More patients left in corridors to free up ambulances

More and more UK hospitals are leaving patients in corridors due to a lack of bed space. NHS bosses say so-called corridor care is freeing up ambulances and saving lives, but BBC Newsnight has spoken to patients who say the growing practice is humiliating and degrading.

Gregory Knowles counted 13 other patients alongside him on a corridor at the Norfolk and Norwich University Hospital (NNUH) in March. Complications after an operation put him back in hospital and on to a ward but at 04:00 one morning he was moved.

The 68-year-old was wheeled in his bed to reception. "I was waking up with people around me. It was horrendous," he told the BBC.

"I had no screens and no facilities for water or for really getting changed. My possessions were on the bottom of the bed. My daughter and partner were as horrified as I was," he said.

His partner Alicia Goulty described how staff had been too rushed to attend to him.

"One day when we got there his catheter had leaked in the bed when he was on the corridor. He was wet with no covers or any screens and I had to take him to the bathroom to get him cleaned".

Ms Goulty said her partner's medication had been missed.

"We had to ask for water for him. We had to ask sometimes for his meals because he got forgotten."

It would be three days until there was room to move Mr Knowles from the corridor and back to a ward.

Another patient admitted to NNUH in March described being "distraught" when she was put in a corridor opposite a nursing station alongside three others.

A nurse at the hospital, who asked to remain anonymous, said: "It's horrible for your patient to say to them, 'This is where I'm going to leave you'. You come into work to be a carer. You want to do it in the best way possible and sometimes you're coming into a situation where you can't do that."

Since 2022, hospitals like NNUH have increasingly adopted a new way of working called the Continuous Flow Model, in which patients are sent from A&E to wards and other areas even if they are full.

They have done this to address soaring ambulance waits outside A&E as paramedics try to offload patients.

In the UK, the model started at the North Bristol NHS Trust and was then implemented at the 10 hospitals with the most delays, according to NHS board papers.

These documents indicate at least 36 hospitals have now adopted the system or a version of it. Some implementations involve "drip-feeding" patients from A&E.

But it often means hospitals will have to put patients on beds in corridors, albeit in a planned and risk-assessed manner.

Trusts have adopted it reluctantly, they say, but it now allows ambulances to get to the sickest patients quicker.

Lesley Dwyer, NNUH chief executive, said demand for beds was forcing tough choices. "We are committed to reducing ambulance delays outside our hospital, which we know is saving lives by improving 999 response times by freeing up ambulances quicker to get to patients in our community."

Back in February, the interim chief executive of NNUH, Nick Hulme, said they had cut ambulance handover delays - but that it had come at a cost.

He said the risk had been moved from outside hospital into corridors but that it was "better for the community".

Prof Steve Hams says the Continuous Flow Model has "without question" saved lives.

The chief nursing officer at North Bristol NHS Trust points to a dramatic improvement in ambulance performance.

The trust pioneered the model during the summer 2022 heatwave amid a spike in admissions. It still struggles to discharge mostly elderly patients deemed fit to leave.

Prof Hams described how ambulance response times to heart attack and stroke patients had more than halved. Average hours lost to ambulance waits outside of A&E had plummeted from 139 hours a day to just six, he said.

Newsnight was taken to a complex care ward at Bristol's Southmead Hospital.

In the corridor was a bed on stand-by but the trust ensures nobody spends the night there with just one such patient per ward. Screens are available to protect patient privacy.

Prof Hams adds what while the model works at his trust, it may not be right for others.

"Caring for people at the end of a corridor is something none of us aspire to do and it is certainly something we would not wish to do here. But on the balance of risk, the safety risk of both our patients and citizens in the community, it's the right thing for us to have done," he said.

However, the Royal College of Nursing has criticised the model for just moving risk, rather than solving it. And the Royal College of Emergency Medicine warned the model was not a "silver bullet".

Dr Louella Vaughan, a medical researcher, said she had concerns about safety.

"If you look at the literature there is absolutely evidence that overcrowding on a ward increases mortality," she said, adding trusts were "rushing" to implement the model because it appeared to work.

"I know of places where an email was sent on a Thursday to say it was being put in on a Monday."

One of the major impediments to freeing hospital bed capacity appears to be worsening.

Across England, patients fit for discharge but unable to leave was on average 59% higher in April than three years ago, according to NHS data., external

Analysis for Newsnight by The Health Foundation also indicates demand is outstripping bed capacity and getting worse.

It estimates the NHS will need 21,000 more beds by 2030 as the population ages and more people develop multiple health conditions.

NHS England told the BBC it had no plans to conduct a national evaluation of the corridor scheme.

"NHS trusts across the country use a variety of models and measures to improve their own flow and we continue to monitor these to identify safe and effective solutions," it said.

The Department of Health and Social Care said: "We have delivered on our pledge to create 5,000 extra permanent hospital beds and more than 10,000 hospital at home beds, freeing up capacity and cutting waiting times."

​​It added that £1.6bn of funding over two years had been provided to support the NHS and local authorities "to ensure timely and effective discharge".