also, actively encouraging staff to share their insights to enable trusts and the wider healthcare system to better understand the nature and scale of risk to patient’s safety would be beneficial. There are also a number of wider system issues that need to be considered: Improved sharing of learning: The NHS must establish robust mechanisms for sharing insights from LfPSE data, ensuring that safety lessons from one trust are accessible more widely across the organisation. National safety alerts or learning forums could support this initiative. Support for staff and patients/families: Equipping staff/patients/families with the skills and confidence to report incidents without fear of blame is essential. Investment in IT infrastructure: Upgrading digital systems across NHS trusts will ensure the LfPSE is accessible and efficient, allowing staff providing corridor care to easily use the IT to report to LfPSE. Real-time feedback mechanisms: Providing timely analysis and feedback to staff will reinforce the value of reporting and enable immediate improvements. Using the safety science tools being promoted in PSIRF: Undertaking thematic analysis and observations of corridor care to identify the reality of ‘work as done’, including: – the risks of unsafe care – the contributory factors to these risks (task, environment, process factors, etc) – the potential opportunities for immediate improvement – sharing these insights across the healthcare system as a matter of urgency. Trusts should be made aware of colleagues who are developing good practice to mitigate risks to patients and to enable them to implement in their environments. Focus on systemic solutions: Policy reforms must address resource allocation, especially around primary care, bed management and alternative care pathways to reduce reliance on corridor care. The combination of corridor care and the limitations of the LfPSE underscores the urgent need for systemic change within the NHS. While the LfPSE is a promising tool for learning from safety events, its full potential will only be realised if these shortcomings are addressed. By prioritising the sharing of learning, fostering a culture of transparency, investing in resources and refining reporting systems, the NHS can take a vital step towards safeguarding patient safety and dignity in even the most challenging circumstances. References The Rt Hon. Professor the Lord Darzi of Denham. Independent Investigation of the National Health Service in England, 12 September 2024. NHS England. Principles for providing safe and good quality care in temporary escalation spaces, 17 September 2024. Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Lintern S, Wheeler C. Hospital advertises for ‘corridor care’ nurses to ease NHS crisis. The Times, 11 January 2025. Patient Safety Learning. Response to RCN report: on the frontline of the UK’s corridor care crisis, 17 January 2025. Claire Cox. How corridor care in the NHS is affecting safety culture: A blog by Claire Cox. Patient Safety Learning, 27 January 2025. NHS England. Learn from patient safety events (LFPSE) service, Last accessed 27 January 2025. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024. Peter Duffy and Helen Hughes. Speaking up for patient safety: A new interview series about raising concerns and whistleblowing. Patient Safety Learning, 15 January 2025.

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

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. This report from the Royal College of Nursing presents the findings of a survey of nursing staff outlining the extent of corridor care across the UK. The responses confirm that corridor care is a widespread issue, with hundreds of unedited responses included in the report. You can read Patient Safety Learning's response to this report here.