Recurring concern
Unreliable complex case management
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Request correctionFirst reported 9 Jan 2015•Latest report 15 May 2026
What this concern includes
Includes failures in explicitly complex case-management arrangements, including inadequate progress, under-use of enhanced case-management systems, absence or unclear allocation of a designated case manager, insufficient monitoring and liaison, and failure to convene or use dedicated complex-case coordination arrangements where these are intended to manage complex or uncertain cases.
Not included
- Excludes generic delays, staffing, communication or documentation deficiencies where complex case management is not the identified unsafe condition.
- Excludes ordinary case management for routine or non-complex cases.
- Excludes failures belonging to a separately named pathway, safeguarding system, placement process or clinical condition when that named concern provides the more specific supported boundary.
- Excludes general multi-agency ownership or care-coordination failures that do not specifically concern complex case management.
- Reports
- 8
- Individual concerns
- 9
- Date range
- 2015–2026
- Stated actions
- 12
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
Insufficient managerial oversight of complex District Nursing cases
This report raised 4 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
Introduce Team Leader of the Day and Coordinator of the Day roles to provide senior support and clear escalation routes.
Stated by Tameside and Glossop Integrated Care NHS Foundation Trust -
Action
Increase caseload reviews and triage to prioritise patients with complex, frail, end-of-life or changing clinical needs.
Stated by Tameside and Glossop Integrated Care NHS Foundation Trust -
Action
Recruit and introduce a senior District Nursing Caseload Facilitator role to strengthen caseload oversight, patient flow and care planning.
Stated by Tameside and Glossop Integrated Care NHS Foundation Trust
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Action
Establish a District Nursing Improvement Group to lead work on triage, caseload management, documentation, escalation and monthly audited assurance reporting.
Stated by Tameside and Glossop Integrated Care NHS Foundation Trust
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Concerns raised1
Lack of a mechanism for multidisciplinary medical coordination under a single practitioner
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
Continue progressing the appointment of care coordinators for patients with complex medical needs.
Stated by NHS Greater Manchester Integrated Care Board
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
Processes for managing complex patients across Greater Manchester specialties are better addressed by the Greater Manchester Integrated Care Board.
Stated by NHS England
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Concerns raised1
Insufficient progress with complex case management
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 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
Establish weekday multidisciplinary daily triage meetings across Adult Mental Health and Local Mental Health Teams for complex referral decisions.
Stated by Nottinghamshire Healthcare NHS Foundation Trust
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Concerns raised1
Lack of national-level complex case forums
This report raised 10 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.
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 current MARAC model provides an effective, flexible forum for agencies to manage domestic abuse safeguarding risks without statutory duties.
Stated by Home Office
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Concerns raised1
Failure of systems to provide supervision and escalation of complex cases involving junior doctors
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.2
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Action
Use Care Flow to require consultant sign-off for specified patients and senior review before learning-disability patient discharge.
Stated by Barking, Havering and Redbridge University Hospitals NHS Trust -
Action
Deliver teaching on diagnostic overshadowing and senior escalation, and add safeguarding and diagnostic overshadowing to the induction pack.
Stated by Barking, Havering and Redbridge University Hospitals NHS Trust
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Concerns raised1
Failure to identify complex cases early and assign them to an appropriately qualified psychiatrist
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.2
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Action
Develop forensic in-reach support for high-risk community patients, including timely advice, risk management and second opinions.
Stated by Greater Manchester Mental Health NHS Foundation Trust -
Action
Complete caseload reviews covering patient numbers and complexity within the enhanced community model.
Stated by Greater Manchester Mental Health NHS Foundation Trust
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Concerns raised2
Failure to provide robust, effective and event-responsive complex case planning
Under-utilisation of enhanced case management for complex prisoners
This report raised 4 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
Lack of a designated clinical case manager for complex and uncertain cases
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.2
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Action
Fill clinical nurse specialist posts to support cancer care coordination.
Stated by Leeds Teaching Hospitals NHS Trust -
Action
Assign a clinical nurse specialist to follow the case and provide communication for every patient attending clinics with a possible cancer diagnosis.
Stated by Leeds Teaching Hospitals NHS Trust
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 local Trust is responsible for addressing whether a clinical case manager role is needed in this case.
Stated by Department of Health and Social Care
Data last updated 7 September 2026