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.
Berkshire
Concerns raised1
Failure of escalation arrangements to provide emergency assessment by critical care-competent staff
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.4
Action
Continue a CQC learning programme to understand outstanding safety practice and support its adoption across independent healthcare providers.
Stated by Independent Healthcare Providers NetworkStated in progressThe respondent said that this action was in progress when they made their response on 12 May 2019.
Action
Discuss escalation policies in independent acute hospitals with the CQC.
Stated by Independent Healthcare Providers NetworkStated plannedThe respondent said that this action was planned when they made their response on 12 May 2019.
Action
Conduct a scoping exercise on providers’ assurance of staff awareness of NEWS and sepsis training.
Stated by Independent Healthcare Providers NetworkStated plannedThe respondent said that this action was planned when they made their response on 12 May 2019.
Action
Encourage providers to establish formal service-level agreements with neighbouring providers for higher-acuity care transfers.
Stated by Independent Healthcare Providers NetworkStated completedThe respondent said that this action was complete when they made their response on 12 May 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Patient transfer does not indicate inappropriate originating care or admission, and independent hospitals can safely manage unanticipated deterioration through planned transfer arrangements.
Stated by Independent Healthcare Providers NetworkDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
There is no evidence that patient transfers are particularly associated with hospitals lacking intensive-care facilities, and national guidance does not require on-site intensive care.
Stated by Independent Healthcare Providers NetworkDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Independent hospitals already have clear processes to manage deterioration and arrange transfers to higher-acuity settings when necessary.
Stated by Independent Healthcare Providers NetworkExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Liverpool and the Wirral
Concerns raised2
Failure to escalate monitoring and management after grossly abnormal blood results
Delays in escalating NEWS to medical staff
This report raised 10 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.
Birmingham and Solihull
Concerns raised1
Failure to apply a consistent MEWS escalation pathway in the Emergency Department
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.
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
Deploy an ED-specific MEWS Observation Chart across BHH and Good Hope Emergency Departments and Solihull Minor Injuries Unit.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 August 2018.
Action
Make the ED MEWS Standard Operating Procedure available to directorate teams on the Trust intranet.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 August 2018.
Action
Disseminate the ED MEWS Standard Operating Procedure and remind speciality clinical teams that a separate ED escalation pathway is in use.
Stated by University Hospitals Birmingham NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 August 2018.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
In emergency departments, MEWS scores of 1–3 do not routinely require Nurse in Charge escalation without overriding clinical concern or deterioration.
Stated by University Hospitals Birmingham NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
South Wales Central
Concerns raised1
Failure to escalate neck or back pain findings to a doctor for reassessment, investigation and diagnosis
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
Conduct two Health Board-wide audits of NEWS score completion and escalation.
Stated by Cwm Taf Morgannwg University Local Health BoardStated completedThe respondent said that this action was complete when they made their response on 7 June 2018.
Action
Progress improvement work in priority clinical areas identified through the NEWS audit.
Stated by Cwm Taf Morgannwg University Local Health BoardStated plannedThe respondent said that this action was planned when they made their response on 7 June 2018.
Wiltshire and Swindon
Concerns raised2
Failure to empower nursing staff to refer critically ill patients to the Critical Care Outreach Team
Lack of an available and understood fallback escalation pathway when Critical Care Outreach cannot assess a patient
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.1
Action
Operate a 24-hour continuity plan that routes critical-care support to ITU nursing or ICU medical staff when outreach is unavailable.
Stated by Great Western Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 December 2017.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing continuity and escalation arrangements ensure staff are always available to support escalation when critical care outreach is unavailable.
Stated by Great Western Hospitals NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Northamptonshire
Concerns raised1
Failure to escalate fistula/graft-site bleeds for renal or surgical review
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
Request an expert review of UK ambulance clinical practice guidelines for renal patients, specifically covering fistula bleeds.
Stated by Association of Ambulance Chief Executives and NASMeDStated plannedThe respondent said that this action was planned when they made their response on 2 December 2017.
Action
Write, publish and issue any resulting new or updated fistula-bleed guidance to ambulance clinicians through the clinical practice guideline development plan.
Stated by Association of Ambulance Chief Executives and NASMeDStated plannedThe respondent said that this action was planned when they made their response on 2 December 2017.
Action
Seek specialist advice from the Vascular Access Society of Britain & Ireland on fistula bleeds and hospital conveyance when bleeding has stopped.
Stated by Association of Ambulance Chief Executives and NASMeDStated completedThe respondent said that this action was complete when they made their response on 2 December 2017.
Northamptonshire
Concerns raised1
Failure to seek attendance by the attending spinal surgeon for postoperative instability
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.
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
Require both the Consultant Surgeon and Consultant Anaesthetist to attend when either is recalled or a deteriorating patient requires escalation.
Stated by Woodland HospitalStated completedThe respondent said that this action was complete when they made their response on 15 September 2017.
Action
Review and finalise education standards incorporating standards on patient assessment, management of deterioration, and surgery-related complications.
Stated by Nursing and Midwifery CouncilStated in progressThe respondent said that this action was in progress when they made their response on 15 September 2017.
Preston and West Lancashire
Concerns raised1
Failure to seek medical direction on future management after a peri-arrest
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.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Norfolk
Concerns raised1
Delays and failures in escalating serious patient deterioration to senior medical staff
This report raised 10 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.
Blackpool and the Fylde
Concerns raised1
Failure to act on elevated National Early Warning Scores
This report raised 9 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 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.
