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Guess what… winter is coming… again… no surprise there, and…
… unsurprisingly… familiar headlines…
‘NHS overwhelmed,’ ‘patients on trolleys’, ‘delayed admissions.’… but there’s more to the story.
Last year, 1.88 million patients in England spent more than 12 hours in A&E. Of those, over half a million, that’s roughly 28%, waited, up to an extra 12 hours after a decision to admit. (A number-fest is here)
Corridor-care in its most brutal form. A system groaning under pressure.
Not all hospitals are equal in this struggle. Reporting and analysis repeatedly flags a small handful of trusts as the ones who struggle the most…
… I could name them, but I won’t.
They have enough aggro to deal with. If I know who they are, they will and so will NHSE.
These are the Trusts that see the longest waits, the highest trolley counts. Patients who bear the brunt of a system stretched to breaking point.
However, before we embark on a round of Streeting-manager-bashing, board- beatings, or hospital shaming we need to be clear…
... high numbers don’t necessarily mean poor intent or poor leadership.
Often, it reflects structural pressures. High bed occupancy, delayed transfers of care, frail populations, staffing shortages and the lack of community support.
Trusts trying to run a system too big for the space. In places too small for the demand...
... adult bed occupancy routinely in the 93–96%. Well above the widely cited safe, ~85% threshold.
The places where corridor-care counts are the worst, account for perhaps ~30 % of the national numbers.
Targeting resources would very likely give disproportionately good returns.
The fact is; hospital estates, built for smaller populations decades ago, are now under strain from far bigger demand... 18% of the acute provider estate pre‑dates the NHS and 43% is more than 30 years old.
Overlay that with high patient flows and you have a perfect storm of corridor care.
When the risk is concentrated in particular trusts, in common they usually have buildings, workforce and systems stretched beyond design, the fix is not just more beds…
… it’s hospital by hospital, trust by trust, understanding where the bottlenecks are and targeted action.
It doesn’t help that the data is opaque.
Two separate 12-hour metrics exist. One from arrival to departure. One from decision to admit.
Full conformance with the latest version of Emergency Care Data Set, Version 4.0, was not achieved by the July 1, 2025 deadline because of updating clunky IT systems and has been extended to July next year.
Note to Streeting; get on top of this.
That leaves us with national totals and press reporting but I can't see a clear definitive picture of where interventions would do the most good.
We need to know exactly where the problem is, how big it is and what’s driving it. Without that, winter planning is winter-wonder-land.
Present solutions are a patchwork of; ring-fenced beds, discharge-to-assess pathways, virtual-wards and surge wards.
Longer-term; we need a social care system that can support timely discharge… but Streeting and his band of advisor-has-beens, run-away from dealing with the real problems that could make a difference.
Fewer people are funded for long‑term social care despite rising demand. The result, acute hospitals face greater inflow and slower discharge.
Be under no illusion; the waits start on Streeting’s desk in Whitehall and end with yer granny on a trolley, in a corridor near you.
TPart of the problem is, corridor care has been demonised. I understand why.
Corridor care. Say the words. People think chaos, failure, shame., but…
… walk into those corridors, watch the nurses, the doctors, the healthcare assistants and you see something very different.
Improvisation under impossible pressure. People doing everything humanly possible to keep patients safe.
Is corridor care a moral triumph. Or a moral outrage?
It’s both.
A testament to the people prepared to work in these conditions rather than walk away…
and …
...an outrage that the system has been starved of capital investment for decades and now faces chaotic political leadership…
… unfunded reorganisation and fairy-tale IT.
System overload is not unheard of in other countries, Ireland and Australia have experienced it…
... but England is a huge outlier with about about 2.4 hospital beds per 1,000 population versus an average of almost double that across OECD countries.
Winter is a predictable challenge… and the DH+ (because they're effectively running the show) cannot simply repeat the same assumptions year after year and hope for a different outcome.
Corridor care is horrible but not inevitable. It's measurable. That means we can figure out what to do to fix it.
It's also a tribute to the people who try to make it work and a shameful condemnation of the failure of politics.
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