Failure to obtain timely specialist clinical advice when local expertise is insufficient
First to latest report 9 Jul 2014 — 6 May 2026
Reports that mention this concern
13
Times this concern has been raised
15
Stated actions linked to this concern
18
What this concern includes
Includes failures in arrangements for recognising the need for, requesting, accessing, communicating or acting on specialist clinical advice from another hospital or specialist centre when local expertise is insufficient or the patient's condition requires specialist input.
What is not included
Excludes generic clinical delays, referrals or communication failures where specialist advice is not the identified unsafe condition.
Excludes failures limited to obtaining routine specialist appointments or treatment after appropriate specialist advice has already been obtained.
Excludes deficiencies in specialist expertise or treatment quality where the access and advice process itself is not deficient.
Excludes failures belonging to a separately named specialist pathway or condition-specific referral system when that narrower boundary is the supported recurring concern.
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.
Care Quality Commission2
Cwm Taf Morgannwg University Local Health Board2
Blackpool Teaching Hospitals NHS Foundation Trust1
Cardiff & Vale University LHB1
County Durham and Darlington NHS Foundation Trust1
Department of Health and Social Care1
East Kent Hospitals University NHS Foundation Trust1
Epsom Hospital1
Leeds Teaching Hospitals NHS Trust1
Manchester University NHS Foundation Trust1
National Institute for Health and Care Excellence1
NHS England1
NHS South West London Integrated Care Board1
Pennine Acute Hospitals NHS Trust1
Prince Charles Hospital (Merthyr Tydfil)1
NHS trust9
Healthcare site4
Executive non-departmental public body2
Health and social care service regulator2
Health professional body2
Local health board2
Devolved government1
Integrated care board1
Ministerial department1
Professional body1
Reports and published responses 13 reports
See individual reports that have raised this concern, and the actions taken in response
South Wales Central
Concerns raised2
Lack of an established protocol for escalation and referral of HPB-related matters to a tertiary centre
Delays in seeking specialist advice and transferring patients to a tertiary centre
Linked responses
Cwm Taf Morgannwg University Local Health Board
The Health Board
Welsh Government
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Cwm Taf Morgannwg University Local Health Board
Require early consultant-to-consultant referral to the University Hospital of Wales HPB team for specialist advice and transfer decisions.
Welsh Government
Share lessons from the case with other health boards to inform their inter-hospital pathway arrangements.
The Health Board
Reinforce the expectation of early consultant-level discussion for suspected bile duct injury and complex benign HPB cases.
The Health Board
Remind relevant partners to use the existing HPB escalation framework, designated contacts and urgent advice procedures, and consider timely transfer.
The Health Board
Use focused communication and education to reinforce referral and escalation principles for suspected bile duct injury.
The Health Board
Develop and disseminate a formal regional escalation and referral framework specifying triggers, discussion timescales, contacts and transfer expectations.
The Health Board
Embed learning through clinical governance, oversee implementation of revised escalation arrangements, confirm communication, and test compliance through audit or case review.
Cwm Taf Morgannwg University Local Health Board
Transfer indicated patients promptly to the University Hospital of Wales HPB team and coordinate timely acceptance while avoiding unnecessary delays.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Welsh Government
Existing health board actions to improve clinical understanding, referral and inter-hospital transfer arrangements are considered appropriate and proportionate to resolve the concerns.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
The Health Board
Established clinical standards provide guidance; the principal failure was inconsistent application, not absence of specialist knowledge or access.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
North Yorkshire and York
Concerns raised1
Failure to seek specialist input from the Leeds treating team
This report raised 9 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Leeds Teaching 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.2
Leeds Teaching Hospitals NHS Trust
Use Patient Pass to coordinate and record referrals, information requests and advice between hospitals and specialist departments.
Leeds Teaching Hospitals NHS Trust
Contact York surgical colleagues to explain communication arrangements and discuss measures to prevent similar coordination failures.
Inner West London
Concerns raised1
Unsafe access pathway requiring physically frail QMH patients to travel by LAS ambulance to SGH A&E for psychiatric advice
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Manchester South
Concerns raised1
Failure to obtain and follow up further haematology advice when INR remains above target
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Manchester University NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Manchester University NHS Foundation Trust
Existing 24-hour haematology support, anticoagulation guidance and ward-team responsibilities provide arrangements for INR management and follow-up.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Herefordshire
Concerns raised1
Failure to consult the overseeing hospital’s relevant specialist department when admitted patients have conditions overseen by another hospital
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
Wye Valley 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.1
Wye Valley NHS Trust
Operate divisional standard operating procedures requiring named local consultants and consultation with relevant specialist departments at the overseeing hospital.
Manchester North
Concerns raised1
Delays in obtaining specialist-centre advice despite lack of local expertise
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Northern Care Alliance 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.1
Northern Care Alliance NHS Foundation Trust
Remind trainees to refer patients urgently to endocrinology when Cushing’s disease is suspected or diagnosed.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Northern Care Alliance NHS Foundation Trust
The response disputes that referral to Salford Royal was delayed, stating that diagnostic testing was necessary before specialist referral.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Surrey
Concerns raised2
Failure to obtain appropriate specialist assistance for hyponatraemia management
Failure to complete specialist consultation for hyponatraemia management
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Epsom and St Helier University 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.1
Epsom and St Helier University Hospitals NHS Trust
Classify desmopressin as a high-risk drug requiring specialist advice before discontinuation and a plan for reintroduction.
Blackpool and the Fylde
Concerns raised1
Failure to obtain requisite specialist advice for unfamiliar conditions
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
Blackpool Teaching Hospitals 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.2
Blackpool Teaching Hospitals NHS Foundation Trust
Appoint a consultant physician with specific expertise in managing Parkinson’s disease.
Blackpool Teaching Hospitals NHS Foundation Trust
Issue an internal alert reminding staff about timely Parkinson’s disease management, specialist referral and access to the procedure on the Trust intranet.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Blackpool Teaching Hospitals NHS Foundation Trust
The existing Parkinson’s disease procedure and specialist contact arrangements provide sufficient access to timely advice and assistance when required.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Inner South London
Concerns raised1
Failure to escalate children with jaundice to suitable specialist care
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
West Sussex
Concerns raised1
Lack of on-site specialist clinical support for complications
This report raised 14 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Care Quality Commission
Department of Health and Social Care
Queen Victoria Hospital 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.2
Queen Victoria Hospital NHS Foundation Trust
Review alternative pathways and external oversight for PEG placement, including competency-based training and accreditation.
Queen Victoria Hospital NHS Foundation Trust
Progress the BSUH partnership memorandum and develop robust documentation or an SLA for specialist services.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Queen Victoria Hospital NHS Foundation Trust
QVH disputes that its lack of on-site specialists prevents access to specialist opinion, because agreements with BSUH provide specialist advice and imaging.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Department of Health and Social Care
NHS Improvement, NHS England, and the Care Quality Commission, working with the Trust and commissioners, were responsible for ensuring appropriate action.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Care Quality Commission
The service-level agreement provides immediate access to general surgical advice, so specialist expertise is available despite no general surgeon on site.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.