First reported 19 Jan 2017•Latest report 18 Jan 2024
Definition
What this concern includes
Includes failures of neurosurgical referral pathways or dedicated referral mechanisms, including referral initiation, receipt, communication, escalation and timely access to specialist neurosurgical advice.
Not included
Excludes generic communication failures not tied to neurosurgical referrals.
Excludes clinical assessment, treatment or staffing deficiencies unless they directly impair the neurosurgical referral system.
Excludes downstream delays occurring after a referral has successfully provided access to specialist advice.
Reports
6
Distinct published reports
Individual concerns
10
A report can raise multiple concerns
Date range
2017–2024
First to latest report issue date
Stated actions
24
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.
Calderdale and Huddersfield NHS Foundation Trust1
Cardiff & Vale University LHB1
Care Quality Commission1
Cwm Taf Morgannwg University Local Health Board1
East Lancashire Hospitals NHS Trust1
Hywel Dda University LHB1
Leeds Teaching Hospitals NHS Trust1
Manchester University NHS Foundation Trust1
NHS England1
Nottingham University Hospitals NHS Trust1
Powys Teaching Local Health Board1
Sandwell and West Birmingham Hospitals NHS Trust1
Sheffield Teaching Hospitals NHS Foundation Trust1
Swansea Bay University Local Health Board1
University Hospitals Birmingham NHS Foundation Trust1
NHS trust5
Devolved government1
Executive non-departmental public body1
Health and social care service regulator1
Local health board1
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 to refer patients with strong clinical signs of a brain bleed for specialist neurosurgical advice, particularly after refusal of lumbar puncture
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.6
Action
Update clinical guidance to require neurology opinions when patients refuse or have inconclusive lumbar punctures.
Stated by Sandwell and West Birmingham Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 25 January 2024.
Action
Use an anonymised case in a learning session for medical staff on the need for neurology referral.
Stated by Sandwell and West Birmingham Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 25 January 2024.
Action
Recirculate the ratified guidance and provide supportive communications to staff.
Stated by Sandwell and West Birmingham Hospitals NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 25 January 2024.
Action
Review the case and the high-suspicion, negative-CT, refused-lumbar-puncture scenario at a neurosurgical governance day.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 25 January 2024.
Action
Share the Trust’s internal subarachnoid-haemorrhage management guideline with SWBH to support review of its guidance.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 25 January 2024.
Action
Circulate a letter to catchment-area emergency departments reiterating the established referral pathway and availability of on-call neurosurgical advice.
Stated by University Hospitals Birmingham NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 25 January 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
A neurology referral cannot be made for a patient with full mental capacity who refuses lumbar puncture without the patient's consent.
Stated by Sandwell and West Birmingham Hospitals NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
No specific guidance exists for suspected subarachnoid haemorrhage where a patient refuses lumbar puncture or another assessment.
Stated by University Hospitals Birmingham NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Established national guidance and referral practice are considered sufficient; not every patient refusing lumbar puncture requires specialist referral.
Stated by University Hospitals Birmingham NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Lancashire and Blackburn with Darwen
Concerns raised1
Failure to expedite scanning or contact tertiary neurosurgical services after specialist input
This report raised 16 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.3
Action
Operate a year-round radiology inpatient coordinator or navigator function to improve referral communication, patient flow and scan escalation.
Stated by East Lancashire Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 March 2021.
Action
Develop a standard operating procedure defining navigator functions and referrer actions for radiology access and efficiency.
Stated by East Lancashire Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 8 March 2021.
Action
Hold twice-weekly clinico-radiological meetings to discuss difficult cases and support imaging decisions without requiring personal attendance.
Stated by East Lancashire Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 March 2021.
Manchester South
Concerns raised1
Delays in obtaining and chasing up specialist neurosurgical input
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.2
Action
Use the updated Emergency Department adult head injury pathway to guide assessment, CT scanning, neurosurgical referral and clinical documentation.
Stated by Manchester University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 1 December 2020.
Action
Embed the Clinical Decision Support Tool in the Emergency Department Electronic Patient Record to guide adult head injury management and CT requirements.
Stated by Manchester University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 1 December 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Salford Royal’s neurosurgical team provided advice on the same day, contrary to the apparent inquest conclusion that advice took 24 hours.
Stated by Manchester University NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
West Yorkshire Eastern
Concerns raised4
Lack of clarity about appropriate use of the electronic referral portal
Lack of clarity about the issues for which specialist guidance is sought
Failure to specify the clinical questions in specialist referrals
Referral routing failing to provide radiologists’ reports
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 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.
South Wales Central
Concerns raised2
Lack of backup neurosurgical specialist capacity to field referrals
Failure of the neurosurgical referral system to provide timely and reliable communication
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.2
Action
Implement urgency screening and escalation safeguards for urgent neurosurgical referrals, including prioritisation and direct consultant contact when needed.
Stated by NHS Wales Joint Commissioning CommitteeStated completedThe respondent said that this action was complete when they made their response on 23 August 2019.
Action
Introduce an interim email arrangement to improve communication around the neurosurgical referral process.
Stated by NHS Wales Joint Commissioning CommitteeStated completedThe respondent said that this action was complete when they made their response on 23 August 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Urgent neurosurgical referrals will continue using telephone and bleeps because electronic systems lack 24-hour monitoring and mobile signals are unreliable.
Stated by NHS Wales Joint Commissioning CommitteeExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Further e-referral rollout cannot proceed until networking issues between C&V and CTM are resolved.
Stated by NHS Wales Joint Commissioning CommitteeUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
C&V UHB’s IT Development Team is responsible for resolving networking issues before the e-referral system can be rolled out further.
Stated by NHS Wales Joint Commissioning CommitteeRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Nottinghamshire
Concerns raised1
Lack of a clear pathway for referral for life-saving neurosurgery
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.
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.11
Action
Obtain assurance from regional neuroscience centres and referring hospitals that emergency neurosurgical transfer pathways are in place and followed regardless of critical care bed availability.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 19 February 2017.
Action
Require hospitals with informal transfer agreements to establish and obtain joint sign-off for written protocols preventing refusal of critical surgical transfers because of critical care bed availability.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Roll out the emergency neurosurgical transfer pathway assurance process to the London and South regions.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Continue monitoring the relevant healthcare sector to assess compliance with emergency care pathways and protocols.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 19 February 2017.
Action
Implement a protocol for accepting and transferring patients requiring life-saving specialist intervention irrespective of critical care capacity.
Stated by Nottingham University Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 19 February 2017.
Action
Obtain formal ratification of the transfer protocol from the Mid Trent Critical Care Network and NUH.
Stated by Nottingham University Hospitals NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Disseminate the protocol and related expectations to regional hospitals, specialist organisations, local medical directors and all UK critical care units.
Stated by Nottingham University Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 19 February 2017.
Action
Continue monitoring the performance of the life-saving transfer protocol for adverse events.
Stated by Nottingham University Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 19 February 2017.
Action
Draft and share a local protocol requiring acceptance and immediate transfer of time-critical neurosurgical patients with NUH.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 February 2017.
Action
Discuss and finalize the local emergency neurosurgical admission protocol with relevant staff.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 19 February 2017.
Action
Share the agreed emergency neurosurgical admission protocol with catchment-area trusts through the Working Together Partnership and Medical Directors.
Stated by Sheffield Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Immediate transfer may not be possible during major theatre infrastructure failure or when a major incident overwhelms theatre capacity.
Stated by Nottingham University Hospitals NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
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Includes failures of neurosurgical referral pathways or dedicated referral mechanisms, including referral initiation, receipt, communication, escalation and timely access to specialist neurosurgical advice.
