Corridor care: the unacceptable new norm in hospitals
Researcher
On Monday, a new report by the Royal College of Physicians (RCP) confirmed just how widespread ‘corridor care’ now is in NHS hospitals. The answer: very.
Corridor care – when hospital patients are treated in inappropriate spaces, including corridors, supply cupboards, gyms and offices – haunts the NHS, now seemingly, all year round. While this used to only be a feature of hospitals in their annual ‘winter crisis’, RCP found between June and August, 59 per cent of clinicians the RCP surveyed had delivered corridor care.
This type of care is unacceptable even as a one-off, let alone as part of the standard day-to-day operation of hospitals. Not only does it risk patients receiving lower quality care, it also fundamentally undermines patient privacy, dignity and confidentiality.
Many cite insufficient hospital capacity as the cause, suggesting demand for hospital services dramatically outstrips available supply. But it is well established that the supply of staff and services in hospitals has grown faster than demand, all while corridor care and so-called capacity issues have become more prevalent. In turn, this obscures the true cause.
In reality, corridor care is typically the result of poorly managed patient flow – the movement of patients in, out and through hospitals.
Poor patient flow is the root of almost all hospital crises, from overcrowding and delays, to avoidable mistakes, cancelled elective procedures and fragmented care. This means patients medically ready to be discharged remain stuck in hospital beds for days or weeks, patients wait hours in ambulances outside hospital doors, and admitting a patient from A&E to a ward is painfully slow.
That said, it is true the physical hospital should only be for those patients who absolutely need to be there. And the current reality is far from this, in turn increasing demand on hospitals and exacerbating patient flow problems.
Initiatives such as the recently announced virtual hospital, NHS Online, help the hospital to be just that. By treating more patients virtually, this frees up beds and capacity for patients needing in-person care.
But this won’t be enough, and risks underestimating the structural problems that drive unacceptable patient flow. The ‘solution’ to patient flow problems has typically been to create more beds – more space for patients to go. But creating more hospital capacity doesn’t enable discharges to be delivered more efficiently on the weekend, doctors to make decisions more quickly or more managers to smooth the transitions between hospital departments.
If anything, more resources only serve to entrench the current, inefficient model, rather than incentivise its fundamental reform. Only with radical change will the right staff, clinicians, diagnostics and treatments be available at the exact time and place they’re needed – the foundation of effective flow.
What this change should look like, and how to deliver this, is the topic of Re:State’s third and final ‘Hospital of the Future’ paper, publishing next week. With 26 recommendations, Hospital of the future: ending the patient gridlock comprehensively details how to align capacity and demand, achieve operational efficiency, and resolve both internal and external bottlenecks.
For too long, it has been assumed the problems facing hospitals will resolve themselves if demand can be reduced. This oversimplification has meant the inner workings of hospitals have remained opaque. As we head into what is widely expected to be a particularly severe ‘winter crisis’, with sky-high waiting lists, far-from-met Government targets, and rock-bottom patient satisfaction, this cannot continue.
For the benefit of patients, hospitals and the public purse alike, it is more vital than ever that policymakers begin gripping the issue of patient flow.