First reported 23 Aug 2013•Latest report 27 May 2026
Definition
What this concern includes
Includes failures of clinical escalation for significant patient concerns, abnormal findings, changing clinical conditions or treatment problems where escalation to an appropriately senior clinician is required, including obstetric escalation and escalation by junior staff during busy shifts.
Not included
Excludes generic organisational governance failures where no clinical concern requiring senior clinical review is identified.
Excludes failures of escalation in non-clinical operational, safeguarding, complaints or emergency-control-room processes.
Excludes delays in senior review where the failure is solely lack of consultant availability and no escalation deficiency is identified.
Excludes failures limited to documentation, communication or training unless they directly constitute or undermine escalation of a significant clinical concern.
Reports
72
Distinct published reports
Individual concerns
81
A report can raise multiple concerns
Date range
2013–2026
First to latest report issue date
Stated actions
103
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 Care6
University Hospitals Sussex NHS Foundation Trust6
NHS England5
Essex Partnership University NHS Foundation Trust4
Mid and South Essex NHS Foundation Trust3
Royal Sussex County Hospital3
University Hospitals Birmingham NHS Foundation Trust3
Lancashire Teaching Hospitals NHS Foundation Trust2
Milton Keynes University Hospital2
Nursing and Midwifery Council2
Recipient name withheld2
Royal College of Obstetricians and Gynaecologists2
Tameside General Hospital2
Aneurin Bevan University LHB1
Barking, Havering and Redbridge University Hospitals NHS Trust1
NHS trust45
Healthcare site19
Executive non-departmental public body6
Health professional body6
Ministerial department6
Type not available4
Private limited company3
Health and care professional regulator2
Independent healthcare provider2
Integrated care board2
Local health board2
Company1
Company limited by guarantee1
Coronial office1
Executive agency1
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.
Hampshire, Portsmouth and Southampton
Concerns raised1
Failure to escalate increased abdominal pain to a senior doctor within 2 hours
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.3
Action
Implement a Bariatric Discharge Protocol in the pathway booklet requiring pre-discharge specialist review, pain-control assessment, discharge criteria and consultant discussion when criteria are unmet.
Stated by Portsmouth Hospitals University NHS TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Disseminate the Bariatric Discharge Protocol through surgical governance and team meetings and email it to surgical staff with bariatric out-of-hours or emergency responsibility.
Stated by Portsmouth Hospitals University NHS TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Further disseminate the Bariatric Discharge Protocol at the Biannual AGM, nursing surgical study day and surgical ward-level safety huddles.
Stated by Portsmouth Hospitals University NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 18 December 2024.
Essex
Concerns raised3
Delays in escalating deteriorating maternity patients for senior and critical care review
Failure to obtain consultant obstetric input, medical review and imaging before therapeutic anticoagulation
Failure to escalate obstetric emergencies to an obstetric consultant
This report raised 13 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.9
Action
Provide guidance on preventing and managing postpartum haemorrhage, including clinical assessment, monitoring, escalation and multidisciplinary response.
Stated by Royal College of Obstetricians and GynaecologistsStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Provide guidance defining circumstances requiring consultant attendance in acute obstetric and gynaecological care, including maternal collapse and major haemorrhage.
Stated by Royal College of Obstetricians and GynaecologistsStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Teach and practise SBAR escalation during annual multidisciplinary PROMPT training.
Stated by Mid and South Essex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Launch the RCOG escalation toolkit, including AID language, conflict-resolution teaching and team-of-shift handover practices.
Stated by Mid and South Essex NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 18 December 2024.
Action
Implement the OBS UK obstetric bleeding care bundle covering risk assessment, quantitative blood-loss measurement, escalation, and rapid clotting tests.
Stated by Mid and South Essex NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 18 December 2024.
Action
Implement the national MEWS observation package and escalation policy, including trigger-team referral and mandatory maternity-inpatient use.
Stated by Mid and South Essex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Embed deterioration recognition, concealed-bleeding assessment and escalation training in PROMPT, induction, local teaching, drills and written staff communications.
Stated by Mid and South Essex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Adopt a rota requiring junior registrars to pair with senior registrars and establish supervision and risk-mitigation arrangements when the intended skill mix is unavailable.
Stated by Mid and South Essex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Action
Provide guidance on reducing venous thromboembolism risk during pregnancy and the puerperium, including anticoagulation decisions when bleeding risk exists.
Stated by Royal College of Obstetricians and GynaecologistsStated completedThe respondent said that this action was complete when they made their response on 18 December 2024.
Inner North London
Concerns raised1
Failure to inform and consult the consultant about the clinical presentation
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.
Gwent
Concerns raised1
Failure to refer patients to a senior medical practitioner in line with the NEWS algorithm
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.
Inner North London
Concerns raised1
Use of unreliable text messaging for escalation of serious patient concerns
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.3
Action
Reinforce urgent deterioration escalation through Resident Doctor communications, safety alerts, telephone or face-to-face consultant contact, and appropriate diagnostic-test ordering.
Stated by HCA International Limited (trading as HCA Healthcare UKStated completedThe respondent said that this action was complete when they made their response on 28 June 2024.
Action
Reinforce Consultant-to-Consultant communication for urgent clinical matters and embed the expectation in Consultant practising-privileges policy.
Stated by HCA International Limited (trading as HCA Healthcare UKStated completedThe respondent said that this action was complete when they made their response on 28 June 2024.
Action
Update and distribute the Resident Doctor induction handbook to prohibit text messaging for urgent escalation and require telephone or face-to-face communication.
Stated by HCA International Limited (trading as HCA Healthcare UKStated completedThe respondent said that this action was complete when they made their response on 28 June 2024.
Manchester South
Concerns raised1
Failure of senior nursing staff to identify missed CC Outreach referrals
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.
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
Maintain weekly NEWS2 compliance spot checks, provide staff feedback, and take urgent action when ward compliance falls below 90%.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 May 2024.
Action
Monitor NEWS2 audit results and related improvement actions through the Managing Deteriorating Patient Group and Sepsis Improvement Board.
Stated by Tameside and Glossop Integrated Care NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 May 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The hospital is responsible for considering the operational concerns and reporting the actions and improvements it will take.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Nottinghamshire
Concerns raised1
PEWS escalation pathway failing to trigger senior Emergency Department doctor review for scores of 6-8
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.4
Action
Install live Nervecentre oversight screens to identify elevated or overdue paediatric observations and support senior monitoring.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Review and circulate the Children and Young People escalation tool, specifying escalation triggers and required actions.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Implement and disseminate senior review and out-of-hours consultant call criteria for paediatric Emergency Department care.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Require PEWS scores of 6–8 or a single parameter score of 3 to trigger review by a Tier 3 or above doctor, and cascade the guidance to staff.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Manchester South
Concerns raised1
Lack of a clear escalation process for omitted critical medicines
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 concerns
Each 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
Position
Lancashire Teaching Hospitals NHS Foundation Trust is the appropriate organisation to respond to concerns one to seven.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Inner North London
Concerns raised1
Failure to escalate unsuccessful nasogastric tube placement to appropriate medical expertise
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 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.1
Action
Update the nasogastric-tube policy to cover surgical drainage and escalation of difficult or unsuccessful tube placement.
Stated by University College London Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 19 December 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
UCLH states the NG tube was removed appropriately because drainage was low, and that subsequent insertion was inherently difficult and unpredictable.
Stated by University College London Hospitals NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
West Yorkshire Eastern
Concerns raised1
Failure to escalate, assess and investigate NEWS-triggered deterioration
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 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.5
Action
Maintain and improve escalation protocols for recognising and responding to deteriorating patients.
Stated by Mid Yorkshire Teaching NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 8 December 2023.
Action
Provide ongoing deterioration-response education to nursing, allied health and junior medical staff.
Stated by Mid Yorkshire Teaching NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 8 December 2023.
Action
Provide a 24/7 Deteriorating Adult Response Team for patients meeting deterioration referral criteria.
Stated by Mid Yorkshire Teaching NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2023.
Action
Augment the deteriorating-patient response service with additional capacity.
Stated by Mid Yorkshire Teaching NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2023.
Action
Operate the Call 4 Concern patient-safety initiative, connecting ward calls from patients or families to Deteriorating Adult Response Team members.
Stated by Mid Yorkshire Teaching NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Points 1 and 4 of the concerns are not directly relevant to the RCR’s remit or responsibilities.
Stated by Royal College of RadiologistsOutside remitThe respondent said that this matter was outside its role or authority.
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Includes failures of clinical escalation for significant patient concerns, abnormal findings, changing clinical conditions or treatment problems where escalation to an appropriately senior clinician is required, including obstetric escalation and escalation by junior staff during busy shifts.
