Transfers out

2024 has seen continued growth in the diversity of provision in the UK. Within the NHS estate there were 160 new Community Diagnostic Providers reporting imaging and other diagnostic activity, of which a small proportion are run by independent providers. The NHS has also launched elective hubs where surgery is carried out away from locations that may be affected by pressures relating to emergency services. Similarly, many new day-case locations have been opened by independent providers to offer treatment to NHS and privately-funded patients. 

Against this changing provider landscape, it is important that organisations have arrangements in place for those rare occasions where emergencies arise. Approaches vary and there is no one-size-fits-all right answer, but typically a combination of arrangements may be in place including staff training in critical care and the deteriorating patients, transfers to nearby facilities with more critical care capabilities and on-site arrangements. 

Independent providers are not required to publish these arrangements but around 90% of hospitals that carry out elective activity run by IHPN members publish their critical care arrangements on the PHIN website. IHPN would encourage all providers to be clear about their arrangements at each location. 

Patients should always be treated in the most appropriate care setting and independent healthcare providers, as in the NHS, undertake robust pre-admission processes to establish that they are an environment in which a patient can be safely treated.  

While data from PHIN shows around 1 in 7 independent sector providers have the ability to care for Level 2 and Level 3 higher acuity patients in intensive care (ICUs) or high dependency units (HDU), all independent healthcare providers should have formal arrangements in place with neighbouring healthcare providers who are able to provide the necessary care in the event of a patient’s health deteriorating unexpectedly. The CQC looks at these arrangements as part of their inspection of independent providers.  

This separation of care is similar to the NHS. Around half of NHS locations that offer services such as general surgery, orthopaedics, gynaecology and cardiology do not have an ICU on site.  

Analysis of the latest PHIN data shows that there were 697 unplanned transfers of privately funded patients (including from NHS Private Patients Units) to the NHS for the twelve months to September 2023 – representing 0.08% of the total 804,250 discharges. It is important to note that an emergency transfer does not indicate that the independent provider has been in any way negligent, but rather that a patient’s health has unexpectedly deteriorated or become more serious and needs to be treated in a more appropriate setting.