Recurring concern

Unreliable hospital acceptance arrangements for patients requiring treatment

First to latest report 14 Nov 2014 — 16 Apr 2025

Reports that mention this concern: 4
Times this concern has been raised: 6
Stated actions linked to this concern: 8

What this concern includes

Includes failures in hospital or emergency-department arrangements for accepting patients requiring treatment, including absent or unclear acceptance procedures, criteria, responsibilities, inter-hospital or cross-agency agreements, and communication needed to determine and safely implement acceptance.

What is not included

Excludes clinical treatment, assessment or admission failures after a hospital has reliably accepted the patient.
Excludes general hospital bed shortages, referral delays or transfer problems where the acceptance decision or acceptance arrangements are not themselves deficient.
Excludes generic communication, staffing or policy deficiencies without a direct hospital acceptance-process connection.
Excludes routine eligibility, commissioning or administrative decisions unrelated to safely accepting patients for treatment.
Excludes the existing concern on cross-Trust transfer arrangements when the assertion concerns transfer after acceptance rather than the hospital acceptance decision itself.

Trends

Reports over time

Reports mentioning this concern, over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

NHS England2

Cleveland Police1

Department of Health and Social Care1

Foreign, Commonwealth & Development Office1

Home Office1

Independent Office for Police Conduct1

Legal representatives of the interested persons1

Maidstone and Tunbridge Wells NHS Trust1

NHS South Tees Clinical Commissioning Group1

The Hospital of St Thomas the Apostle in Doncaster1

Reports and published responses 4 reports

See individual reports that have raised this concern, and the actions taken in response

16 Apr2025
Inner West London
Concerns raised1
1. Lack of a set procedure for UK hospital acceptance of patients from other countries
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses

Foreign, Commonwealth & Development Office
NHS England
Respondent positions 4
1. NHS England
  The concerns about procedures for accepting foreign patients fall outside NHS England’s remit.
  Outside remit
1. NHS England
  DHSC and FCDO are identified as the more appropriate organisations to respond to concerns about accepting foreign patients for treatment.
  Redirects responsibility
2. NHS England
  Acceptance of foreign patients by NHS hospitals is governed by existing local procedures rather than a national procedure.
  Existing arrangements considered sufficient
3. Foreign, Commonwealth & Development Office
  Responding to the concern falls outside the respondent’s remit and is instead a matter for the Health Department.
  Outside remit
AI-generated summary

Abdulrahman AlAjmi · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Abdulrahman AlAjmi died at the London Clinic on 7 August 2024 from multiorgan failure after arriving in the UK for medical treatment in a substantially poorer condition than had been reported. The report found that the flight probably contributed to his death by exacerbating serious pre-existing medical conditions. Concerns included the absence of uniform systems for accepting and transferring overseas patients, ensuring that receiving services have accurate and up-to-date medical information, and safely treating patients who arrive more unwell than anticipated.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of a set procedure for UK hospital acceptance of patients from other countries
Wider context from the report
“1. In the course of the evidence it was confirmed that there is no set procedure regarding the acceptance by hospitals in the UK of patients for treatment from other countries. ”
Source location
Abdulrahman AlAjmi · Prevention of Future Deaths report
Page 1 · concerns
Open source report
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
The concerns about procedures for accepting foreign patients fall outside NHS England’s remit.

Verbatim wording from the response
“The concerns raised in your Report do not sit within NHS England’s remit. NHS England notes that the Coroner has also addressed your Report to the Department of Health and Social Care (DHSC) and the Foreign, Commonwealth and Development Office (FCDO) who are the more appropriate organisations to respond to your concerns. Where we are able to, NHS England will be happy to support these organisations in addressing the concerns raised.”

Source location
Response from NHS England
Page 1 · response
Published 24 April 2025
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
DHSC and FCDO are identified as the more appropriate organisations to respond to concerns about accepting foreign patients for treatment.

Verbatim wording from the response
“The concerns raised in your Report do not sit within NHS England’s remit. NHS England notes that the Coroner has also addressed your Report to the Department of Health and Social Care (DHSC) and the Foreign, Commonwealth and Development Office (FCDO) who are the more appropriate organisations to respond to your concerns. Where we are able to, NHS England will be happy to support these organisations in addressing the concerns raised.”

Source location
Response from NHS England
Page 1 · response
Published 24 April 2025
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Acceptance of foreign patients by NHS hospitals is governed by existing local procedures rather than a national procedure.

Verbatim wording from the response
“While we note that, in this case, the receiving hospital was private and not under NHS jurisdiction, it is currently the case that any acceptance of a foreign patient by an NHS hospital would be subject to local procedures. We have therefore ensured that North West London Integrated Care Board (NWL ICB), the host ICB for the London Clinic, are aware of Abdulrahman’s case and the concerns raised in your Report for assurance purposes.”

Source location
Response from NHS England
Page 1 · response
Published 24 April 2025
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Responding to the concern falls outside the respondent’s remit and is instead a matter for the Health Department.

Verbatim wording from the response
“I don't believe a response sits within my remit and seems more for the Health Department [DHSC].”

Source location
Response from FCDO
Page 1 · response
Published 24 April 2025
Open published response
17 Feb2016
Mid Kent and Medway
Concerns raised1
1. Delays in securing acceptance by an appropriate vascular site
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Matthew Crowley · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Matthew Crowley, aged 39, presented to Maidstone Hospital acutely unwell with sepsis and multiple organ failure, and died at Pembury Hospital at 06.47 on 10 June 2015 after transfer. The report identified concerns including delays in triage, senior medical review, treatment escalation, decision-making and transfer, as well as inadequate communication with the receiving ITU.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Delays in securing acceptance by an appropriate vascular site
Wider context from the report
“(4) Despite a vascular site declining to accept the patient until his renal function was optimised and a CT angiogram performed, a delay was caused by enquiries being made whether a second vascular site would accept the patient ”
Source location
Matthew Crowley · Prevention of Future Deaths report
Page 2 · concerns
Open source report
14 Dec2015
Central and South East Kent
Concerns raised1
1. Delays in accepting transfer of suspected aortic dissection patients while awaiting CT imagery
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response

Guy'S and St Thomas' NHS Foundation Trust
Stated actions 2
1. Guy'S and St Thomas' NHS Foundation Trust
  Clarify and reinforce to cardiothoracic registrars that aortic dissection referrals must be discussed immediately with the duty consultant, who decides transfer and any pre-transfer CT review.
2. Guy'S and St Thomas' NHS Foundation Trust
  Extend the open-door policy to ascending-aorta and arch dissections, enabling consultant-authorised immediate transfer with guaranteed theatre and critical-care capacity.
Respondent positions 1
1. Guy'S and St Thomas' NHS Foundation Trust
  Clarified consultant escalation and guaranteed immediate transfer arrangements are considered sufficient to prevent recurrence of confusion and delay.
  Existing arrangements considered sufficient
AI-generated summary

Kevin John Gilbert · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Kevin John Gilbert suffered an aortic root dissection on 29 January 2015 and died after cardiac arrest during transfer from William Harvey Hospital to St Thomas’ Hospital. The concerns included confusion about transfer protocols, delay in accepting him for transfer, and refusal to escalate the decision to a consultant; the report stated that his chances of survival would have been greater had the delay been avoided.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Delays in accepting transfer of suspected aortic dissection patients while awaiting CT imagery
Wider context from the report
“• Given that Mr Gilbert was presenting at William Harvey Hospital as an acute emergency requiring specialist surgery at a tertiary centre and that his diagnosis of suspicion made on presenting clinical symptoms by a Consultant in Accident and Emergency medicine which was confirmed by CT scan, it was not reasonable for ████████ to rely on his understanding of the procedure of accepting such patients and wait for the CT imagery before agreeing that he could be transferred. ”
Source location
Kevin John Gilbert · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Clarify and reinforce to cardiothoracic registrars that aortic dissection referrals must be discussed immediately with the duty consultant, who decides transfer and any pre-transfer CT review.

Verbatim wording from the response
“In January 2015, shortly after Mr Gilbert died, the referring consultant wrote to Mr Avlonitis, consultant cardiothoracic surgeon and raised concerns about the delay in transfer. Following receipt of the letter Mr Avlonitis wrote to all registrars in the Cardiothoracic Department to clarify the department’s process for accepting dissection referrals. He confirmed that all such referrals must be discussed immediately with the duty consultant and any decision to ask to review CT imagery before transfer could only be made by a consultant. The text of the email is shown below.”

Source location
Kevin-GILBERT-Response
Page 2 · response
Published 14 December 2015
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Extend the open-door policy to ascending-aorta and arch dissections, enabling consultant-authorised immediate transfer with guaranteed theatre and critical-care capacity.

Verbatim wording from the response
“I would also like to make the Coroner aware of a more recent change to the management of dissection referrals at the Trust. It has always been the case that there is an ‘open door’ policy for leaking abdominal aortic aneurysms, meaning they are accepted by the vascular surgical team for immediate transfer if clinically appropriate, with a guarantee that theatre and critical care capacity will be made available. This approach has now been extended to include dissections of the ascending aorta and arch such as suffered by Mr Gilbert. Therefore, from May 2016, any such referral to this Trust will be discussed immediately with the duty consultant cardiac surgeon (as outlined above), who will then be able to authorise immediate transfer if clinically indicated, with that same guarantee that theatre and critical care capacity will be made available.”

Source location
Kevin-GILBERT-Response
Page 2 · response
Published 14 December 2015
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Clarified consultant escalation and guaranteed immediate transfer arrangements are considered sufficient to prevent recurrence of confusion and delay.

Verbatim wording from the response
“The Trust is absolutely committed to learning from incidents and about how care can be improved and delivered more effectively. I am confident that following the email, and the reinforcement of the message by consultant staff, that all junior staff are completely clear that dissection referrals must be reviewed immediately by the duty consultant and they understand that the transfer decision must be made by a consultant.”

Source location
Kevin-GILBERT-Response
Page 2 · response
Published 14 December 2015
Open published response
14 Nov2014
Teesside
Concerns raised3
1. Lack of memorandum of understanding or guideline for taking aggressive detainees to A&E departments
2. Insufficient A&E consultant understanding of which detainees will be accepted for treatment
3. Insufficient police understanding of A&E treatment for detainees
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses

Cleveland Police
NHS Durham Dales, Easington and Sedgefield CCG
NHS Hartlepool and Stockton on Tees CCG
NHS North Durham CCG
NHS South Tees Clinical Commissioning Group
Stated actions 6
1. NHS Durham Dales, Easington and Sedgefield CCG and NHS Hartlepool and Stockton on Tees CCG and NHS North Durham CCG and NHS South Tees Clinical Commissioning Group
  Establish joint guidance for assessing, treating, discharging and communicating information about aggressive or medically unwell detainees attending emergency departments.
2. NHS Durham Dales, Easington and Sedgefield CCG and NHS Hartlepool and Stockton on Tees CCG and NHS North Durham CCG and NHS South Tees Clinical Commissioning Group
  Inform relevant NHS and police staff about the agreed detainee-management guidance.
3. Cleveland Police
  Issue Cleveland Police guidance for managing aggressive detainees transferred to emergency or mental-health services, incorporating agreed police and NHS arrangements.
1. Cleveland Police
  Brief custody staff, medical staff and frontline officers on the new detainee-transfer guidance.
2. Cleveland Police
  Review the effectiveness of the guidance after six months.
3. NHS Durham Dales, Easington and Sedgefield CCG and NHS Hartlepool and Stockton on Tees CCG and NHS North Durham CCG and NHS South Tees Clinical Commissioning Group
  Hold discussions with Durham Constabulary to ensure officers know that patients should be taken to the emergency department.
AI-generated summary

Kirk William Williams · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Kirk William Williams ingested several drugs and displayed highly agitated and aberrant behaviour before being restrained by police. Although one officer considered that he should be taken to hospital, he was taken to a police station and later suffered cardiac arrest and died in hospital. The concerns included differing understandings between police and A&E staff about treating aggressive detainees, and the absence of clear dialogue or guidance for managing such medical emergencies.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of memorandum of understanding or guideline for taking aggressive detainees to A&E departments
Wider context from the report
“(2) Some police officers still consider that notwithstanding that they may be faced with a medical emergency, A&E departments will not treat violent or aggressive patients. (3) The various consultants that gave evidence are clear that they will treat violent patients provided that (a) treatment is warranted and (b) they are provided with sufficient assistance from either or both the police or security staff. (4) It therefore follows that there is a mismatch in perception and expectations between Cleveland police officers and local A&E staff. (5) There did not appear to be a sufficiency of understanding within Cleveland Constabulary about how and whether detainees may be treated at A&E departments. (6) Further or alternatively, the insufficiency in understanding lies with A&E consultants and their perception of what type of patients will be accepted and allowed to be treated in their departments. (7) There does not appear to be a dialogue between Cleveland Constabulary and local A&E departments to address these particular misunderstandings or misconceptions. (8) There does not appear to be any memorandum of understanding or guideline to cover aggressive detainees in police custody being taken to A&E departments. (9) Without a fuller understanding of the true position, police officers will continue to be faced with the perennial dichotomy of whether to take an aggressive medical emergency detainee to an A&E department for treatment or to a police station to prevent self harm or harm to others. ”
Source location
Kirk William Williams · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Insufficient A&E consultant understanding of which detainees will be accepted for treatment
Wider context from the report
“(2) Some police officers still consider that notwithstanding that they may be faced with a medical emergency, A&E departments will not treat violent or aggressive patients. (3) The various consultants that gave evidence are clear that they will treat violent patients provided that (a) treatment is warranted and (b) they are provided with sufficient assistance from either or both the police or security staff. (4) It therefore follows that there is a mismatch in perception and expectations between Cleveland police officers and local A&E staff. (5) There did not appear to be a sufficiency of understanding within Cleveland Constabulary about how and whether detainees may be treated at A&E departments. (6) Further or alternatively, the insufficiency in understanding lies with A&E consultants and their perception of what type of patients will be accepted and allowed to be treated in their departments. (7) There does not appear to be a dialogue between Cleveland Constabulary and local A&E departments to address these particular misunderstandings or misconceptions. (8) There does not appear to be any memorandum of understanding or guideline to cover aggressive detainees in police custody being taken to A&E departments. (9) Without a fuller understanding of the true position, police officers will continue to be faced with the perennial dichotomy of whether to take an aggressive medical emergency detainee to an A&E department for treatment or to a police station to prevent self harm or harm to others. ”
Source location
Kirk William Williams · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Insufficient police understanding of A&E treatment for detainees
Wider context from the report
“(2) Some police officers still consider that notwithstanding that they may be faced with a medical emergency, A&E departments will not treat violent or aggressive patients. (3) The various consultants that gave evidence are clear that they will treat violent patients provided that (a) treatment is warranted and (b) they are provided with sufficient assistance from either or both the police or security staff. (4) It therefore follows that there is a mismatch in perception and expectations between Cleveland police officers and local A&E staff. (5) There did not appear to be a sufficiency of understanding within Cleveland Constabulary about how and whether detainees may be treated at A&E departments. (6) Further or alternatively, the insufficiency in understanding lies with A&E consultants and their perception of what type of patients will be accepted and allowed to be treated in their departments. (7) There does not appear to be a dialogue between Cleveland Constabulary and local A&E departments to address these particular misunderstandings or misconceptions. (8) There does not appear to be any memorandum of understanding or guideline to cover aggressive detainees in police custody being taken to A&E departments. (9) Without a fuller understanding of the true position, police officers will continue to be faced with the perennial dichotomy of whether to take an aggressive medical emergency detainee to an A&E department for treatment or to a police station to prevent self harm or harm to others. ”
Source location
Kirk William Williams · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Establish joint guidance for assessing, treating, discharging and communicating information about aggressive or medically unwell detainees attending emergency departments.

Verbatim wording from the response
“A meeting was held between the Medical Directors and senior A&E medical staff of both Foundation Trusts and Detective Chief Superintendent ████████ from Cleveland Police.”

Source location
2014-0499-Response-by-South-Tees-Clinical-Commissioning-Group
Page 1 · response
Published 14 November 2014
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Inform relevant NHS and police staff about the agreed detainee-management guidance.

Verbatim wording from the response
“• All relevant staff, both NHS and Police, to be informed of the guidelines agreed for future reference.”

Source location
2014-0499-Response-by-South-Tees-Clinical-Commissioning-Group
Page 2 · response
Published 14 November 2014
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Issue Cleveland Police guidance for managing aggressive detainees transferred to emergency or mental-health services, incorporating agreed police and NHS arrangements.

Verbatim wording from the response
“At point 8 in your report you identified that there did not appear to be a Memorandum of Understanding or guidance to cover aggressive detainees in Custody being taken to A&E Departments.”

Source location
2014-0499-Response-by-Cleveland-Police
Page 1 · response
Published 14 November 2014
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Brief custody staff, medical staff and frontline officers on the new detainee-transfer guidance.

Verbatim wording from the response
“• All staff both NHS and Police to be informed of the guidelines agreed for future reference.”

Source location
2014-0499-Response-by-Cleveland-Police
Page 2 · response
Published 14 November 2014
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Review the effectiveness of the guidance after six months.

Verbatim wording from the response
“It is my intention to review the effectiveness of the guidance in six months’ time and to take any appropriate action where necessary, whether that is amendments to the guidance in conjunction with the two Trusts, or further training to ensure staff are aware of and are implementing the guidance.”

Source location
2014-0499-Response-by-Cleveland-Police
Page 2 · response
Published 14 November 2014
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Hold discussions with Durham Constabulary to ensure officers know that patients should be taken to the emergency department.

Verbatim wording from the response
“County Durham and Darlington NHS Foundation Trust have confirmed that the lead Security Officer for the Trust has held discussions with Durham Constabulary lead officers to ensure that all police officers know that patients should be taken to the Emergency Department.”

Source location
2014-0499-Response-by-South-Tees-Clinical-Commissioning-Group
Page 2 · response
Published 14 November 2014
Open published response

Actions and positions describe what organisations say in published responses. Implementation is not independently verified.

Data last updated 7 September 2026

What this concern includes

Trends

Reports mentioning this concern, over time

Concerns raised1

Lack of a set procedure for UK hospital acceptance of patients from other countries

Linked responses

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4

Concerns raised1

Delays in securing acceptance by an appropriate vascular site

Concerns raised1

Delays in accepting transfer of suspected aortic dissection patients while awaiting CT imagery

Linked response

Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1

Concerns raised3

Lack of memorandum of understanding or guideline for taking aggressive detainees to A&E departments

Insufficient A&E consultant understanding of which detainees will be accepted for treatment

Insufficient police understanding of A&E treatment for detainees

Linked responses

Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6

Respondent positions 4

Stated actions 2

Respondent positions 1

Stated actions 6