‘Energy and focus’ needed outside hospitals to reduce corridor care, says RCN

The government must put greater ‘energy and focus’ into care delivered outside of hospital settings to help eliminate corridor care, an influential committee of MPs has been told.

Royal College of Nursing (RCN) chief executive and general secretary Professor Nicola Ranger warned nurses working in emergency departments (ED) had grown ‘ashamed’ by the level of care being provided and, in some cases, felt unable to even give patients eye contact.

Professor Ranger was giving evidence to the health and social care committee this morning when she advised that a solution to corridor care, which has recently been defined by NHS England (NHSE), was to give greater attention on discharging patients or preventing the admission of patients who could be treated elsewhere.

‘I think this is how we got in this mess. Risk isn’t something we spread… inch by inch by inch we’ve got compromises and that is what happening now.

‘If we had actions to mitigate right in the beginning, then maybe we wouldn’t have got in this mess. Where is the focus [on people who don’t need to be in hospital]?

‘There are nursing homes, there is availability for patients in other settings – that’s where we need to put energy and focus.’

Professor Ranger called for ‘a date and time where we say [corridor care] is going to stop’.

Related Article: Reframing eating disorder recognition in primary care

Concerns have previously been raised by the RCN about shortages in community nursing, GP access and social care fuelling hospital overcrowding and forcing treatment into unsafe corridor spaces.

Professor Ranger warned the committee today that there are ‘still 24,000 nursing vacancies’ across England.

Secondary care minister, Karin Smyth, was also questioned by MPs in the same meeting, and was asked whether the government had plans to increase intermediate and community care capacity.

The minister acknowledged that more funding was being invested into the acute sector instead of the community and said it is ‘urgent’ a shift is made. However, she did not specify any identifiable plans to improve capacity.

During the committee meeting, Professor Ranger added that nurses feel ‘ashamed’ by the level of care provided in EDs and are avoiding eye contact with patients.

The chief executive highlighted a survey conducted by the RCN last year in which more than 5,000 nursing staff shared their ‘harrowing experiences’ of caring for patients in inappropriate places.

‘When patients are struggling for a nurse to give them eye contact that is not a good place to be, when nursing is about vigilance and care,’ said Professor Ranger.

‘That’s a real symptom of many nurses not feeling proud of what they’re doing. This is an emergency, we cannot get to a place where people don’t feel proud about what they’re doing.’

Sarah-Jane Marsh, national priority programme director for urgent and emergency care for NHSE, agreed that primary and community care was part of the solution, warning that older patients often had the longest discharge times but ‘shouldn’t have been admitted in the first place’.

‘[We need to] identify who [the patients] are so we can look after them in primary care,’ she said.

‘Then they have a team looking after them who are multidisciplinary. If they then deteriorate and become unwell in the community, the response should come from people who know them and care for them at home.’

Kelly McGovern, chief nursing officer at West Hertfordshire Teaching Hospitals NHS Trust, was also among the panel questioned by the committee and was praised by Professor Ranger as an organisation that was managing corridor care well.

Related Article: Research raises questions about vitamin D and calcium supplements for fracture prevention

Ms McGovern told the committee a reason for that was the level of care management outside of the hospital setting.

‘We are managing outside, we are doing neighbourhood health, virtual hospitals, I could tell you 100 things we are doing,’ she said.

The sessions comes after a new definition of corridor care was recently established by NHSE to help collect and analyse data on the scale of the situation across the country.

Professor Ranger also told the committee that, though the RCN was ‘pleased’ about the new definition for corridor care, it felt that data only forms part of the solution.

‘The only thing that will totally make a difference is the genuine culture to say this is unacceptable,’ she said.

‘Data can be played off to say whatever you want, that’s why we need to make this about people and patients.’

Speaking after the meeting, committee chair Layla Moran said: ‘We heard harrowing stories of hospital staff feeling demoralised, even embarrassed, by what patients are experiencing in overcrowded hospital corridors and make-shift spaces. In these conditions older patients are more like to suffer falls and may not have access to call bells.

Related Article: District nurse referral forms reviewed after coroner’s concerns over patient death

‘We urge the Government to get to grips with underlying problems. Under-resourced social care services are limiting hospitals’ ability to discharge patients, and stronger community services are needed to reduce unnecessary admissions and free-up beds in hospitals.’

It is expected that the first recorded data on corridor care will be available in May, as advised by Ms Smyth.

Published on 4 March, the definition states that for general and acute beds, corridor care relates to the number of patients who are receiving care for more than 45 minutes on a ward outside of a bed space.

For EDs, it said corridor care is the number of patients who received care in an ED corridor for more than 45 minutes within the previous 24-hour reporting period. This includes patients receiving treatment, waiting for admissions, or transfer.