Search the hub

We know acute mental health wards are not safe for patients or staff. Efforts to reduce coercion and restrictive practice are often complex and are poorly implemented. Services continue failure to understand incidents and the dynamic milieu of wards in real-time. The staffing and skill mix of services are under constant pressure. Recent research, #WardSonar, has successfully focused on enabling patients to highlight when the pressure on wards is building and can predict when incidents might occur. The challenge remains enabling staff to listen to and respond to real-time data. Register

Parkinson’s is the fastest growing neurological condition in the world. Currently there is no cure for Parkinson’s, but medication plays a vital role in managing symptoms and preventing deterioration. In this blog, Joanne explains how delays to her mother’s time-critical medication in hospital led to her condition deteriorating.  I want to share my story about my mother’s treatment after she was admitted to hospital with a sore knee. She lived independently and walked with one stick prior to her admission. Her Parkinson’s was well managed with her medication. Right at the beginning of my mother’s inpatient stay she received the wrong amount of her time critical medication and her usual timings were not honoured, despite information given to medical staff on admission. My mother lost all her function which caused her to fall, she couldn’t sit up properly and was lying to the side and hunched over. She managed to feed herself a few times in this lying to the side/hunched over position. This in turn meant she aspirated and then took pneumonia. She also has heart failure, and the amount of antibiotics needed to shift the pneumonia then caused fluid overload which made her heart failure worse. We were not given much hope for her. She lost 4 stone of weight and was hospitalised for a total of 96 days. At times, she could not even coordinate her hand to mouth to eat. I was constantly having to chase the medical staff for her medication to be given at the correct times. I was made to feel like a pest. They even ran out at one stage, and the dosage was over 2 hours late. My mother was never incontinent on admission to hospital but that also soon changed. She deconditioned, was frail and then had trouble with orthostatic hypotension which restricted her rehab. She had several urinary tract infections which in turn caused delirium which was very upsetting. It is of my opinion that the medication delays caused the problems. I complained about the care and got her moved to a local hospital. She came on leaps and bounds, and they were bang on time constantly with her meds. No issues at all. Two physiotherapists had her up and walking. She was finally discharged from hospital on day 96 with a Zimmer frame with wheels and the assistance of two people. The physiotherapy team felt confident she wasn’t at her baseline and could improve to having the Zimmer and assistance of one. Things felt more positive. She then went to a rehab care centre where the physiotherapy input was minimal. The physiotherapist there reassessed her and told me that she would never walk again as it was too unsafe. Medical advice was to find a permanent nursing home for her. I then contacted a private neuro physiotherapist who specialises in Parkinson’s and he has hope for her and has had her up and walking again. I’m so very upset and traumatised by what has happened to my mother. It’s a very sad situation that we are currently faced with and I have no doubt that it all has been caused by an incorrect dosage and delays to the set timings of her Parkinson’s medication during her hospital admission. I do not feel the medical staff understood the importance of her time critical medication. There needs to be more awareness throughout health trusts and training for any staff involved in dispensing these medications. Guidelines or standards should be implemented and in place for time critical medication. It is not acceptable to follow general medication guidelines for time critical Parkinson’s medication. Share your story Have you or someone you care for been affected by any of the issues raised in Joanne's blog? Or perhaps you are a healthcare professional putting measures in in place to reduce errors around time-critical medication? You can comment below (sign up for free first) or email us at [email protected] to share your insights. Related reading Medication delays: A huge risk for inpatients with Parkinson’s Keeping patients with Parkinson’s safe in hospital: 4 key actions for staff Preparing to go into hospital – tips for people with Parkinson's and their carers Lightning Learning: Time Critical Medications ‘Every minute counts’: taking a national approach to time-critical medicines

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.

In this interview, David Osborn, chartered occupational safety and health practitioner and member of the Covid-19 Airborne Transmission Alliance (CATA), speaks to Lotty Tizzard, Digital Content Manager at Patient Safety Learning, about how CATA was established during the pandemic to advocate for adequate respiratory protection for NHS employees.  David explains how CATA advocated for the government and heath service to recognise that Covid-19 is passed on by aerosol transmission (through microscopic particles in the air). He also outlines why surgical masks do not adequately protect people against catching airborne viruses and describes how inadequate respiratory protective equipment (RPE) contributed to thousands of NHS staff catching Covid-19 at work. As a result, many healthcare workers died and a large number still live with the ongoing symptoms of Long Covid. David describes CATA's involvement as a Core Participant in the Covid-19 Inquiry and outlines what he hopes will be done to ensure the UK is better prepared for future pandemics. Patient Safety Learning is also a member of CATA. Clarification David wishes to clarify a point raised in the interview: "When talking about the “IPC Cell” I said that they 'didn’t produce minutes'. In fact, notes or minutes were taken at all IPC Cell meetings. The point I was making is that they were not published ('produced' in the sense of being released into the public domain), when the minutes of most other groups such as SAGE and NERVTAG were published. The few IPC Cell minutes that have trickled into the public domain have mostly been as a result of Freedom of Information requests by a colleague and a few that I have managed to obtain myself. In some cases, public authorities have taken around 18 months to disclose documents, and it has required the intervention of the Information Commissioner's Office. I anticipate that more minutes will be disclosed for public scrutiny as time goes on." You can read more about CATA and the Covid-19 Inquiry in David's blogs and presentations on the hub: Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn Healthcare workers with Long Covid: Group litigation – a blog from David Osborn Covid-19 : A risk assessment too far? A blog by David Osborn CATA and the UK Covid-19 Public Inquiry: Presentation from David Osborn Join the conversation Were you working in health and social care during the pandemic? We'd like to hear about your experience of health and safety at work. Were you provided with adequate PPE to carry out your job safely? Did you catch Covid-19 while at work? You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing [email protected]

At a recent Patient Safety Education Network meeting, Karen Male, ward leader at the University Hospital Southampton, gave a presentation on how she reduced falls on her ward. We asked Karen to share her journey and insights in a blog for the hub. The Patient Safety Education Network is a informal voluntary peer network for those in patient safety education and training roles. It provides a monthly drop-in session with guests to talk through issues of importance to those in patient safety education and training roles and now has over 470 members. You can find out about the network here. The challenge I joined the ward 14 months ago at a time when there was a high number of falls. In one year there was 72 falls, including four high-harm falls, and we would regularly have three falls a day. Falls prevention and staff confidence was low in the management and assessment of falls, and policies and procedures were not being followed. The ward layout was challenging—a corridor with three-bedded bays, long and narrow. Many of the patients were older and there had been a lot of Covid infections. My goal was simple: to reduce the falls in our ward. What I did I organised an entire ward awayday focusing on falls education, prevention, management of falls, and policies and procedures—everyone attended at the same time. This allowed the staff to discuss the way they worked ('work as done'). Back at the ward a Baywatch bay and a PHUDD scoring system was set up with the aim to reduce falls, particularly unwitnessed falls, by identifying if someone is high, medium or low risk of falling. The ward is a long corridor so one to two Baywatch bays are required. The PHUDD scoring system was used to identify those patients most at risk and to identify where they can go on the ward for the safest outcomes and if additional support is needed. It’s completed at least once daily for patients. On the PHUDD scoring system, 1 point was given to each question where the answer is yes. A point was added for any fall in the hospital. This was then used to decide which patient needed to be in the Baywatch bay. This score is on the handover and reviewed daily and at catch ups. Outcomes We have significantly reduced our falls—there has been 61.7% reduction in falls. There has been two long periods with no falls (one for a 48-day period and one for a 50-day period). Since the education day, we have had 1 or 2 falls a month rather than 5-11 falls every month. In the last 4 month we have had 6 falls instead of the potential 44. Staff are now educated on policies and procedure around the prevention of falls and the management of falls. Staff are proactive in the prevention of falls. Everyone knows that the Baywatch bay is the priority. And then everyone has their ends of the bay but we all cover each other. We have signs to say that’s it’s a Baywatch bay—for staff but also for relatives to say we can’t leave this bay. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. Night staff feel empowered to move patients who were most at risk to higher observation beds as they are the staff group most affected by falls on the ward. Bay nursing introduced handovers conducted outside of the bays, which enhanced the communication as opposed to being in an area away from the patients. We have completed a falls After Action Review and were praised for our significant improvement in post falls management and documentation. Senior management across our Trust have asked to learn more about the falls reduction plan. Barriers faced I met barriers. Staff were not acting in the way I wanted so I met resistance. But I was very honest with them. Told them what the consequences were. Got the most resistant on board first and then everyone else was easier. At the beginning the staff were demotivated and didn’t feel part of a team. We need to keep our teams valued and motivated. It’s an ongoing commitment to staff. We are always looking at how we can improve and asking staff what their ideas are. I think the biggest thing I did was look at what was my one main priority. And that’s what we focused on—falls. Now we are moving to pressure ulcers. If you pick one big thing to work on it’s easier. Give it a big focus and then, once sorted, move on to the next thing rather than trying to do everything at once. Next steps Training and education is essential—this has continued regularly from the ward leadership team. I’d like to do some simple quantification—more cost effective, efficient. PHUDD score gives us evidence. You might have enough staff but we might have five patients with a particularly high score. So we have more staff around the bays to even it out where it’s needed. We are now doing another nurse-led trial setting daily goals for patient mobility. We are very clear what the goals are, to increase mobilisation, and these goals are on the handover sheets for everyone to see. Further reading on the hub Yellow kits - an innovation to reduce the risk of falls in Accident and Emergency departments "The greatest part of this adventure has been the sharing of information." The Patient Safety Education Network one year on Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martin Have you implemented a new initiative in your organisation? Have you improved patient safety where you work? We would love to hear from you and share on the hub your journey. If you are a member, you can share directly on the hub or please contact [email protected] to discuss further.

This webinar for UK healthcare professionals will be delivered by DISN UK Group committee members. It will focus on using diabetes technology–insulin pumps, CGM, POCT–in the hospital. We will discuss and outline the newest JBDS technology guideline and provide the attendees with most up to date information regarding using diabetes technology when a person with diabetes is admitted to hospital. Educational outcomes – 3 points: Recognise different types of diabetes technology Use of diabetes technology in the different scenarios in inpatient setting Effective support for people with diabetes and use of diabetes technology when admitted to hospital Register for the webinar

This conference focuses on developing systems and processes for locally driven ward and unit accreditation for quality. These approaches can be used as a tool to encouraging ownership of continuous quality improvement at ward, unit or service level, reduce variation and increase staff pride and team working within their practise. Through practical case studies of organisations that have successfully introduced locally driven ward and unit accreditation systems the conference will provide practical guide to implementing systems, and improving staff engagement in driving forwards improvement for the benefit of patients, service users and communities. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/ward-accreditation-for-quality-conference or email [email protected]. hub members receive a 20% discount. Email [email protected] for discount code. Follow this conference on Twitter @HCUK_Clare #wardaccreditation