Recurring concern
Failure to seek medical attention when a person's condition warrants it
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Request correctionFirst reported 5 Sep 2013•Latest report 16 Jun 2026
What this concern includes
Includes failures to recognise the need for and promptly seek medical, paramedic or other appropriate clinical assistance when a person's injury, pain, fall, deterioration or other condition warrants it, including failures in care homes and emergency-response settings.
Not included
- Excludes delays or failures occurring after medical assistance has already been requested, including ambulance attendance or hospital handover delays.
- Excludes failures limited to the quality of assessment or treatment after medical assistance has been obtained.
- Excludes failures to seek advice about routine care arrangements where no immediate or clinically warranted need for medical attention is identified.
- Excludes generic staffing, training, communication or documentation deficiencies unless they directly result in failure to seek warranted medical attention.
- Reports
- 56
- Individual concerns
- 61
- Date range
- 2013–2026
- Stated actions
- 81
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 recontact the EMA when a caller reports deterioration
This report raised 8 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
Strengthen CPD and learning programmes for QSF-certified organisations, covering records, operator competence, training, decision-support tools, escalation, and information-sharing with emergency services.
Stated by TSA
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.6
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Position
The failure to communicate deterioration was an individual failure to follow established procedures, not a deficiency in those procedures.
Stated by Appello Careline Limited
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Position
Further procedural change is not considered necessary because established training, audit and supervision processes will continue reinforcing compliance.
Stated by Appello Careline Limited -
Position
Existing procedures, training, auditing and continuous improvement provide a robust framework for managing the identified risks.
Stated by Appello Careline Limited -
Position
The specific case concerns should be addressed by Appello and SECAMB, rather than by the national ambulance membership organisation.
Stated by Association of Ambulance Chief Executives -
Position
Concerns about Apello Careline’s emergency-call guidance, information handling and artificial intelligence trials are outside NHS England’s remit.
Stated by NHS England -
Position
Apello Careline is best placed to respond to concerns about its emergency-call guidance, information handling and artificial intelligence trials.
Stated by NHS England
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Concerns raised1
Failure of prison officers who restrain prisoners to recognise ABD and treat it as a medical emergency
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.
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 call an ambulance promptly for a medical emergency
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.3
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Action
Review and strengthen welfare escalation procedures for prompt emergency-service contact when guests present serious symptoms.
Stated by FOLD -
Action
Require immediate ambulance calls when a guest’s vital signs and temperature are high, regardless of hallucinations or antidepressant history.
Stated by FOLD -
Action
Contract and deploy Frontline Medical Response medical staff and life-support equipment at all nighttime events to support welfare assessment and escalation.
Stated by FOLD
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Concerns raised1
Failure to escalate deteriorating patients for medical assessment
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.2
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Action
Strengthen verbal handovers during shift changes to support identification and escalation of safety concerns.
Stated by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust -
Action
Launch and embed Trust-wide Safety Huddles at BDGH for real-time identification and escalation of safety concerns.
Stated by Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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Concerns raised1
Failure to recognise post-fall deterioration and seek timely medical assessment
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.2
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Action
Developed an action plan addressing unwitnessed falls, medical attention, record keeping, auditing and staff training.
Stated by Green Range Limited -
Action
Provided fall prevention and management training to staff.
Stated by Green Range Limited
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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
Failure to seek further medical care when prescribed antibiotics cannot be obtained
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 the medication policy to require medical advice when emergency medication is unavailable for three hours.
Stated by WCG Abbey Ltd
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Concerns raised1
Failure to trigger a Medical Emergency call when elevated NEWS scores require medical review
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.3
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Action
Share learning from the case and reinforce NEWS2 escalation, trigger-response-team and local escalation requirements with surgical staff.
Stated by Mid and South Essex NHS Foundation Trust -
Action
Establish a hospital out-of-hours service in the surgical department to provide a more robust response and senior support to surgical wards.
Stated by Mid and South Essex NHS Foundation Trust -
Action
Reiterate NEWS and local clinical escalation processes to new surgical residents during standard induction.
Stated by Mid and South Essex NHS Foundation 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
NEWS2 escalation, trigger response, out-of-hours support and consultant acting-down arrangements provide sufficient staffing safeguards for urgent surgical cases.
Stated by Mid and South Essex NHS Foundation Trust
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Concerns raised1
Failure to obtain timely medical advice after a resident fall
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.1
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Action
Apply the Group Falls Policy and supporting flowcharts covering falls protocols, referrals, care planning, risk assessment and post-fall actions.
Stated by Four Seasons Health Care Group
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Concerns raised1
Failure to promptly seek medical attention for residents who require it
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.
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
Update admissions, falls prevention and risk-assessment policies to require timely assessment, injury monitoring and medical escalation.
Stated by Sheffcare -
Action
Roll out refresher training on pre-admission assessments, detailed care notes, falls documentation and escalation, using anonymised scenarios and monthly monitoring.
Stated by Sheffcare -
Action
Discuss falls, documentation and escalation requirements with staff through huddles, supervision and management briefings.
Stated by Sheffcare
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Action
Complete a quality-assurance systems review for linked care plans, risk assessments, falls escalation and care-note updating.
Stated by Sheffcare
Data last updated 7 September 2026