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.
Brighton and Hove
Concerns raised1
Failure to report raised NEWS scores to doctors or critical care outreach
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.3
Action
Improve ward staff familiarity with National Early Warning observations, scoring and escalation through reflection and additional training.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 August 2016.
Action
Disseminate National Early Warning System safety guidance to all staff through the weekly Spotlight on Safety message and Patient Observation Policy link.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 August 2016.
Action
Circulate a monthly patient-safety bulletin highlighting recognition and escalation of care for deteriorating patients.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 18 August 2016.
West Sussex
Concerns raised1
Reluctance among nursing staff to escalate to senior doctors
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.3
Action
Introduce a revised NEWS policy allowing contact with the staff member best placed to provide timely assistance.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 August 2016.
Action
Remind Twineham ward nursing staff to escalate patient concerns to the nurse in charge.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 August 2016.
Action
Roster a trained senior Band 6 nurse on Twineham ward throughout the 24-hour period to provide guidance and support escalation.
Stated by University Hospitals Sussex NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 August 2016.
Inner North London
Concerns raised1
Delay in escalating falls to the responsible consultant
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.
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
Deliver multidisciplinary training on falls prevention and post-falls care, with regular assessment of planned and delivered care.
Stated by Barts Health NHS TrustStated completedThe respondent said that this action was complete when they made their response on 26 July 2016.
Manchester North
Concerns raised1
Failure of midwives to escalate to or consult with relevant specialist clinicians
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.2
Action
Deliver training on recognising abnormal maternal observations and escalating to medical practitioners with clear clinical management plans.
Stated by The TrustStated completedThe respondent said that this action was complete when they made their response on 30 June 2016.
Action
Provide Critical Care outreach support and follow-up when elevated early warning scores are identified.
Stated by The TrustStated in progressThe respondent said that this action was in progress when they made their response on 30 June 2016.
West Sussex
Concerns raised1
Failure to consult clinical advisors in complex KMSS 111 cases
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.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing NHS Pathways training and call-handling arrangements are considered sufficient to provide a safe service.
Stated by South East Coast Ambulance Service NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Inner West London
Concerns raised1
Lack of timely escalation of clinical concerns from junior to senior staff
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.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Central and South East Kent
Concerns raised1
Failure to escalate transfer acceptance decisions to a Consultant when requested
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.2
Action
Clarify and reinforce to cardiothoracic registrars that aortic dissection referrals must be discussed immediately with the duty consultant, who decides transfer and any pre-transfer CT review.
Stated by Guy'S and St Thomas' NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 14 December 2015.
Action
Extend the open-door policy to ascending-aorta and arch dissections, enabling consultant-authorised immediate transfer with guaranteed theatre and critical-care capacity.
Stated by Guy'S and St Thomas' NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 14 December 2015.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Clarified consultant escalation and guaranteed immediate transfer arrangements are considered sufficient to prevent recurrence of confusion and delay.
Stated by Guy'S and St Thomas' NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Gloucestershire
Concerns raised1
Failure to escalate clinical care to more senior colleagues in the obstetric department
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.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Milton Keynes
Concerns raised1
Lack of leadership authority to require timely doctor attendance and CTG review
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
Change the patient whiteboard to record the doctor-review time for suspicious CTG traces.
Stated by Milton Keynes University Hospital NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 29 September 2015.
Action
Clarify staff responsibilities for patient reviews, senior-help escalation and upward-escalation timescales in writing.
Stated by Milton Keynes University Hospital NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 September 2015.
Action
Embed a revised SBAR handover communication tool in practice.
Stated by Milton Keynes University Hospital NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 September 2015.
Action
Recirculate the written escalation policy to all staff.
Stated by Milton Keynes University Hospital NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 29 September 2015.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
The concerns were identified and appropriately escalated; junior midwives are qualified and understand how to summon emergency assistance.
Stated by Milton Keynes University Hospital NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
The CTG did not require immediate intervention, and staff escalated appropriately when the doctor did not attend within a reasonable timescale.
Stated by Milton Keynes University Hospital NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Clear escalation instructions already exist for all midwifery and medical staff, including escalation to a consultant.
Stated by Milton Keynes University Hospital NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Bedfordshire and Luton
Concerns raised1
Failure to escalate the level of care when there is a deviation from the norm
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 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.
