Recurring concern
Failure to reliably escalate requests for medical review
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Request correctionFirst reported 7 Apr 2014•Latest report 28 Mar 2025
What this concern includes
Includes failures to recognise, initiate, communicate, verbally escalate, track or follow up requests for medical review when a patient's condition or safety concern requires timely clinical assessment, including requests raised by families, carers or care staff.
Not included
- Excludes delays caused solely by clinician unavailability after a request has been reliably escalated and accepted.
- Excludes failures to conduct the clinical review itself when the request and escalation process operated reliably.
- Excludes generic communication, documentation or staffing deficiencies that are not directly tied to escalating a request for medical review.
- Excludes routine scheduled reviews where no patient-specific concern or request for timely medical assessment is identified.
- Reports
- 14
- Individual concerns
- 14
- Date range
- 2014–2025
- Stated actions
- 19
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
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.
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.
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Concerns raised1
Failure to escalate significant post-fall injuries for medical review
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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.2
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Action
Deliver mandatory refresher training on falls, head-injury recognition, recording, and escalation protocols to all care staff.
Stated by Daryel Care -
Action
Update care-documentation guidance and training with structured prompts for detailed injury descriptions and recording the rationale for non-escalation after initial reporting.
Stated by Daryel Care
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
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Position
The fall and developing injury were recorded in care notes, and the head injury was escalated promptly to the multi-disciplinary team.
Stated by Daryel Care
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Position
Clinical oversight, including decisions about post-discharge medical review, was understood to be led by the Rapid Response team within the multi-agency framework.
Stated by Daryel Care -
Position
Prior hospital assessment, existing MDT escalation, no acute red flags, and imminent care handover supported continued observation without separate immediate medical re-escalation.
Stated by Daryel Care -
Position
Daryel Care reported the fall to Adult Social Care, while ambulance attendance and hospital treatment had already addressed the immediate response.
Stated by London Borough of Islington
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Concerns raised1
Lack of clinician awareness of the ability to challenge ambulance call categorisation and request clinical review
Responses linked to these concernsEach 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
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Action
Publish and maintain a national framework enabling healthcare professionals to challenge ambulance call categorisation and request clinical review.
Stated by NHS England
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The framework advises healthcare professionals that they may challenge the assigned ambulance category or response time based on clinical concern.
Stated by NHS England
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Concerns raised1
Failure to request medical review verbally when appropriate
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Remove doctors’ task books and route non-urgent requests through Cerner, with urgent concerns verbally escalated to medical staff or the Acute Care Team.
Stated by East Lancashire Hospitals NHS Trust -
Action
Display the ward escalation plan with staged escalation requirements, observation frequencies and staff responsibilities, supported by staff awareness and training.
Stated by East Lancashire Hospitals NHS Trust -
Action
Enable nursing staff to accompany doctors on ward rounds and use the daily multidisciplinary meeting to escalate concerns and immediate actions.
Stated by East Lancashire Hospitals NHS Trust
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Action
Arrange simulation-based deterioration training for community-ward staff, including assessment, escalation, handover, documentation and gastrointestinal-bleeding scenarios.
Stated by East Lancashire Hospitals NHS Trust
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Concerns raised1
Failure to escalate episodes of raised blood pressure for medical review
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Train staff on NEWS2 blood-pressure updates and revise NEWS2 scoring and recording templates in RiO.
Stated by East London NHS Foundation Trust -
Action
Enable automatic RiO alerts for physical-health observations outside expected limits, including action guidance.
Stated by East London NHS Foundation Trust -
Action
Provide Cazaubon Ward staff training on elevated blood-pressure assessment and repeat measurement.
Stated by East London NHS Foundation Trust
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Action
Audit Cazaubon Ward blood-pressure management monthly.
Stated by East London NHS Foundation Trust
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Concerns raised1
Failure at triage to escalate referrals for medical review within 10 minutes of admission
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Provide ongoing Sepsis training on the Sepsis 6 bundle and NEWS documentation, escalation and implementation to medical and nursing staff.
Stated by Cwm Taf Morgannwg University Local Health Board
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Concerns raised1
Failure to request necessary medical attention
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 concernsEach 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
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Action
Update and implement the home's falls policy and procedure with clearer instructions for unwitnessed falls and post-fall actions.
Stated by Interhaze Ltd
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Concerns raised1
Delays in seeking out-of-hours medical advice and requesting GP review
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Implement the GP and NHS 111 escalation procedure, including urgency assessment, clear clinical communications and service-level auditing.
Stated by Shaw Healthcare Limited
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Concerns raised1
Failure to act on deterioration or requests for earlier prompt review raised through the flagging process
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 concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to escalate deteriorating patients for medical review
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Develop deteriorating-patient protocols tailored to each young person’s care needs.
Stated by EAM Caregroup -
Action
Establish escalation of family, carer or professional concerns to primary care, out-of-hours services or paramedics regardless of nursing observations.
Stated by EAM Caregroup -
Action
Implement an updated When to Seek Medical Advice policy, requiring staff acknowledgement and signatures and addressing family concerns.
Stated by EAM Caregroup
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Action
Update the hospital admission and discharge policy to include When to Seek Medical Advice guidance.
Stated by EAM Caregroup
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Concerns raised1
Failure to seek medical assistance when insulin is refused over an extended period
This report raised 9 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach 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
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Action
Prioritise diabetes care planning, including instructions for seeking medical assistance when insulin or medication is refused.
Stated by Adbolton Hall Limited
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
Diabetes care is considered adequately assessed and provided because relevant authorities were satisfied the home’s complex-needs admissions were safe.
Stated by Adbolton Hall Limited
Data last updated 7 September 2026