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With over 135 million outpatient appointments delivered in 2023/24, outpatient care is one of the most widely used services in the NHS. Yet despite its importance, too many patients experience long waits, inconsistent communication, and a system that can feel fragmented and impersonal. As demand continues to rise, the need for a more co-ordinated, patient-centred approach has never been clearer. In this timely and forward-looking session, the Patients Association explores a bold new vision for outpatient reform: one that places patients not just at the centre of care, but in true partnership throughout it. Chaired by Sarah Tilsed, our Head of Partnerships and Involvement, you'll hear from: Irene Poku, patient advocate, Anne Kinderlerer, Digital Health Clinical Lead at the Royal College of Physicians Theresa Barnes, Associate Medical Director for Clinical Services at Countess of Chester Hospital NHS Foundation Trust. It will unpack the key themes from Prescription for outpatients: reimagining planned specialist care, a joint report from the Patients Association and the Royal College of Physicians. This roadmap for reform proposes five ambitions and eight transformational shifts to create outpatient services that are timely, equitable, and genuinely collaborative. As the NHS looks to the future through the lens of the 10-Year Health Plan, this is a chance to be part of the conversation about what outpatient care should look like and how we can get there. Register

This report sets out how the NHS will resuscitate urgent and emergency care, with a focus on getting patients out of corridors, keeping more ambulances on the road, and enable those ready to leave hospital to do so as soon as possible. Summary of actions and impact for patients and carers Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter By the year-end, with improvement over winter, we expect to: Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes). Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients. Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care. Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe. Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually. Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25. Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points. Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards. Meet the maximum 45-minute ambulance handover time standard. Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care. Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings. Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days . Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month. National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference Allocating over £370 million of capital investment to support: Around 40 new same day emergency care centres and urgent treatment centres. Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments. Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.

The images on the left highlight the increased delays in ambulance responses and the potentially catastrophic consequences. Equally, the panic-inducing headlines of measures brought in to resolve the crisis. I work on the healthcare frontline and I’d like to share my experience of the 'Wait 45' policy in my trust and the impact it is having. Implementation of a new policy In December 2024, all ambulance trusts in England were told to implement a new policy, ‘Release to Respond’, also known as the ‘Wait 45’ policy, which means ambulances will only wait at Emergency Departments (ED) for 45 minutes before patients are left and the crews make their way to the next call. This was initiated following increasing waits for crews to handover patients to the ED. These waits were not inconsiderable periods of time, with many reports of crews spending their entire shift parked outside the ED with just one patient. This has resulted in some appalling headlines—for example, elderly people being left waiting for up to 15 hours for an ambulance to arrive and people having cardiac arrests where ambulances are not available to respond. Based on this, the adoption of the ’Release to Respond' policy makes sense. However, the introduction of this policy has been met with some scepticism and equally horrendous headlines about patients being dumped while crews run. The policy states that crews will not dump and run, and that handovers will be given, and patients will be placed on a chair, trolley or wheelchair in a dedicated space. But this policy is another example of not identifying the whole problem and bringing in a measure that only addresses the needs of one part of the healthcare system, while making it considerably worse for other parts! What is the point of an integrated care system (ICS) and board (ICB) if they do not look at an integrated intervention to address this situation? What is the reality of the ’Wait 45’ policy? The Wait 45 policy in my trust has completely changed the way the ED manages patients. 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. It used to be that corridor care was for patients who had been seen, had a plan and who were either waiting to go home or for a bed on a ward. Now, in my trust, the corridor is for undifferentiated patients (patients who present with symptoms that have not yet been diagnosed or categorised) that come in directly from the ambulances. This has increased the risk to patients and staff. The corridor is used as soon as the department is full and then, only when the corridor is full to capacity, does the Wait 45 policy get initiated. At this point it is almost guaranteed that the corridor will need additional staffing from somewhere, while the first crew need to wait their 45 minutes—the hospital now has 45 minutes to find these additional staff otherwise the nurse: patient ratio increases in the corridor. The ratios of nurse to patients differs depending on the area of the hospital: in major treatment areas it is 1:4 but in the corridor it is 1:6; however, there is no upper limit of patients in the corridor and staff are often moved from other in-patient areas to work in the ED where they are invariably working in the corridor. These nurses will not have a ED background and will find it challenging and may miss the subtle signs that an experienced ED nurse may spot. There is often a lack of support for nurses in the corridor, leaving additional staff having to rely on their previous experience and judgement to guide them on what needs to be done. Handover criteria not being met Ambulance trust and the acute trust staff should at handover discuss the criteria for placing patients in a corridor—i.e., patients are supposed to be independent, able to move themselves to the toilet, be clinically stable and not have an infectious presentation However, in my experience this criteria is often not followed, as highlighted in the following examples I have seen and heard: Suspected neutropenic patients placed in the corridor. These patients have a low neutrophil count (a type of white blood cell) and are more vulnerable to infections. The concern for those on immunosuppressants seems to be non-existent now; there was a significant concern during the Covid-19 pandemic, but now being immunosuppressed is met with a tut, roll of the eyes and a shrug of the shoulders. It rarely features in handovers. Ambulance crews handing over patients that needed a hoist transfer at their nursing home; it is clearly not appropriate to care for these patients in a corridor where they should be mobile to use bedpans or commodes. Elderly patients who have fallen—either with significant trauma or with no apparent injuries—placed in the corridor. One patient had pain in their neck and received a trauma CT scan in the corridor—surely this patient should not have been in a corridor in the first place! Patients with diarrhoea and vomiting placed in the corridor, sometimes next to the neutropenic patients. Those with significant respiratory symptoms suggestive of influenza or Covid-19 placed in the corridor, despite the known risks to those that are in the corridor with them. I have even had a patient with a Glasgow Coma Scale of 10 (this is a tool that healthcare providers use to measure decreases in consciousness) handed over to the corridor… Wouldn’t resuscitation be a better location for them? Unintended consequences It is easy to understand why ‘Release to Respond’ policies are needed. With no external pressure, it appeared that many trusts lacked the willingness to investigate changes to reduce the overcrowding in the ED. However, while I recognise that the ambulance trusts need to have their staff available and not tied up at hospitals, this is making the ED unsafe. Another unintended consequence of these policies is that the working relationships between the ED nurses and the ambulance crews has deteriorated. I have noticed an increasing lack of willingness to help each other and incivility is growing. Asking simple questions results in dirty looks and aggressive questioning about ’who are you‘. The natural feeling is now one of defence, protecting each other against comments, pulling back into areas of comfort and knowledge. The standard replies are now ‘no’ and a feeling that this is not my problem or my fault. Unilateral measures that do not address the whole problem I cannot help but think implementing a unilateral solution like the ‘Release to Respond’ policy is based entirely on ‘work as imagined’ and benefits only one part of a highly complex area. It places additional burdens on already overstretched resources. The worst of which is that EDs are still seen as being made of elastic, with the ability to continually expand even when the evidence shows every hospital is beyond capacity every day of the year! When I first heard about ICSs and ICBs, I really hoped we would start to see a time of collaboration, working together to solve some of the issues within healthcare. Sadly, there does not yet seem to have been a change. In fact, it feels very much that we renamed but stayed the same. Probably, because all that has happened since the ICSs were introduced is restructuring after restructuring. They are not being allowed to work. Please, don’t get me wrong. I can see why these policies are in place. If I called an ambulance, I would like it to be available to respond and unfortunately currently they are not and have not been for a while. But I cannot help but think that until the ICS and regional NHS organisations take ownership of these problems, and all the stakeholders are represented at the table to analyse, design, implement and, most important of all, EVALUATE an intervention, we are condemned to keep implementing unilateral measures that do not address the whole problem. Further reading on the hub The crisis of corridor care in the NHS: patient safety concerns and incident reporting A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces How corridor care in the NHS is affecting safety culture: A blog by Claire Cox Share your insights Do you have experience of corridor care either as a patient or a healthcare professional? What impact have you seen on patient safety? You can comment below (sign up here for free first) or email the editorial team at [email protected]