Briefing for the debate on petition P-06-1534 End corridor care in Wales
Key points
Corridor care or other temporary escalation spaces (TES) is a consequence of system-wide challenges, including issues with patient flow.
Our members recognise that treating patients in corridors and other TES is unsuitable, undignified, can be unsafe and is frustrating for patients and their families, leaving NHS staff unable to provide the care they would like to.
NHS leaders and frontline staff work incredibly hard to keep patients safe. With rising demand on the NHS, in part due to an ageing population and more people living with multiple long-term health conditions, NHS leaders and hospital staff are left with no alternative but to make difficult decisions to manage risk within the health and care system.
NHS leaders don’t want to see ‘corridor care’ replaced by (ambulance) ‘car park care’. A ban on using TES could force more ambulances waiting longer at Emergency Departments (EDs). This might decrease the risk of harm for the patients waiting at EDs, but it will slow response times to other (possibly more serious) emergencies, leading to harm elsewhere in the system and in our communities.
While there is a drive to provide alternatives to admission to EDs - such as through Same Day Emergency Care Centres, minor injury units and advanced paramedic practitioners providing specialist care in the community – demand and capacity issues in the rest of the system, such as in primary, community and social care, tend to inadvertently push demand back onto EDs, which is open 24/7.
At any one time, roughly 15% of beds in the Welsh NHS are occupied by patients who are clinically optimised' ready to return home or move on to the next stage of care (medically fit to be discharged) but cannot do so because there is no available package of care for them and their needs. This is due to the need to desperately reform the social care system across the UK to stabilise the market and achieve consensus on sustainable solutions.
Health leaders continue to work on the root causes of corridor care provision/ TES, targeting flow through the system by improving patient discharge, working with local authorities to improve social care support – a key in preventing demand - and prioritising vulnerable older patients at the ‘front door’ through increased frailty screening.
However, this is not enough. NHS leaders therefore urge the following areas are prioritised:
- Sustainability of social care sector: Stabilising the social care sector through radical reforms and long-term investment to support patient flow and keep people out of hospital, preventing the prevalence of corridor care.
- Prevention and early intervention: Sustainable emergency care and hospital capacity for those who need it most requires a strong focus on prevention and early intervention to significantly reduce the number of patients requiring emergency hospital admission.
- Capital: A comprehensive, 10-year capital investment strategy for health and social care, including exploring alternative mechanisms to generate capital investment, to modernise facilities, upgrade equipment and improve digital systems. This would improve productivity, patient safety and experience.
- Workforce: NHS leaders stress the urgent need for a clear, costed, long-term health and social care workforce plan from the Welsh Government to ensure both hospitals and community settings can sustainably meet future demand and support the workforce.
Priorities
Social Care
The stagnation of patient flow has severe consequences across the health and social care system. In hospitals, limited capacity forces patients to be treated in unsuitable spaces such as hallways and waiting rooms, compromising safety, dignity, privacy and timely care, while harbouring access to essential equipment and appropriate monitoring. Blocked flow also leaves patients waiting in ambulances, causing handover delays that reduce response times in the community and limit beds for planned care.
These delays stem from whole-system pressures, particularly the fragility of social care services. When social care is under-resourced, patients who are medically fit for discharge cannot leave hospital, occupying beds needed for those with more acute needs. This creates a chain reaction: ED patients cannot move onto wards, hospital entrances become blocked, and ambulances are prevented from responding to further emergencies in the community, worsening ambulance response times.
Remaining in hospital longer than needed also increases the risk of a patient catching a hospital-acquired infection and speeds up deconditioning. For every 10 days of bed rest in hospital, a person over the age of 80 will experience 10 years of muscle ageing. These factors can make it harder for people to recover, regain their independence and lead to a higher likelihood they will need more enhanced care and support on discharge. A hospital bed is also the most costly, and often the least appropriate, part of the system for someone to be cared for.
The NHS and social care are intrinsically linked. Stabilising the social care sector through radical reforms and long-term investment is key for keeping people well at home and preventing their conditions from escalating to the point where they require emergency hospital admission in the first place.
Prevention
Prevention and early intervention play a foundational role in demand on the health and care system and patient outcomes. By strengthening early intervention services, the system can help people live well in their homes, preventing them from reaching the crisis point that necessitates an emergency hospital admission. There needs to be an increased focus on community-based support rather than acute hospital care. For example, there are targeted falls prevention initiatives in place to help reduce the number of frail people falling and requiring admission to emergency departments.
Prevention via public health programmes deliver an average return of £14 for every £1 spent, proving that investment in prevention makes both moral and financial sense and is vital for the sustainability of our health and care services. A key example is the widespread uptake of vaccinations, which have a huge impact on the prevalence of seasonal respiratory illnesses like flu and are drivers of hospital admissions.
Sustainable emergency care requires a strong focus on prevention and early intervention to reduce the number of patients presenting to the ED. Every admission prevented frees up capacity, reducing ambulance delays and helping patient flow. To ensure prevention is prioritised NHS leaders are calling on the next Welsh Government to deliver a cross-government national strategy to improve health and wellbeing.
Capital investment
The lack of sufficient long-term funding for capital investment significantly contributes to and exacerbates the need for corridor care in Wales. Maintaining, modernising and expanding the NHS estate (buildings, equipment and digital infrastructure) is crucial for efficient patient flow and infection control. As highlighted by the Health Foundation, the UK has invested poorly in health capital compared to peer nations for decades, spending approximately 55% less than the EU-14 and £33 billion less between 2010 and 2024 than comparable OECD countries. Older hospitals often have rigid designs and cannot be easily adapted or expanded and hundreds of millions of pounds of capital budgets is spent on making old infrastructure safe. This means there is a fixed and insufficient number of appropriate clinical spaces forcing staff to use corridors, waiting areas and temporary rooms when patient demand exceeds the original design capacity.
Our members call for the next Welsh Government to commit to a comprehensive, 10-year capital investment strategy, including exploring alternative mechanisms to generate capital investment. This must be comprehensive, covering not just essential maintenance but also modernising buildings and equipment and upgrading digital infrastructure. This will enable the NHS and social care to drive efficiency, productivity and sustainability, while improving patient outcomes and the physical working environment for staff.
Workforce
Corridor care impacts NHS staff who are sometimes unable to provide the standard of care they are professionally committed to deliver, leading to burnout and low morale. Corridor care indicates challenges in the system, including staff shortages in the face of overwhelming demand that outpaces the available resources and facilities.
NHS leaders stress the urgent need to invest in a long-term plan for the NHS and social care workforce and their education to ensure hospitals and community settings can meet future demand and the changing needs of patients. This will enable the implementation of multi-professional, digitally enabled, motivated, engaged and valued workforce across the NHS and social care.
Conclusion
There are many reasons why treating patients in corridors or TES is unsuitable and NHS leaders are committed to addressing the root causes. This includes trying to improve flow through the system by improving patient discharge, working with local authorities to improve social care support, and prioritising vulnerable older patients at the front door. Our members advocate for further integration between health and social care and welcome Welsh Government initiatives that focus on effective prevention, moving services into the community and rethinking capital investment to upgrade outdated hospital infrastructure.
Further information
If you would like further information on any of the issues raised in the briefing, please contact Nesta Lloyd Jones on Nesta.Lloyd-Jones@welshconfed.org
The Welsh NHS Confederation is the only membership body representing all the organisations making up the NHS in Wales: the seven local health boards, three NHS trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales and Health Education and Improvement Wales). We also host NHS Wales Employers and are part of the NHS Confederation.
