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RCN warns of treatment in corridors and long trolley waits


Patients are being routinely left on trolleys for hours and treated in corridors and other inappropriate areas, the Royal College of Nursing has warned in the wake of new survey results.

More than a fifth of nurses surveyed said situations where patients received care in corridors or areas not designated for care occurred at least once a day.

The situation was even worse in accident and emergency settings, with 51% of A&E nurses reporting that patients received care in corridors or other inappropriate areas on a daily basis.

Overall, 79% said patient safety was being compromised by patients being kept in such areas.

Almost half of respondents also said they had encountered patients being cared for, or asked to wait for care, on trolleys for long periods in the last six months. Trolley waits averaged six hours and 23 minutes.

The findings from the survey of around 1,250 acute sector nurses and healthcare assistants “raise questions about capacity in some hospitals”, the RCN said. It is calling on trusts to halt bed closures until they can demonstrate that alternative services in the community are up and running.

The survey results appear to demonstrate a return to the capacity problems of the 1990s when headlines about patients being left on trolleys were commonplace. 

RCN chief executive and general secretary Peter Carter said: “Two years ago we warned that the need to make £20bn in efficiency savings in England alone would risk sending the NHS back to the days of treating patients in corridors or areas not designed for care. Sadly, it looks like those days have now returned.

“Treating patients on corridors or areas not designed for care is a high risk strategy, which can have a serious impact on patient care. Patients need to be able to interact with staff, to be able to reach call bells and to know they are visible.

“They also need regular monitoring and easy access to equipment if their condition deteriorates. Finally, patients need to have their privacy and dignity protected.”

However, the College of Emergency Medicine released guidance last month stating that patients should be moved to trolleys in ward corridors to wait for a bed, rather than wait in overcrowded A&E departments. It said that although it was controversial it was the safest way of dealing with hospital capacity problems (news, page 4, 24 April). 

The survey forms part of the RCN’s Frontline First campaign, which was launched in November 2010 and is focused on trying to prevent the loss of NHS workforce capacity.

The college said latest monitoring data from the campaign suggested 26,300 posts had gone in the two years to April with a further 34,700 at risk over the next three years.  

In response to the survey, health minister Simon Burns said: “There is no excuse for patients to be left waiting on trolleys. The NHS has beds free and available, and hospitals should be supporting their nurses to ensure that patients are admitted to them quickly. We will not hesitate to take action where we find hospitals failing to do so.

“With an ageing population, we need to make sure we care for people better outside hospital so that they do not need to go in for treatment. This will help reduce pressure on beds and nurses working in hospitals.

“Over the last year, we have seen the number of emergency admissions to hospital go down for the first time in years, but we need to maintain this improvement so that people stay healthier for longer and that nurses have more time to care for patients in hospital.”

Dean Royles, director of the NHS Employers organisation, which represents trusts, added: “Hospitals and services will have varying demands from area to area and service to service, and NHS employers fully recognise the importance of having the right staffing levels to provide the safest care.

“Organisations need to plan care in a way that is best for the patient. We encourage NHS employers to put the ward sister or charge nurse in the driving seat to plan the right staffing levels and ensure patients get the safest care.”


Readers' comments (14)

  • This problem of using trolleys as beds appears to be common place in the district general hospitals our governments have closed so many beds over the past few years that now with increased populations there are sadly not enough beds available. If we had a pandemic the health service and their staff would not be able to cope effectively.Patients are at a higher risk of developing pressure areas whilst being cared for on these trolleys, it may take litigatious claims against the hospitals for the Healthcare Authorities to take any notice.All of this leaves nurses having to care for extra patients without adequate staffing levels. Managers need to urgently risk assess these areas and ensure staff are well suported importantly managing work related stress amongst their staff.

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  • our hospital is constantly full!!! the emergency department queues all day and more often than not all night too.
    i would like to know where these free bed spaces all hospitals are supposed to have are mr simon burns!!!
    i agree that patients should wait in wards for beds to be available. EDs are constantly pushed to the limits, minimal staff and equipment yet patients still pile in. ED staff struggle to care for vast numbers of patients, if wards and specialities stepped up and actually took some responsability for their admissions im sure the bed crisis situation would soon be resolved.
    another burning issue is hospital bed blocking because there are no placements available for those requiring care or nursing homes

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  • Totally agree with Anon 8:41, where I work in A & E, patients queue in corridors everyday for clinical space. Nurses are forced to decide which of their patients, who are waiting for a bed, are the most suitable to go back in the corridor to allow the sicker patients to come into a space. Whenever the trolleys on wards policy is activated, and only when a discharge for a ward patient is imminent on that ward then all of a sudden things move and beds are found, ward nurses have no idea about managing the risk, why does it take all day to discharge and why does it take almost an hour to clean a bed???? And yes bed blocking is massive in my trust for a number of reasons but mainly social care in Wales is a disgrace.

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  • It is the easiest get-out to blame colleagues for 'assumed' failings. A culture which is endemic in the health service, and I am sick of hearing it. 'Bed blocker' is such a derogatory term. I remember it referring to a piece of inamimate block of wood. Discharging patients is a team effort, which includes family, carers and oustide agencies. Many 'long term' admissions could be avoided if patients had a short admission to sort out their problem in the firdt place. Many of these patients would probably return home, instead of reaching a crisis, deteriorating, losing independence and requiring complex care. I have personal experience of this with my mother, sadly no longer with me. She was admitted on Dec 23rd with severe abdominal pain, discharged against my better judgement on Christmas Eve (come to your own conclusions), only to be admitted a few days later with a perforated DU. She spent 6 months in hospital with numerous complications, most of which were avoidable. She went into hospital independent, still riding her bike, and discharged a frail lady using a zimmer frame, subsequent falls and a broken pelvis, needing myself and carer input for the rest of her life.

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  • I think the two anons at 8.41 and 8.57 are a bit wrong here. To get back at you, why is it that AED staff fill my ward with unsuitable patients, who I can't get to the right areas for days (even weeks), extending their stay in hospital whilst the right team waits to assess them, being nursed by people with poor understanding of their clinical condition ( don't give me that about a qualified nurse being able to do everything, everwhere because they are adult trained) closing my beds to appropriate admissions, just to get them out of the AED because of trolley waits? The amount of times I've been told misleading information from AED staff just so they can get rid of a patient who is about to breach is unfunny.
    This is why nurses are at the bottom, because every time we should show solidarity with one another, we B.W.O on each other instead of blaming the real culprits ( the bed managers!)

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  • Oh dear, Anons blame ward staff, ward staff blame bed manager and so on and so forth. The real problem is the lack of Govt funding to help clear up the log jam created by patients waiting on transitional care. I reallly get annoyrd at A/E nurses who are quick to put down ward staff. They forget what it is like in a busy heavy ward and these two on here seem to think they are some sort of elete. I know from personal experience that when asked to go and clean a bed so a patient can come out A/E staff refused even though they had the staff to do it. Not exciting enough?

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  • Another nasty discussion, who can believe that nurses are attacking nurses. How can we expect any support when staff behave this way. It's hard enough when the media, patients, relatives and management blame the nursing staff for everything that happens in the NHS.

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  • Sad Sad comments. Having nursed for nearly 40 years I find daily nursing duties does not include dasic care or contact with patients. This is partly due to work load but also due to nurses happyand now expected too take on doctors tasks (which they are releived to give away). We need too for the patients sake put the patient in the centre of our day at work. PATIENTS NEED TO BE NURSED

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  • tinkerbell

    Nursing has lost the plot. What really is our role and function anymore? It happened insidiously when nurses took on more and more decisions that were not their remit in the first place.

    First and foremost my role is to take care of the patients in my care. I can only function and do my job properly if i remember that. I am not wonderwoman, (resigned from that role couple of years ago, have to remind myself on a daily basis not to slip back into it.) Managers don't have unrealistic expectations of what i can achieve, don't set me up to fail, i won't go along with that game anymore. You do your job and i'll do mine. I can excel at my job if you do yours properly.

    It is not my job to decide which patient is more in need of bed than another, that is the doctors job. I can pass on my concerns but s/he has to take the ultimate decision and push for that to happen.

    It is not my job to find a bed, that is the bed managers job.

    It is not my job to build beds, that is a carpenters job.

    It is not my job to magic up a bed when there aren't any. That is a magicians job.

    It is not my job to change a light bulb whilst balancing off a 3 legged chair that needs fixing, that is maintenance.

    It is not my job to do all the housekeeping and dusting and washing of patients clothing, that is housekeeping.

    I have learned that if i do everyone elses job then i can't effectively do my own to the detriment of the patients currently in my care and i am making someone else redundant. They don't like it when i remind them 'if i do your job then what do you actually do?'

    I am not bed manager, doctor, admin clerk, housekeeper, handyman/woman, porter, nurse all rolled into one. I am a nurse and i providing hands on nursing care. If i am asked by someone else who should be doing their job to do theirs and mine too i would reply 'sorry i'm too busy with the people'.

    I will not sit endlessly in meetings to discuss the ins and outs of a ducks arse when i should be on the ward. This meeting has come to an end i have to get back out there. You sort out your remit and i'll sort out mine. My wonderwoman days are over.

    I don't ask you to do my job please don't ask me to do yours. I'm going back to my roots - being a nurse.

    Let's keep it a lot more simple so that we can come out with a smidgen of our sanity intact.

    Let's stop trying to please everyone else and leaving our own job undone.

    In these dire times i think the only way is to tell it like it is without all the pussyfooting around. I have become too exhausted to do anything less. I need to save my energy for things i can achieve.

    So Simon Burns stop hesitating and take action, put your money where your mouth is.

    As above says PATIENTS NEED TO BE NURSED. Good slogan for us all to remember when we are called away to do something and someone elses job.

    This is not about being a 'jobsworth' because peoples lives at stake here if i am not allowed to do my job effectively.

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  • I work in ED and I have worked on a ward prior to the ED so I have seen both sides.

    The problem is not in ED, which is very easy to blame (something our trust managers have done on many occasions)as we are the front entrance to unplanned admissions.

    ED may make inappropriate admissions, but that is because medics would rather err on the side of caution (rightly or wrongly), because if they did discharge someone who then was readmitted through the ED then they would be hauled over the coals by senior medics and the ED would not meet one of the Care Quality Indicators.

    The wards are not to blame, they are as stretched as we are.
    The problem is systemic:

    a)wards are being closed to 'save' money

    b)trusts are being run as businesses with departments/divisions being seen as 'profit' centres; the concept of the NHS as a non-profit making organisation is alien to the people brought in to manage the trusts..

    The one thing that I have to come to hate is this business of different areas blaming each other. We are supposed to be on the same side working as a team, not at each others throats.
    The system/service cannot change whilst this is happening. Divide, conquer and rule is the order of the day and it is working.

    Overcrowding in the ED has an adverse effect on patient treatment and ultimately mortality. The same is probably true on overcrowded wards.

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