First reported 13 Dec 2013•Latest report 24 Nov 2025
Definition
What this concern includes
Includes delays or unreliable operation of the end-to-end hospital admission process, including emergency-department handover, patient flow, bed availability, escalation or active management, when these directly prevent or delay admission.
Not included
Excludes delays in a specific treatment or procedure after admission unless they are themselves part of the admission process.
Excludes deficiencies in admission documentation, assessment, communication or review when they do not directly concern whether admission is provided promptly.
Excludes generic staffing, resource or policy deficiencies that are not directly tied to unsafe delay or failure in hospital admission.
Excludes delays or failures in non-hospital placements unless they directly determine whether required hospital admission is provided.
Reports
47
Distinct published reports
Individual concerns
53
A report can raise multiple concerns
Date range
2013–2025
First to latest report issue date
Stated actions
176
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.
Department of Health and Social Care23
Betsi Cadwaladr University LHB10
Welsh Ambulance Services NHS Trust9
NHS England8
Care Quality Commission3
Greater Manchester Health and Social Care Partnership3
Welsh Government3
Ysbyty Gwynedd3
Conwy County Borough Council2
Cwm Taf Morgannwg University Local Health Board2
Denbighshire County Council2
Flintshire County Council2
Greater Manchester Mental Health NHS Foundation Trust2
Health Services Safety Investigations Body2
NHS Greater Manchester Integrated Care Board2
Ministerial department23
NHS trust19
Local health board13
Executive non-departmental public body10
Healthcare site8
Health-system partnership5
Integrated care board4
Devolved government3
Health and social care service regulator3
Private limited company3
Devolved legislature2
Welsh county borough council2
Welsh county council2
Coronial office1
Education sector body1
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.
North West Wales
Concerns raised1
Failure of the vascular emergency transfer pathway to provide direct hospital admission
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.4
Action
Map the emergency ischaemic limb patient journey across North Wales hospitals, identify delays and bottlenecks, and take steps to reduce them.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 25 October 2022.
Action
Commence the vascular emergency bypass pathway for direct admission of suitable stable patients to the vascular ward and monitor its implementation until embedded.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 25 October 2022.
Action
Finalise and implement the vascular emergency bypass pathway with BCU Health Board, including direct hospital admission arrangements and operational contact and destination details.
Stated by Welsh Ambulance Services NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 25 October 2022.
Action
Operate the implemented vascular bypass protocol across the South East Wales Vascular network for conditions including abdominal aortic aneurysm and ischaemic limb.
Stated by Welsh Ambulance Services NHS TrustStated completedThe respondent said that this action was complete when they made their response on 25 October 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The vascular pathway cannot be released for immediate use until the Health Board provides a contact number and destination.
Stated by Welsh Ambulance Services NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Norfolk
Concerns raised1
Failure to maintain emergency department and inpatient capacity for timely ambulance admissions
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.
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.15
Action
Continue commissioning Hospital Ambulance Liaison Officers across the three acute hospitals to coordinate handover and ambulance turnaround.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 9 January 2023.
Action
Support further development and expansion of GP Streaming Units across the three acute hospitals to improve patient flow and prompt assessment.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Expand Same Day Emergency Care provision across acute hospital sites as an alternative pathway to Emergency Department attendance.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 9 January 2023.
Action
Coordinate the system Discharge Programme, including joint planning, delivery and monitoring of hospital-flow and discharge improvements.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Commission additional health and social care beds, community care packages and domiciliary care to increase discharge capacity.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 9 January 2023.
Action
Fund additional social workers and use external agencies to provide Care Act assessments and domiciliary care supporting discharge home.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 9 January 2023.
Action
Deliver the Leading for System Change project to identify and address system-wide discharge barriers.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Coordinate local improvement, escalation and monitoring programmes covering ambulance alternatives, falls response, Emergency Department surge, care homes, workforce and discharge.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Develop a virtual ward across the three acute hospitals to support early discharge and avoid Emergency Department attendance.
Stated by NHS Norfolk and Suffolk Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Deliver six new ambulance hubs to reduce handover delays.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Deliver 42 new or upgraded hospital discharge lounges to support safe, timely discharge.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Provide 5,000 additional staffed permanent hospital beds.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 9 January 2023.
Action
Scale up virtual ward capacity beyond its existing level.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 9 January 2023.
Action
Provide dedicated funding for social care to reduce beds occupied by patients ready for discharge.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Action
Establish Same Day Emergency Care services across every hospital with a major emergency department.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 9 January 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
The rapid-release protocol can only be mobilised in specific clinical circumstances, limiting its use to reduce ambulance handover delays.
Stated by NHS Norfolk and Suffolk Integrated Care BoardUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Discharge capacity was constrained after national funding ended and the ICB’s temporary local funding extension ceased.
Stated by NHS Norfolk and Suffolk Integrated Care BoardUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Safe discharge depends fundamentally on adequate social care provision, limiting the system’s ability to relieve hospital congestion independently.
Stated by NHS Norfolk and Suffolk Integrated Care BoardUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Manchester South
Concerns raised1
Lack of acute hospital bed capacity
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.10
Action
Continue rolling out Urgent Treatment Centres to provide a consistent urgent-care service.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 23 November 2020.
Action
Continue Same Day Emergency Care initiatives to reduce non-elective hospital admissions.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 23 November 2020.
Action
Maintain Nightingale Hospitals, their surge capacity and NHS use of independent-sector hospital capacity.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 23 November 2020.
Action
Expand NHS 111 to provide urgent-care advice and direct patients to appropriate services more quickly.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 23 November 2020.
Action
Implement agreed principles requiring direct specialty acceptance, specialty assessment of stable patients, and expanded Same Day Emergency Care across Greater Manchester.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 23 November 2020.
Action
Implement NHS 111 First so patients are directed to call 111 before attending an Emergency Department.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 23 November 2020.
Action
Implement pre-Emergency Department triage and streaming to direct patients to the most appropriate service.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 23 November 2020.
Action
Adopt and implement Greater Manchester Discharge to Assess guidance, including standard referral, rapid triage, discharge medication, testing, PPE and next-day follow-up processes.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 23 November 2020.
Action
Create additional community discharge capacity, including reablement support, domiciliary care and community beds.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 23 November 2020.
Action
Review community-based capacity to ensure discharge pathways have the correct types of capacity.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 23 November 2020.
Manchester South
Concerns raised1
Lack of surgical bed capacity delaying transfer from the Emergency Department
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.7
Action
Provide funding to continue enhanced hospital discharge arrangements and maintain safe, timely patient discharge over winter.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Provide NHS Long Term Plan funding for primary and community care by 2023/24.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Roll out support for care home residents so more people can receive care in their communities.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Continue developing the Urgent and Emergency Care Operational Hub’s methods for managing demand and patient flow to reduce emergency department crowding.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 1 October 2020.
Action
Implement Greater Manchester Discharge to Assess guidance, including standard referral, rapid triage, testing and PPE, medication supply, and next-day follow-up processes.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Create additional community-based capacity to support discharge pathways and improve acute-hospital patient flow.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Review community-based capacity to support discharges.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 1 October 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Stockport health system partners are responsible for taking action to address urgent and emergency care safety concerns.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Lack of sufficient emergency department and inpatient bed capacity
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
Continue rolling out Urgent Treatment Centres, NHS 111 appointment booking and Same Day Emergency Care to manage urgent and emergency demand.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 1 October 2020.
Action
Maintain Nightingale hospitals, their surge capacity and NHS use of independent-sector hospital capacity.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Introduce NHS 111 First to provide low-complexity care digitally and direct patients to appropriate settings more quickly.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Provide NHS Trusts with a share of £300 million additional capital funding to upgrade facilities before winter.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Provide £588 million to continue enhanced hospital-discharge arrangements over winter and maintain safe, timely discharge.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Fund primary and community care, including national support for care homes, through the NHS Long Term Plan’s £4.5 billion annual commitment by 2023/24.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Implement NHS 111 First across Greater Manchester before winter to direct patients to appropriate services before Emergency Department attendance.
Stated by NHS Greater Manchester Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Implement a pre-Emergency Department triage and streaming system before winter to direct patients to appropriate services.
Stated by NHS Greater Manchester Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 1 October 2020.
Action
Develop more sophisticated Urgent and Emergency Care Operational Hub methods to manage demand, patient flow and Emergency Department crowding.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 1 October 2020.
Action
Implement the Greater Manchester Discharge to Assess pathway, including a single referral form, timely triage, testing and PPE compliance, medication supplies and next-day follow-up.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Action
Create additional community-based capacity to support discharge pathways and improve acute-care patient flow.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 1 October 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Stockport health system partners are responsible for implementing improvements addressing urgent and emergency care safety concerns.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
South Wales Central
Concerns raised1
Delays in admission to Critical Care
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 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.
Manchester City
Concerns raised1
Failure to expedite the search for and securing of an appropriate inpatient bed
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 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.
Manchester West
Concerns raised1
Limited overnight availability of Hyper Acute Stroke unit admission at Fairfield Hospital and Stepping Hill Hospital
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 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.
North Wales (East and Central)
Concerns raised2
Failure to eliminate factors causing delays in hospital admission and treatment
Failure to provide timely ambulance handover and admission
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 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.
North Wales (East and Central)
Concerns raised1
Failure to provide timely admission to the emergency department
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.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes delays or unreliable operation of the end-to-end hospital admission process, including emergency-department handover, patient flow, bed availability, escalation or active management, when these directly prevent or delay admission.
