Testimony from nurses regarding the overwhelming pressure on A&E departments across the UK has rightly shocked the public and the health secretary, Wes Streeting. The alarming yet unavoidable conclusion of a new report from the Royal College of Nursing (RCN) is that “corridor care”, as treatment given in hallways or other unsuitable areas is known, has been normalised to a disturbing degree.
The accounts of 5,408 nurses came in response to a survey launched before Christmas to counter the lack of official data and national oversight of rising A&E pressures. It reveals the increased medical risks that follow from patients being treated away from wards, for example due to the lack of access in these spaces to supplies, including oxygen. Nurses also explained the psychological distress caused. Lack of bodily privacy, dignity and having to receive life-changing information in unsuitable conditions were among patient experiences described. Nurses reported trying to look after people in cupboards and even toilets as well as hallways. More than two-thirds said they delivered care in an unsuitable setting on a daily basis.
Additional pressures on hospital beds and ambulance services over the winter months are nothing new. This year, high levels of flu and other viruses have contributed to at least 14 hospitals in England formally declaring a critical incident, which means that staff leave can be cancelled and resources redirected towards emergency care. But the research by the RCN, coupled with the appearance of job advertisements for nurses in which “corridor care” was specified, has raised awareness dramatically. Last week in the House of Commons, Mr Streeting described the practice as unsafe and cruel. But he said he could not guarantee that it would end next year, as it would take longer than this to undo the damage done to the NHS by the Conservatives.
While the impact on the quality of healthcare, particularly concerns around safety, is the most pressing problem, it is clear from the report that these are unacceptable working conditions that nurses find it hard to tolerate as well. The report reveals their shame and anxiety as well as sympathy for patients. Some described feeling heartbroken or voiced an intention to quit.
Issues with morale are not, of course, limited to nurses. Surveys of family doctors have frequently shown that they suffer from high levels of burnout and compassion fatigue. There have been repeated warnings that unmanageable workloads could lead many more to choose early retirement – exacerbating existing shortages. Ambulance workers have also described feeling overwhelmed by this winter’s crisis. When patients are held in corridors on stretchers, paramedics must sometimes wait with them.
Strengthening the workforce is expected to be a key theme of the 10-year plan for the nation’s health that ministers will present shortly. What the RCN’s report does – with the voices of nurses – is to humanise and highlight a well-known problem. It also brings emergency medicine to the forefront of debate about the NHS, at a moment when ministers have opted to prioritise elective care waiting times. And it highlights the dissatisfaction of nurses, four months after they rejected a 5.5% pay award, making further strike action a strong possibility. There are no easy answers here. The RCN, like the MPs on the health committee who wrote to Mr Streeting about the winter crisis, know this. But staff and patients are right to see this not merely as a problem but a crisis.
