Failure to escalate significant clinical concerns to appropriately senior clinicians
First to latest report 23 Aug 2013 — 27 May 2026
Reports that mention this concern
72
Times this concern has been raised
81
Stated actions linked to this concern
103
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.
What is 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.
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.
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
Reports and published responses 72 reports
See individual reports that have raised this concern, and the actions taken in response
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.
Linked response
University Hospitals Sussex 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.3
University Hospitals Sussex NHS Foundation Trust
Improve ward staff familiarity with National Early Warning observations, scoring and escalation through reflection and additional training.
University Hospitals Sussex NHS Foundation Trust
Disseminate National Early Warning System safety guidance to all staff through the weekly Spotlight on Safety message and Patient Observation Policy link.
University Hospitals Sussex NHS Foundation Trust
Circulate a monthly patient-safety bulletin highlighting recognition and escalation of care for deteriorating patients.
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.
Linked response
University Hospitals Sussex 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.3
University Hospitals Sussex NHS Foundation Trust
Introduce a revised NEWS policy allowing contact with the staff member best placed to provide timely assistance.
University Hospitals Sussex NHS Foundation Trust
Remind Twineham ward nursing staff to escalate patient concerns to the nurse in charge.
University Hospitals Sussex NHS Foundation Trust
Roster a trained senior Band 6 nurse on Twineham ward throughout the 24-hour period to provide guidance and support escalation.
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.
Linked response
Barts Health 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
Barts Health NHS Trust
Deliver multidisciplinary training on falls prevention and post-falls care, with regular assessment of planned and delivered care.
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.
Linked response
The 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
The Trust
Deliver training on recognising abnormal maternal observations and escalating to medical practitioners with clear clinical management plans.
The Trust
Provide Critical Care outreach support and follow-up when elevated early warning scores are identified.
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.
Linked response
South East Coast Ambulance Service NHS Foundation Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
South East Coast Ambulance Service NHS Foundation Trust
Existing NHS Pathways training and call-handling arrangements are considered sufficient to provide a safe service.
Existing 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.
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.
Linked response
Guy'S and St Thomas' 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
Guy'S and St Thomas' NHS Foundation Trust
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.
Guy'S and St Thomas' NHS Foundation Trust
Extend the open-door policy to ascending-aorta and arch dissections, enabling consultant-authorised immediate transfer with guaranteed theatre and critical-care capacity.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Guy'S and St Thomas' NHS Foundation Trust
Clarified consultant escalation and guaranteed immediate transfer arrangements are considered sufficient to prevent recurrence of confusion and delay.
Existing 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.
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.
Linked response
Milton Keynes University 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.4
Milton Keynes University Hospital NHS Foundation Trust
Change the patient whiteboard to record the doctor-review time for suspicious CTG traces.
Milton Keynes University Hospital NHS Foundation Trust
Clarify staff responsibilities for patient reviews, senior-help escalation and upward-escalation timescales in writing.
Milton Keynes University Hospital NHS Foundation Trust
Embed a revised SBAR handover communication tool in practice.
Milton Keynes University Hospital NHS Foundation Trust
Recirculate the written escalation policy to all staff.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Milton Keynes University Hospital NHS Foundation Trust
The concerns were identified and appropriately escalated; junior midwives are qualified and understand how to summon emergency assistance.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Milton Keynes University Hospital NHS Foundation Trust
The CTG did not require immediate intervention, and staff escalated appropriately when the doctor did not attend within a reasonable timescale.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Milton Keynes University Hospital NHS Foundation Trust
Clear escalation instructions already exist for all midwifery and medical staff, including escalation to a consultant.
Existing 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.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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.