Recurring concern
Failure to reliably escalate requests for medical review
- Reports that mention this concern
- 14
- Times this concern has been raised
- 14
- Stated actions linked to this concern
- 19
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.
What is 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.
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
Most frequent recipients
Reports about this concern sent to each recipient.
Reports and published responses 14 reports
See individual reports that have raised this concern, and the actions taken in response
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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.
Linked responses
- Daryel Care
- London Borough of Islington
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
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Daryel Care
Deliver mandatory refresher training on falls, head-injury recognition, recording, and escalation protocols to all care staff.
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Daryel Care
Update care-documentation guidance and training with structured prompts for detailed injury descriptions and recording the rationale for non-escalation after initial reporting.
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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Daryel Care
The fall and developing injury were recorded in care notes, and the head injury was escalated promptly to the multi-disciplinary team.
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Daryel Care
Clinical oversight, including decisions about post-discharge medical review, was understood to be led by the Rapid Response team within the multi-agency framework.
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Daryel Care
Prior hospital assessment, existing MDT escalation, no acute red flags, and imminent care handover supported continued observation without separate immediate medical re-escalation.
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London Borough of Islington
Daryel Care reported the fall to Adult Social Care, while ambulance attendance and hospital treatment had already addressed the immediate response.
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Concerns raised1
Lack of clinician awareness of the ability to challenge ambulance call categorisation and request clinical review
Linked response
- NHS England
Stated actions 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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NHS England
Publish and maintain a national framework enabling healthcare professionals to challenge ambulance call categorisation and request clinical review.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
NHS England
The framework advises healthcare professionals that they may challenge the assigned ambulance category or response time based on clinical concern.
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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.
Linked response
- East Lancashire Hospitals NHS Trust
Stated actions 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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East Lancashire Hospitals NHS Trust
Remove doctors’ task books and route non-urgent requests through Cerner, with urgent concerns verbally escalated to medical staff or the Acute Care Team.
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East Lancashire Hospitals NHS Trust
Display the ward escalation plan with staged escalation requirements, observation frequencies and staff responsibilities, supported by staff awareness and training.
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East Lancashire Hospitals NHS Trust
Enable nursing staff to accompany doctors on ward rounds and use the daily multidisciplinary meeting to escalate concerns and immediate actions.
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East Lancashire Hospitals NHS Trust
Arrange simulation-based deterioration training for community-ward staff, including assessment, escalation, handover, documentation and gastrointestinal-bleeding scenarios.
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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.
Linked response
- East London NHS Foundation Trust
Stated actions 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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East London NHS Foundation Trust
Train staff on NEWS2 blood-pressure updates and revise NEWS2 scoring and recording templates in RiO.
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East London NHS Foundation Trust
Enable automatic RiO alerts for physical-health observations outside expected limits, including action guidance.
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East London NHS Foundation Trust
Provide Cazaubon Ward staff training on elevated blood-pressure assessment and repeat measurement.
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East London NHS Foundation Trust
Audit Cazaubon Ward blood-pressure management monthly.
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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.
Linked response
- Cwm Taf Morgannwg University Local Health Board
Stated actions 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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Cwm Taf Morgannwg University Local Health Board
Provide ongoing Sepsis training on the Sepsis 6 bundle and NEWS documentation, escalation and implementation to medical and nursing staff.
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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.
Linked response
- Interhaze Ltd
Stated actions 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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Interhaze Ltd
Update and implement the home's falls policy and procedure with clearer instructions for unwitnessed falls and post-fall actions.
-
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.
Linked response
- Shaw Healthcare Limited
Stated actions 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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Shaw Healthcare Limited
Implement the GP and NHS 111 escalation procedure, including urgency assessment, clear clinical communications and service-level auditing.
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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.
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.
Linked response
- EAM Caregroup
Stated actions 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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EAM Caregroup
Develop deteriorating-patient protocols tailored to each young person’s care needs.
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EAM Caregroup
Establish escalation of family, carer or professional concerns to primary care, out-of-hours services or paramedics regardless of nursing observations.
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EAM Caregroup
Implement an updated When to Seek Medical Advice policy, requiring staff acknowledgement and signatures and addressing family concerns.
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EAM Caregroup
Update the hospital admission and discharge policy to include When to Seek Medical Advice guidance.
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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.
Linked response
- Adbolton Hall Limited
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
Adbolton Hall Limited
Prioritise diabetes care planning, including instructions for seeking medical assistance when insulin or medication is refused.
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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Adbolton Hall Limited
Diabetes care is considered adequately assessed and provided because relevant authorities were satisfied the home’s complex-needs admissions were safe.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026