Government and private healthcare negotiators are locked in talks about whether the private sector should pick up the tab when its patients are transferred to NHS intensive care.
The NHS plan says a 'concordat' will be drawn up between the NHS and the private sector. This will enable the NHS to make greater use of private facilities to tackle waiting lists.
But HSJ understands it could also allow the NHS to reclaim the costs of providing emergency treatment for patients transferred from private facilities.
The Commons health select committee called last year for 'measures to allow the NHS to recover the costs of remedial treatment'.
It was particularly concerned that this should happen where 'practitioners in the independent sector have been negligent' and if intensive care is needed 'as a direct consequence of elective treatment undertaken in the independent sector'.
Dr Peter Nightingale, consultant in anaesthesia and intensive care at Manchester's Withington Hospital and Intensive Care Society president-elect, said: 'The primary problem we perceive is that patients in the NHS might be disadvantaged by private patients coming in.'
He said the ICS was trying to ensure that the NHS was reimbursed and said it would like private insurance to cover intensive care in the NHS.
Dr Carl Waldmann, an ICS member and director of intensive care unit at the Royal Berkshire Hospital, estimated that his own trust had seen transfers amounting to 60 patient days in the past year. Nationally, he thought that about 1,000 patients a year were transferred from private hospitals to the NHS.
Nottingham University professor of public health medicine Brian Williams estimated the cost to the NHS at 'a small number of millions of pounds' per year.
But Dr Waldmann also highlighted a problem with intensive care teams being asked to 'leave an NHS hospital to go to the private hospital to stabilise a patient', saying it gave rise to the question: 'Who is covering for the NHS?'
Dr Alasdair Short, director of intensive care at Mid-Essex Hospitals trust, said: 'In terms of being able to back up these sorts of problems, if we are full or nearly full, it means cutting back on elective surgery.'
A spokesperson for private hospital provider BMI Healthcare differentiated between transfers that were 'planned, contracted and paid for as a matter of routine' between BMI and NHS hospitals, and 'unplanned' transfers.
In 'unplanned' cases, 'if the patient is insured then it's the insurer who will determine whether or not they pay'.
But the insurance industry is not involved in the concordat talks. And it is divided on the question of reimbursing the NHS.
Claire Cater, head of public affairs at BUPA - a private hospital provider that also offers health insurance - said the picture was 'mixed'.
BUPA has 'standing arrangements' with trusts where the nature of the surgery or the patient 'might need some backup'. Otherwise, patients 'as taxpayers' were 'entitled to NHS intensive care'.
A Department of Health spokesperson said 'the main principles as laid out in the NHS plan' had been agreed, and negotiators were discussing the details 'including arrangements for the movement of patients from one sector to another'. The talks are due to conclude in 'mid to late September'.