Hospitals Making Hundreds of 999 Calls for On-Site Transfers Amid ‘Fragmented Systems’

Hospitals in England made more than 600 emergency 999 calls last winter to transfer patients between buildings on the same site, highlighting what experts describe as “fragmented systems” and a lack of internal transfer capacity.

A freedom of information (FOI) request to ambulance trusts found that 635 such “same-site” trips were made between 1 November 2024 and 13 February 2025. These calls typically occurred when a patient’s condition deteriorated in a non-acute facility, such as a step-down or rehabilitation unit—co-located with an acute hospital.

Ambulances Called for 300-Metre Transfers

Reasons recorded in ambulance logs included “minor trauma”, “fracture/dislocation”, “on floor”, “medical minor”, “alcohol intoxication” and “fit/seizure”. In several cases, the A&E department was only a few hundred metres away. One senior clinician said their team had to call 999 for a patient transfer to an emergency department located “barely 300 metres” away, because the trust’s internal transport service was restricted to non-urgent or pre-booked journeys.

“It sounds absurd, but the system is designed in silos,” the clinician said. “If the step-down unit is technically under community services, you can’t just walk the patient over; even if the A&E is next door.”

Fragmentation and Risk

Experts say the data expose the operational consequences of years of organisational fragmentation within the NHS estate, where multiple service contracts and staffing models coexist on the same hospital grounds.

Dr Helen Matthews, a consultant in acute medicine, said: “These figures illustrate a real gap in how hospitals manage deterioration outside of core acute wards. When patients are in non-acute areas and suddenly become unwell, the system often isn’t configured to move them safely and quickly without defaulting to 999.”

In addition to placing avoidable pressure on ambulance services already facing record response times, clinicians warn that such situations delay care and increase risk for patients who need urgent assessment.

System Pressures and Policy Gaps

Several trusts have acknowledged that internal transfer capacity was constrained during the winter months, with many on-site transport teams redeployed to patient discharge or inter-hospital transfers.

Policy advisers have called for clearer national guidance to differentiate between internal and emergency transfers and for trusts to establish on-site rapid response teams capable of safely moving deteriorating patients without requiring 999 support.

A senior NHS manager familiar with the FOI data said: “It’s a symptom of how services have evolved piecemeal over the years. Estates are shared between multiple providers, each with their own budgets and responsibilities. The result is that even short patient moves can fall between organisational cracks.”

An Avoidable Strain

While 635 incidents over three months may represent a small proportion of total ambulance activity, analysts argue the number is symbolically significant, reflecting inefficiencies across co-located facilities.

“These are journeys that should never require a blue-light call,” said one operational lead. “It’s a reminder that system integration isn’t just about data or governance, it’s about the basics of how patients move through care safely.”

The figures, which exclude non-emergency patient transport services, underscore how operational silos within NHS hospitals continue to create avoidable burdens on emergency care and ambulance capacity, even within a single hospital site.