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Heather Wilson is a Programme and Policy Officer in the Healthy Lives team at the Health Foundation, as well as a registered nurse who continues to work in a central London emergency department. This blog is with contributions from Joanne Bosanquet, the chief executive of the Foundation of Nursing Studies and a Visiting Professor at the University of Surrey. 

When public areas such as train stations breach their capacity, emergency protocols are rolled out and stations are closed. Yet when hospitals become overcrowded, there isn’t the option to stop urgent and emergency care. Instead, staff have to develop workarounds, delivering care in areas not designed – nor safe or effective – for clinical use, a phenomenon commonly known as ‘corridor care’. The increasing frequency of corridor care is alarming – both for patient safety and staff morale, and because it risks normalising substandard care delivery. 

Corridor care largely occurs when emergency departments are inundated with patients. 45,000 people visit major hospital A&E departments in England each day, 16% more than 10 years ago. Many of these patients require hospital admission or further care. Limited beds within hospitals, stretched community services and chronically low social care capacity mean that A&E often becomes a bottleneck, with patients unable to ‘flow’ out of the department because there are no free beds elsewhere in the hospital. Trolley waits are also increasing. In January 2024, 54,000 patients waited more than 12 hours in A&E for admission to a hospital bed, compared with just 29 patients in December 2015. 

The impact on staff, patients and families 

For staff, there is consistent evidence that this practice leads to lower morale and poorer mental health outcomes in the workplace. It also impacts their ability to care for patients, as staff working in corridors don’t have direct access to – or room to use – routine equipment such as observation machines and patient hoists. 

As an emergency care nurse at a central London trust, I have been fortunate not to have experienced the extreme nature of corridor care that is becoming an everyday occurrence at other hospitals. We have not yet resorted to beds lining the corridors, but I have seen an increase in the conversion of non-clinical spaces to areas where we are seeing and treating patients. Storage areas have been converted into waiting rooms and cubicles, often housing up to five patients receiving care in chairs. These cheap workarounds might help to plug the gap in infrastructure in the short term, but they are not sustainable or safe solutions. 

For patients and their families, the experience can be traumatising. Patients can feel invisible out of the sight of staff. The physical environment is distressing, with harsh lighting, little to no privacy and difficulty accessing basic needs such as water or even a toilet. As such spaces are not designed to accommodate people for long periods of time, families are left standing for hours, unable to leave their relative due to fears they will be alone or forgotten. As patients being treated in corridors are surplus to safe-staffing numbers, they are experiencing delays to their care, creating a risk to patient safety. Furthermore, patient confidentiality and privacy are near impossible to maintain in public spaces, and concerns around data are not to be ignored. 

Joanne Bosanquet, the chief executive of the Foundation of Nursing Studies, recently experienced corridor care first hand: ‘I recently spent over 10 hours in a hospital with an elderly relative who was bounced between bays in the emergency department until eventually we were parked within thick red lines on the floor of a narrow corridor. My relative was lying flat on a trolley, and I was left guarding the invisible line around the space in fear of inevitable violation of the space due to the constant human traffic. I have never felt so angry. We became instantly invisible. I spoke to the matron and asked why the divisional executive team had allowed this to happen. “What are we supposed to do?” she responded. I said, “Say no”.’ 

Corridor care is a complex issue driven by a multitude of factors. There is a dual challenge whereby population health is worsening alongside an erosion of health and social care services. Meanwhile, we have an ageing population, with more people living longer in ill health, causing demand for services to rise. The health and social care system, particularly primary care, has not seen the required investment to ensure this demand can be met. 

Increasing numbers of patients will present in A&E for treatment they cannot access elsewhere, and this will be more common in more deprived areas. This is known as the inverse care law – another phenomenon we are in danger of accepting as normality. Further, physical care settings are no longer fit for purpose, as the cost of eradicating the NHS maintenance backlog has reached £11.6bn. The health and social care workforce is also facing chronic staffing shortages, particularly in nursing. Severely underfunded community and social care services are struggling to meet demand, which contributes to both greater hospital admissions and delayed discharges. Over a third of delayed hospital discharges are due to a lack of access to social services

At what point do we say enough is enough? At what point can staff, patients and families refuse to be treated in corridors? There is no doubt that complex action is needed across all the factors set out in this blog, all of which will require long-term, sustainable funding alongside dedicated policymaking. While emergency protocols are welcome in the immediate term, we must reconsider what is acceptable in the longer term to ensure a practice introduced to mitigate a crisis does not become the norm. Corridor care was scarcely seen in practice a few years ago, so it certainly is not inevitable. No patient can be comfortable in a corridor – nor should staff or policymakers get comfy while this practice occurs on their watch. 

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