Addressing specific clinical priorities

Never events

Independent providers continue to report never events directly to commissioners and through the LFPSE platform. NHS England’s response to the 2024 Never Event Framework Consultation was published in September 2025. This stated that further engagement and discussion with stakeholders is required to create a new framework. We welcome the basis of the new framework, which should:

• Align with the Patient Safety Incident Response Framework (PSIRF)
• Focus on learning rather than meeting a definition based on strength of barriers
• Reflect patient safety events that are of significant concern to patients.

The existing Never Events Framework will remain active while this new process is in development. While the number of never events relating to the treatment of NHS patients remains small, we continue to strive to reduce never events to zero.

Preventing blood clots

Venous thromboembolism (VTE), commonly known as blood clots, is a significant international patient safety issue. The first step in preventing death and disability from VTE is to identify those at risk so that preventative treatments (prophylaxis) can be given.

The NHS Standard Contract sets an operational standard of 95% of admitted patients aged 16 and over being risk assessed for VTE within 14 hours of admission to hospital, using the criteria in NICE guidance. NHS England collects information from providers of acute elective procedures about their approach to assessing patients for their VTE risk.

In 2025, independent providers carried out VTE assessments for 96.1% of eligible patients, compared to 91.0% by NHS organisations.

Transfers out

We have seen significant growth in the diversity of provision in the UK over the past few years both from independent providers and from within the NHS estate. For example, we have seen numerous new community diagnostic providers reporting imaging and other diagnostic activity, and the NHS has 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. We 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. This includes comprehensive pre-operative assessment and health optimisation to ensure patients are clinically suitable for their planned procedure.

Pre-operative optimisation – such as stabilising long-term conditions, managing risk factors including anaemia, diabetes or hypertension, and ensuring patients are appropriately prepared for surgery – plays an important role in reducing avoidable complications and the likelihood of deterioration.

Data from PHIN shows that around one in seven independent sector providers has the ability to care for Level 2 and Level 3 higher acuity patients in intensive care (ICUs) or high dependency units (HDU). This separation of care is similar to the NHS as 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 774 unplanned transfers of privately funded patients (including from NHS Private Patients Units) for the 12 months to June 2025 – representing 0.08% of the total 940,095 discharges.

Patients may require transfer for a variety of reasons, many of which are unrelated to the quality of care or treatment received and do not necessarily indicate that the patient has received substandard care. For example, sudden clinical events such as a stroke, the identification of incidental findings requiring specialist investigation or treatment, or an acute diagnosis during an outpatient appointment may all indicate the need for transfer. In such circumstances, transfer is a precautionary and appropriate clinical decision to ensure the patient receives care in the setting best equipped to meet their needs