Recurring concern
Unreliable escalation policy for care concerns
- Reports that mention this concern
- 35
- Times this concern has been raised
- 35
- Stated actions linked to this concern
- 59
What this concern includes
Includes failures in the named or directly corresponding escalation-policy process, including policy clarity, dissemination, staff understanding, embedding, use when triggers arise and assurance that escalations are made through the required route.
What is not included
- Excludes generic escalation failures where no escalation policy or equivalent bounded policy process is identified.
- Excludes generic staff training, communication or staffing deficiencies unless they directly impair understanding or use of the escalation policy.
- Excludes failures in the substantive response after an escalation has been correctly made.
- Excludes escalation processes belonging to a separately named system or pathway when that system provides the more specific supported boundary.
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.
Reports and published responses 35 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised1
Unclear process for escalating cases to obtain medical input
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- The Care Bureau Limited
- West Northamptonshire Council
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
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West Northamptonshire Council
Make contact management a key focus of future monitoring visits at the Care Bureau and wider provider services.
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The Care Bureau Limited
Implement an Emergency Action Plan in new Care Plans, signposting fall-response actions and emergency-service escalation for service users and families.
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The Care Bureau Limited
Present the case as a lessons-learned study to Registered Managers and require dissemination to care and office staff in their branches.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
West Northamptonshire Council
Implemented measures are considered sufficient to address the concerns and reduce the likelihood of similar issues arising.
-
Concerns raised1
Lack of escalation policies
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Premiere Health Limited
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
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Premiere Health Limited
Implement a clinical escalation protocol requiring early medical review when symptoms do not improve.
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Premiere Health Limited
Complete and consolidate operational policies covering medication, infection control, incidents, escalation, safeguarding, concerns and hospital discharge.
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Premiere Health Limited
Store operational policies centrally in a digital governance system accessible to all staff.
-
Concerns raised1
Lack of a clear escalation policy for wound care concerns when residents arrive
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Lentulus Properties Ltd t/a Bamford Grange
- Springcare Limited
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
-
Lentulus Properties Ltd t/a Bamford Grange and Springcare Limited
Issue staff refresher guidance on hospital readmission, wound-care monitoring and relevant policy requirements.
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Lentulus Properties Ltd t/a Bamford Grange and Springcare Limited
Implement enhanced observations to identify subtle deterioration and flag cases requiring urgent escalation.
-
Concerns raised1
Lack of knowledge and embedding of the escalation policy
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
- AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
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
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AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
Discuss the medication concerns policy and first aid procedures with staff at the scheduled December team meeting, including emergency scenarios and policy access.
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AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
Emphasise contacting the office when in doubt during new-joiner induction and explore professional curiosity through full-team meetings.
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AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
Extend induction with in-person walkthroughs of policies and procedures, questions, understanding assessments and support identification before new joiners begin caring.
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AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
Withhold new joiners from rotas until the team is satisfied they understand the organisation’s policy requirements.
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Concerns raised1
Lack of clear protocols for escalation of deteriorating patients
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- HCA International Limited (trading as HCA Healthcare UK
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
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HCA International Limited (trading as HCA Healthcare UK
Reinforce urgent deterioration escalation through Resident Doctor communications, safety alerts, telephone or face-to-face consultant contact, and appropriate diagnostic-test ordering.
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HCA International Limited (trading as HCA Healthcare UK
Deliver Resident Doctor workshops covering escalation protocols, inquest learning, responsibilities, and responding to deteriorating patients.
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HCA International Limited (trading as HCA Healthcare UK
Empower ICU Nurses-in-Charge to escalate deteriorating patients to Resident Doctors and directly to Consultants when required.
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HCA International Limited (trading as HCA Healthcare UK
Revise and strengthen critical-care procedures defining escalation, record-keeping, communication, staffing, and medical-care responsibilities, and share them with relevant staff.
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HCA International Limited (trading as HCA Healthcare UK
Update and distribute the Resident Doctor induction handbook to prohibit text messaging for urgent escalation and require telephone or face-to-face communication.
-
Concerns raised1
Lack of a clear escalation route for mental health concerns or disclosures
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Calderdale Borough Council
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
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Calderdale Borough Council
Require Independent Visitor volunteers to follow a safeguarding code and health-and-safety procedure specifying when concerns must be reported or disclosed.
-
Concerns raised1
Unclear and poorly understood escalation system for unwell patients
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Care Quality Commission
- The Lakes Care Centre Limited
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
-
The Lakes Care Centre Limited
Maintain clear protocols for identifying unwell residents and escalating concerns to district nursing teams and digital health coordinators.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Care Quality Commission
The assessment found no issues with escalation systems or staff understanding, and digital health services were generally used appropriately.
-
Concerns raised1
Lack of effective night-time Internal Escalation Policy measures
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Royal Berkshire 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
-
Royal Berkshire NHS Foundation Trust
Develop, govern and secure approval for a revised night-time Internal Escalation Policy.
-
Concerns raised1
Unclear nursing escalation policy when an external ventricular drain stops draining but continues to oscillate
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
- NHS England
- The Society Of British Neurological Surgeons
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
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NHS England
Engage the Society of British Neurological Surgeons and NHS nurse specialists to develop an action plan and national guideline for external ventricular drain management.
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The Society Of British Neurological Surgeons
Obtain permission to share the Plymouth EVD management SOP with clinical leads on request.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
-
NHS England
Existing local policies, educational materials and professional guidance address EVD care, while locally relevant policies remain appropriate for individual neurosurgical units.
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The Society Of British Neurological Surgeons
Individual Trusts are responsible for reviewing or developing local EVD standard operating procedures where necessary.
-
Concerns raised1
Lack of policy on when to increase welfare checks
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Depaul UK
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
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Depaul UK
Implement an organisational welfare-check procedure defining routine and increased checks, authorisation, duration and recording requirements.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026