First reported 27 Dec 2013•Latest report 4 Mar 2026
Definition
What this concern includes
Includes failures of case monitoring, allocation tracking or referral follow-up where the control does not identify that a case has not been seen, assessed or progressed.
Not included
Excludes failures limited to the quality of clinical documentation when they do not concern identifying cases requiring follow-up.
Excludes delays or missed actions where no monitoring, tracking or follow-up identification failure is described.
Excludes generic staffing, communication or technology deficiencies not explicitly tied to monitoring or follow-up of cases.
Reports
33
Distinct published reports
Individual concerns
36
A report can raise multiple concerns
Date range
2013–2026
First to latest report issue date
Stated actions
49
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care6
Care Quality Commission5
NHS England3
Egton Medical Information Systems Limited2
NHS Greater Manchester Integrated Care Board2
Asthma + Lung UK1
Avenue House Nursing and Care Home1
Bexley Medical Group1
Bow School1
Brighton and Hove City Council1
Bristol NHS Foundation Trust1
British Society Of Gastroenterology1
Bromley by Bow Health Centre1
Chelsea and Westminster Hospital1
City Health Care Partnership CIC1
NHS trust12
Healthcare site10
Ministerial department7
Health and social care service regulator5
Executive non-departmental public body3
Registered charity3
English unitary authority2
Integrated care board2
Multi-service care provider2
Private limited company2
Residential care home2
Clinical commissioning group1
Community interest company1
Company1
English metropolitan district council1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Birmingham and Solihull
Concerns raised1
Failure of the patient allocation system to identify patients who have not been seen
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Roll out the paper-free PICS electronic patient record system across Birmingham Heartlands Hospital AMU, including waiting-time markers for patients awaiting assessment.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 2 November 2021.
Manchester South
Concerns raised3
Lack of GP referral follow-up systems to identify increased patient risk
Failure of GP referral follow-up systems to escalate referrals when required
Lack of GP referral follow-up systems to identify referrals that have not taken place
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Mid Kent and Medway
Concerns raised1
Failure to check whether a person awaiting healthcare has been seen
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Use daily residential roll books, guidance prompts and NOMIS records to capture healthcare requests, follow-up actions and relevant wellbeing information for staff sharing.
Stated by HM Prison and Probation ServiceStated completedThe respondent said that this action was complete when they made their response on 13 October 2021.
Sunderland
Concerns raised1
Failure to identify cases that have not been progressed
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing referral tracking, handover, electronic board and multidisciplinary review mechanisms are sufficient to identify outstanding Crisis Team assessments.
Stated by Cumbria, Northumberland, Tyne and Wear NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
West Yorkshire Eastern
Concerns raised1
Failure to identify urgent cases that drift outside normal hours
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Action
Implement a dedicated out-of-hours workforce system for handling referrals.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Give Social Care Direct access to extended-hours rotas, staff mobile numbers and a manager escalation contact for urgent referrals.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Embed a referral-transfer process requiring dashboard entry and direct confirmation with the worker on shift.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Distribute weekly rota emails with working arrangements and out-of-hours shift guidance, including instructions to check both Urgent Response Dashboards.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Enable all Adult Triage workers to view both East and West Urgent Response Dashboards and monitor submitted referrals.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Instruct out-of-hours Approved Mental Health Professionals to check the Urgent Response Dashboard when starting evening duty.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Action
Require core-hours Urgent Response workers to communicate follow-up requirements directly to extended-hours workers.
Stated by Wakefield City CouncilStated completedThe respondent said that this action was complete when they made their response on 19 November 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Adult Social Care considers its reviewed and strengthened systems sufficiently robust, so no additional actions are required following the report.
Stated by Wakefield City CouncilExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Manchester South
Concerns raised1
Lack of a system to follow up unanswered specialist referrals
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Route tissue-viability referrals by email or telephone, confirm them by summary email and next-day calls, and track follow-up using diary and audit-sheet prompts.
Stated by Olea Care LtdStated completedThe respondent said that this action was complete when they made their response on 31 December 2019.
Action
Change Tissue Viability referrals from fax to email and add prompts to follow up referrals not actioned within two working days.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 31 December 2019.
Action
Require Fernlea staff to obtain email read receipts, telephone the service the following day, and record confirmed visit dates.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 31 December 2019.
Action
Complete the extended comprehensive inspection of Fernlea Care Home, examining pressure-ulcer management and management oversight.
Stated by Care Quality CommissionStated in progressThe respondent said that this action was in progress when they made their response on 31 December 2019.
Manchester North
Concerns raised1
Failure to extend detoxification follow-up beyond the medication course to explore continued substance use
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Norfolk
Concerns raised1
Failure to chase up tissue viability referrals
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Inner South London
Concerns raised1
Failure to identify and address hospital loss to follow-up during medication review
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Contact mental health patients who miss hospital outpatient appointments to establish reasons and support attendance.
Stated by Bexley Medical GroupStated plannedThe respondent said that this action was planned when they made their response on 13 September 2019.
Surrey
Concerns raised1
Lack of follow-up and recording of prescribed medication non-attendance
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of case monitoring, allocation tracking or referral follow-up where the control does not identify that a case has not been seen, assessed or progressed.
