550 people dying every week in the NHS: we need an urgent plan to tackle ‘corridor care’

The story on the front page of the I Paper should concern everyone involved in the future of the NHS.

New research reported today has found an association between overcrowding in emergency departments and increased mortality. The study examined more than 19,000 adult patients across 134 emergency departments in England, Wales and Northern Ireland. On average, the departments studied were operating at 175% occupancy.

The researchers found that for every 10% increase in emergency department occupancy, the chance of a patient dying within the following 28 days increased by 1%. They estimated that overcrowding could be associated with around 550 excess deaths each week, although the researchers emphasise that the uncertainty around that estimate is wide.

The Royal College of Nursing has responded by calling for “immediate and significant investment” in hospital beds and nursing staff, alongside greater capacity in community services and social care.

That word – capacity – matters.

There are many causes of overcrowding and corridor care. Workforce pressures, delayed discharge and the availability of social and community care are all important. But there is also a basic infrastructure question: does the NHS have enough modern, appropriate clinical space to meet the demands being placed upon it?

Too often, the answer is no.

NHS backlog will take twice as long to fix as in 1990s

The NHS estate has suffered from years of underinvestment. AIIP has previously highlighted evidence that the UK invests substantially less than comparable countries in healthcare buildings, equipment and technology, contributing to fewer beds, ageing facilities and shortages in diagnostic capacity.

The NHS repair backlog now exceeds £14 billion. Meanwhile, delivery of the New Hospital Programme stretches over many years.

The New Hospital Programme, announced by the previous Government in 2020, has been beset by delays. Some of the hospitals planned will not start construction until 2039, while the NAO found that Private Finance Initiative (PFI) hospitals were built “on time and on budget”. 

AIIP analysis of the New Hospital Programme indicates at best you might get 45 hospitals built over the next 25 years. In the 10 years of PFI we built 90 hospitals over 10 years so that's twice the output over half a period of time.

This comes after a report by the centre left-leaning IPPR think tank, which was launched at an event with the Health Secretary Wes Streeting . The report warns of preventable deaths in an NHS which has historically invested half the amount into capital compared to other OECD countries.  

There is no single infrastructure solution to corridor care. But we cannot expect doctors and nurses to end the practice if they do not have the beds, wards and clinical facilities in which to treat patients.

We need to build – and we need to build faster

The Government has already recognised the potential role of partnership with private investors in delivering new NHS infrastructure.

Its plans for 250 Neighbourhood Health Centres by 2036, including 120 by 2030, offer an opportunity to bring more treatment into communities and reduce pressure elsewhere in the health service. The first wave of centres is already under way, including schemes involving the existing NHS LIFT estate.

AIIP believes that ambition should go further.

As Lord Hutton, Chair of The Association of Infrastructure Investors in Public Private Partnerships (AIIP), has argued, modern public-private partnerships could also help accelerate investment in the acute hospital estate – from additional wards and facilities to major hospital redevelopment.

Private investment is not a substitute for the workforce, social care or operational reforms the NHS needs. But it can provide additional capital and delivery capacity at a time when the need for modern healthcare infrastructure is urgent.

Today's findings underline why speed matters.

Patients should be treated in properly equipped clinical spaces, not hospital corridors. If lack of capacity is contributing to unsafe care, increasing that capacity must be part of the solution.

More information:T
Preventing deaths and decay: a capital moment for our NHS
Former Minister warns patients will have to wait twice as long for new hospitals
AIIP response to the NHS 10 Year Health Plan
27 new Neighbourhood Health Centres announced