The RCN has slammed the normalisation of corridor care after a new report from the Health Services Safety Investigations Body (HSSIB) found corridor care takes place throughout the year with the practice becoming normalised across the NHS.

The report shows that trusts are making corridor care adaptations more permanent, with some trusts now reportedly deploying staff and installing call bells and plug sockets in corridors.

The RCN says this is the clearest sign of the flawed thinking within a system which has become resigned to the managed decline of care standards.

The report by the government’s own patient safety investigator also found that despite the clear risk to patient safety, dignity and privacy, there is still no national data collection or reporting which would allow ministers and service leaders to determine the harm being done to patients.

In response to the latest findings from investigators at the HSSIB, RCN Chief Nursing Officer Lynn Woolsey said:

“A national safety investigator finding that corridor care is no longer an exception but entirely normalised and all year round is a damning indictment. It means every day vulnerable people are being treated in unsafe and undignified conditions. What’s just as shocking, is that 18 months after nursing staff declared a national emergency over corridor care, ministers and service leaders are still unable to determine the harm being done to patients due to a lack of national data collection and reporting.

“It is difficult to overstate the catastrophic state of the health service if patients’ expectations are so low that they almost expect being left on trollies in corridors with too few staff to care for them. This is the clearest sign of the flawed thinking within a system that is resigned to managed decline. The reality is that there is no safe level of corridor care, or level of staffing that can make it so.

“The secretary of state pledged to eradicate corridor care by the end of this parliament, but this report shows patients and staff alike do not have years to wait. We need government to stop dragging their feet and come good on the promise to publish national level data on corridor care. That’s how we know how truly widespread it is and the potential harm being done.

“To eradicate this unacceptable practice for good, we need real investment in beds, the nursing workforce in hospitals and the community, and crucially, long-overdue action to boost capacity in social care to improve discharge. Every day that corridor care continues is a policy failure with devastating human consequences.”

Ends

Notes to editors

The investigation acknowledged that patient harm linked to temporary care environments may not always be immediately visible. Harm can occur shortly after a patient is placed in such an environment, but may also emerge over a longer period.

The HSSIB report contains testimony from patients including:

• “The corridor is busy, non-stop. I take a long time to get out of bed and am unsteady on my feet and need help moving around. When it is busy, it’s much harder [to move around] and I’m scared I’ll get knocked off my feet.”

A senior nurse told investigators:

• “I have had a patient collapse on me and been unable to pull an emergency buzzer as there are none. I had to shout and wait until someone heard me. Every second in that situation feels like a lifetime, managing the situation alone and the sense of relief when someone hears you is immense."

A senior sister told investigators:

• “Corridor patients are offloaded from ambulances and are the riskiest patients as their stability is unknown and their potential to deteriorate is greater."

  Throughout the HSSIB’s report into temporary care environments, there are many examples of how patient safety was being put at risk using these spaces.

  In the section on impacting privacy, dignity and patient experience, the report found:

• Patients commenting that they did ‘not want to complain’ and displayed a stoic resilience because they could see how busy staff were and that they were doing their best to look after them and other patients.
• Several patients in temporary care environments in EDs said they had challenges with personal care such as washing and toileting or having to be given invasive treatments such as the insertion of cannulas or drips.
• Patients described being fearful because several people in mental health crisis in temporary care environments were shouting and pacing around the Emergency Department,

• Patients said that getting into and out of bed in a busy corridor could be challenging, particularly for those who were older and frail. They also said if staff were busy, then there was no-one to take them to the toilet and they either had to hold on or soil themselves.

On the impact on staff, the report found:

• The report highlights the clear link between moral injury to staff by not being able to provide patients with privacy, dignity and quality care, and patient safety. The report cites impacting staff’s wellbeing through negative emotions such as guilt, shame and anger stemming from the violation of a person’s moral values.
• Staff spoke about difficulties in having private or difficult conversations with patients.
• Several nurses who had been allocated responsibility for the care of patients ‘in the corridor’ for their shift, told the investigation it was ‘horrible’ caring for people in temporary care environments due to limited privacy and dignity they could offer patients. All the nurses said there was less room around patients to carry out their tasks and it could be difficult to manoeuvre equipment around.

When considering where temporary care environments are used, the report found:

• A nurse told the investigation that an older patient had just had a fall while getting out of their chair in a temporary care environment, saying that they did not have a good line of sight of the patient.

When assessing individual patient risks, the report found:

• There was often no emergency call bells in temporary care environments, especially those located on corridors. Some hospitals had given staff portable bells; however, they often went missing, placing reliance on other patients nearby to support patients with no call bell to gain a staff member’s attention.
• The investigation found a stroke rehabilitation gym that had been converted into a ward when required and causing possible long-term detrimental impact on post-strike patients on recovery of function.