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10 years ago, waiting 12 hours in A&E was a rarity. Now long waits are routine, happening during 1 in 10 major A&E attendances. In this report, the charity Age UK sets out the devastating impact that corridor care and long accident and emergency waits can have on older people. They argue that this is a crisis hiding in plain sight in our hospitals and that the Government need to act urgently to tackle this. You can find further articles and reports on the patient safety issues surrounding corridor care here. The report highlights that: 1 in 3 (one third or 32%) of those aged 90 and older are waiting 12 hours or more in A&E to be admitted or discharged home in 2024/25. The number of instances of ‘corridor care’ of 12 hours or more has increased 525-fold since 2015/16. Between 2019/20 and 2024/25 the number of attendances to A&E that resulted in a 12-hour wait for a bed increased by nearly 2000%. Last year, 532,451 people experienced corridor care of 12 hours or more. It calls for the Government to implement the following package of measures: Urgently produce a funded operational plan to reduce the number of long A&E waits and end Corridor Care, with specific deadlines and milestones. Establish a robust system to collect and publish regular data on Corridor Care (as well as long A&E waits), and their impacts on the public, including by age and ethnicity. Make a Minister in the Department of Health and Social Care accountable for reducing long A&E waits and ending corridor care and require them to report on progress to Parliament every six months. Turbo-charge a peer learning programme for hospitals and local health organisations (Integrated Care Boards) to share proven solutions, tackle barriers to discharge and protect and support NHS staff. Work at pace to implement the 10 Year Health Plan, especially the ‘hospital to home’ shift and creation of a Neighbourhood Health Service, ensuring social care and the VCSE (Voluntary Community and Social Enterprise) are fully involved – so fewer older people need to go to A&E in the first place.

We hear time and time again on the hub about the lack of joined up care and communication within and across organisations. Patients and their families and carers not knowing who to contact to chase up a referral, having to travel miles for appointments, miscommunication, diagnostic errors, or having to repeat the patient’s history and medications to every new healthcare professional they see because the notes haven’t been shared or clinicians "don’t have time to read them all". These issues are widespread and urgently need to be addressed if we are to prevent people falling through the gaps and suffering worse health outcomes. In this blog, David* shares his story about his elderly sister and a mix up with an urgent referral which led to a near miss. Background My sister has cancer and she's got a diagnosis of dementia too. The cancer is very aggressive and it causes her a lot of pain. Her care team are managing her pain very well. Due to her age and frailty, chemotherapy was out of the question but she had surgery and it seemed to go well. She was having routine check ups post-op to monitor her. An urgent referral A few months later unfortunately the cancer came back and we got an urgent referral from her GP for her to see her consultant. So when within a couple of weeks we got an invite to the hospital for an appointment we assumed it was for her urgent cancer referral. When we got to the appointment, neither the consultant or her advanced nurse practitioner team, who were all familiar with her diagnosis and history, were there. Instead there was a junior doctor on his own. He asked my sister how she had been since her surgery and was she doing well. When my sister said, well no, the tumour had grown significantly and we think the cancer had come back, he went white and rushed out of the room saying he needed to speak to someone else. Communication issues He came back and said my sister would need 20 days of successive radiotherapy in the hospital (which is at least a two-hour round trip). We had many questions we wanted to ask but he wasn’t able to answer them, and I was very concerned whether this was the right course of treatment for her. There were a number of issues—I had questions about how aggressive the cancer was, whether the cancer had spread elsewhere, whether this was palliative or curative treatment, what impact this would have on my sister’s health. Radiotherapy is harsh and my sister was physically very frail. In the end, because I phoned the advanced nurse practitioner and explained what had happened and my concerns, we were invited back for another appointment, and a few days later we saw the consultant. On the advice given, my sister was told about the significant risks and unsuitability of radiotherapy because of her co-morbidities and she decided not to go ahead with the radiotherapy. This was a relief as I didn’t want her to have unnecessary treatment, especially treatment that would not address her cancer and make her remaining months painful and distressing. The consultant was wonderful, and I’ve written him a lovely letter thanking him, but there has been a big communication issue here which could have led to a different outcome altogether. A 'near miss' The issues here, as I see them, are that the urgent referral got mixed up with the routine post-op appointment, which led to a doctor in training being placed in a situation for which he was untrained and unprepared in making significant treatment decisions. The advice he received and acted upon was from an unnamed consultant who didn’t even speak with or examine my sister. There is also the fact that they didn’t have a conversation with my sister about her options and they just told her she needed the radiotherapy. This is not informed consent! If we hadn't been there with her and questioned it, would she have had that course of treatment, accepted the radiotherapy, even though it was completely unnecessary, which would have led to avoidable harm? This really is a big ‘near miss’. What would have happened if she hadn’t had anyone there to intervene and advocate for her. She has absolute confidence in the health system but, for her family trying to navigate the system, this was incredibly stressful. What happens to the patients who haven’t got a family around to support and advocate for them? We need to look at the whole care pathway and try to design it from the patient and family’s perspective. *The names in this blog have been changed to ensure anonymity. Are you a patient, relative or carer frustrated with navigating the healthcare system? Or is your GP practice or Trust doing something innovative to make it easier for patients? We would love to hear your stories. Please add to our community forum (you will need to register with the hub, it's free and easy to sign up) or email us at [email protected]. Related reading The challenges of navigating the healthcare system: Margaret's story The challenges of navigating the healthcare system: Sue's story Navigating the healthcare system as a university student: My personal experience Lost in the system? NHS referrals "I love the NHS, BUT..." Preventing needless harms caused by poor communication in the NHS (DEMOS, November 2023) Robust collaborative practice must become the bedrock of modern healthcare Robbie: A homeless patient’s struggles with the system Digital-only prescription requests: An elderly woman sent round the houses Lost in the system: the need for better admin Digital-only prescription requests: An elderly woman sent round the houses

We hear time and time again on the hub about the lack of joined up care and communication within and across organisations. Patients and their families and carers not knowing who to contact to chase up a referral, systems not joined up, lack of communication, having to repeat the patient’s history and medications to every new healthcare professional they see because the notes haven’t been shared or clinicians "don’t have time to read them all". These issues are widespread and urgently need to be addressed if we are to prevent people falling through the gaps and suffering worse health outcomes. In this blog, *Margaret shares her and family's experiences of trying to coordinate their elderly father's upcoming surgery. Interoperability issues My father has dementia and has a complex set of health issues, as a lot of elderly people do. He has a number of comorbidities, including vascular, heart, and cognition and memory problems, that has meant coordinating his care between the care home, his GP, the local hospital and a specialist hospital has been quite complex. There have been multiple issues but there were two that stood out. The first issue was at the diagnostic stage. My father has severe vascular problems and he needed fairly urgent and necessary surgery. In order to assess whether he was suitable for surgery, given his heart condition, he needed a scan. We have had problems in the past in getting access to scans on his heart so the GP said in order to move things on quicker it would be good to get the scan done privately. As the surgery was urgent, we paid to get the scan done at a private diagnostic centre. However, when it came to getting the information from the private diagnostic centre to the tertiary hospital where he was being treated we encountered problems. The hospital couldn’t access the scans from the private hospital because they were two different systems which meant there was an interoperability issue as the two systems ‘didn’t talk to each other’. One of the suggestions I was given was that I could drive to the private diagnostic centre, which was about a 40 mile drive from my house, with a CD, and then they would download the scans onto the CD and I could then drive back to the hospital, which was about another 35 mile drive. There were multiple calls and this was really quite distressing for our family because we knew my father needed access to the scans urgently. In the end they said they’d do another scan in the hospital. Although I don't think there were any kind of safety issues with my father having another scan, it did mean that not only did it cause delays and stress for my father and the family, it was also a cost to the NHS, which could have been avoided. Communication problems between departments Then around the same time, the hospital wanted to do another scan on my father to prepare for the surgery. Again, as it was urgent, I kept ringing the hospital asking if he had his scan yet but because my father was under the vascular and cardiac departments it was often difficult to know who to speak to because one department needed information from the other and they hadn't received it. So I’d get through to one department who then told me to phone another department, or I would be put on hold by someone from admin who didn’t know the answer and would say they’d ring back but didn’t because they were very busy. As a carer/relative you don’t know what’s happening and you become worried that your loved one is lost in the system. I persisted in phoning but, coincidentally, at the same time my sister visited my father’s house to pick up some bits for him. She saw there was a letter from the hospital so she opened it and it was a letter inviting my father in to have an outpatient appointment scan in the hospital he was an inpatient in! I ended up going to PALS. The lady I spoke to was understanding, sympathetic, kind and highly efficient. But she told me this happened all the time as the radiology department doesn't have access to the hospital's IT system, so they wouldn't know my father was an inpatient and would have just invited him in in a timely way but they would have done that as if he was an outpatient. I coordinated between the different departments and we finally got the scan for my father, he had the surgery and survived. However, these delays could have compromised his health because the surgery was urgent and if he had deteriorated whilst waiting that may have killed him. As a family we were very conscious that time was of the essence and we had to push continuously. Lack of information given to families These are just two examples from a multiple of occasions where we as a family were trying to get information. My father was elderly and wouldn’t have questioned the doctor. And because of his cognition issues due to his dementia, and also because he was on high doses of pain medication, he becomes confused and we couldn’t always rely on what he told us. However, often the healthcare professionals wouldn’t tell us things, despite me being next of kin and with documented power of attorney, and told us to speak to my father. So as a carer or relative you are trying to join the dots and work within a health system that isn’t coordinated. What I want to see change On the face of it they may seem like quite small examples, but when they build up, they are significant in terms of risk. My father was a high-risk patient and if it wasn’t for our diligence and persistence he would have fallen through the cracks, to a significant detriment to his health. I didn’t want there to be avoidable harm, an investigation and ‘lessons learned.’ I want us to be working in a coordinated and proactive manner to recognise the risks and void any harm. And for that insight to be used to ensure systems and processes are improved for the benefit of other patients and families. Also, I want opportunities to share my experience, not as a formal complaint but for genuine interest in our family’s customer experience. Again, for learning and future preventative action not for blame. *The names in this blog have been changed to ensure anonymity. Are you a patient, relative or carer frustrated with navigating the healthcare system? Or is your GP practice or Trust doing something innovative to make it easier for patients? We would love to hear your stories. Please add to our community forum (you will need to register with the hub, it's free and easy to sign up) or email us at [email protected]. Related reading The challenges of navigating the healthcare system: David's story The challenges of navigating the healthcare system: Sue's story Navigating the healthcare system as a university student: My personal experience Lost in the system? NHS referrals "I love the NHS, BUT..." Preventing needless harms caused by poor communication in the NHS (DEMOS, November 2023) Robust collaborative practice must become the bedrock of modern healthcare Robbie: A homeless patient’s struggles with the system Digital-only prescription requests: An elderly woman sent round the houses Lost in the system: the need for better admin Digital-only prescription requests: An elderly woman sent round the houses

Amanda Wynn is an independent consultant, researcher and trainer based in Cambridgeshire, specialising in older and disabled survivors of domestic abuse and sexual violence. In this blog, Amanda talks about her recent research into sexual assaults against older people by hospital staff. She shares an overview of her findings and calls for greater awareness and support. Motivated by a patient death I undertook my first research into sexual assaults against older people by hospital staff in 2021, after reading about the horrific case of an older patient who died from internal haemorrhaging due to severe vaginal injuries. A member of staff was arrested on suspicion of rape, but ultimately was not charged. I found it staggering that more people weren't aware of what happened to this lady. After placing a post saying as much on social media, I received messages indicating that this wasn't the isolated case I assumed it was. I was curious to know how often older people in hospital are being sexually assaulted by staff - people in positions of trust who should be caring for patients. So, I decided to find out for myself. The findings: increasing numbers, bias and poor support As I don't receive any funding for my research, I had to rely on freedom of information (FOI) requests to get data from NHS England trusts. I looked at the number of incidents reported to staff and recorded on the hospital’s incident system over a 5 year period, from 2016/17 to 2020/21 (financial years). My first paper highlighted at least 75 incidents of sexual assault against patients aged 60+ in NHS Hospitals in England, where the alleged perpetrator was a member of staff. I was surprised by the numbers but also at the responses to the follow-up questions I asked about support for these survivors. In the vast majority of cases, there was no referral to specialist services. Only 21% (16) of the incidents recorded were reported to police. Of these 16, all but two had ‘no further action’ taken. I don’t have the data on how the other two progressed so it is unclear whether any convictions were made. I was keen to review the data to see if anything had changed, so I undertook a similar research project in early 2024. This time, the number of reported incidents was much higher over a shorter reporting period (at least 274 incidents over three years). Once again, the number of victims being referred to Sexual Assault Referral Centres or specialist support was very low. Responses to both sets of FOI requests included anecdotal comments from professionals making worrying assumptions about the reliability of people with dementia when disclosing sexual assault. It was also interesting to note that male victims in reported incidents had a higher prevalence than male victims of sexual assault in general - potentially highlighting an increased risk of sexual assaults against older men in hospital. Limited data but a sad fundamental truth Due to lack of funding for my research, I was able to merely touch the surface and report only quantitative data. That means I am unable to determine if the increase in the number of reported incidents is due to more sexual assaults against older people happening. Or if improved reporting and data recording methods can account, either fully or partially, for the increase. However, what is clear is that older patients in hospital are at risk of sexual assault from the very people who should be assuring their well-being and safety. Opportunity for positive change to reduce harm The main aim of my research is to raise awareness of the issue among front-line professionals. Whilst this can include the potential perpetrators, most will be the people who are best placed to stop such incidents, and to ensure an appropriate response when an incident is reported. NHS England has strengthened its approach to domestic abuse and sexual violence in recent years with duties placed on staff to record and report incidents. There may still be some complacency about how genuine patient reports are though, and therefore less emphasis on support. It's also important for both health care staff and the general public to be aware that sexual assaults in hospital do happen. More awareness of the issue will hopefully lead to more survivors being able to disclose and getting the right support when they do. I would like to develop some training for health and social care staff around responding to disclosures of sexual assault and violence from older people - this will likely be in an eLearning format - but I am keen for access to the training to be free. Too much essential knowledge sits behind paywalls making it prohibitive for the target audience to access. I have the content, but if anyone can help with a platform for hosting and developing online training it would be great to hear! You can contact me at [email protected] if you would like to hear more about my research or the online training. Hopes for the future I would like all health and social care workers to be much more aware of sexual assault against older people - not just in hospitals but in care homes and the community too. Funding for services needs research and data to back it up - my research only touches the edge of the issue and it would be great if more research and eventually specialist support for older survivors of sexual violence can lead on from it. I’d just like to add that I'm really grateful to Hourglass for publishing my research to help get the word out as wide as possible. And, of course, to Patient Safety Learning for giving me the opportunity to share the findings too. Related reading Sexual violence and assault against older people in NHS hospitals in England (2024) Doctors practising despite sexual assault and rape allegations Hundreds of social care residents allegedly sexually assaulted, watchdog reveals Share your insights If you would like to comment on this article or any of the articles published on the hub, please sign up here (for free) and contribute your thoughts and insights below. If you'd like to write about a patient safety issue, experience or improvement project, please read our guide to writing a blog, or contact the editorial team at [email protected].