Recurring concern
Unreliable escalation policy for care concerns
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Request correctionFirst reported 1 Aug 2013•Latest report 31 Mar 2026
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.
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.
- Reports
- 35
- Individual concerns
- 35
- Date range
- 2013–2026
- Stated actions
- 59
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
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.
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.
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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.
Responses linked to these concernsEach 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
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Action
Make contact management a key focus of future monitoring visits at the Care Bureau and wider provider services.
Stated by West Northamptonshire Council -
Action
Implement an Emergency Action Plan in new Care Plans, signposting fall-response actions and emergency-service escalation for service users and families.
Stated by The Care Bureau Limited -
Action
Present the case as a lessons-learned study to Registered Managers and require dissemination to care and office staff in their branches.
Stated by The Care Bureau Limited
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
Implemented measures are considered sufficient to address the concerns and reduce the likelihood of similar issues arising.
Stated by West Northamptonshire Council
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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.
Responses linked to these concernsEach 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
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Action
Implement a clinical escalation protocol requiring early medical review when symptoms do not improve.
Stated by Premiere Health Limited -
Action
Complete and consolidate operational policies covering medication, infection control, incidents, escalation, safeguarding, concerns and hospital discharge.
Stated by Premiere Health Limited -
Action
Store operational policies centrally in a digital governance system accessible to all staff.
Stated by Premiere Health Limited
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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.
Responses linked to these concernsEach 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
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Action
Issue staff refresher guidance on hospital readmission, wound-care monitoring and relevant policy requirements.
Stated by Lentulus Properties Ltd t/a Bamford Grange and Springcare Limited -
Action
Implement enhanced observations to identify subtle deterioration and flag cases requiring urgent escalation.
Stated by Lentulus Properties Ltd t/a Bamford Grange and Springcare Limited
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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.
Responses linked to these concernsEach 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
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Action
Discuss the medication concerns policy and first aid procedures with staff at the scheduled December team meeting, including emergency scenarios and policy access.
Stated by AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern -
Action
Emphasise contacting the office when in doubt during new-joiner induction and explore professional curiosity through full-team meetings.
Stated by AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern -
Action
Extend induction with in-person walkthroughs of policies and procedures, questions, understanding assessments and support identification before new joiners begin caring.
Stated by AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
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Action
Withhold new joiners from rotas until the team is satisfied they understand the organisation’s policy requirements.
Stated by AS Chiltern Homecare Ltd T/A Caremark (Three Rivers & Chiltern
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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.
Responses linked to these concernsEach 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
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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 UK -
Action
Deliver Resident Doctor workshops covering escalation protocols, inquest learning, responsibilities, and responding to deteriorating patients.
Stated by HCA International Limited (trading as HCA Healthcare UK -
Action
Empower ICU Nurses-in-Charge to escalate deteriorating patients to Resident Doctors and directly to Consultants when required.
Stated by HCA International Limited (trading as HCA Healthcare UK
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Action
Revise and strengthen critical-care procedures defining escalation, record-keeping, communication, staffing, and medical-care responsibilities, and share them with relevant staff.
Stated by HCA International Limited (trading as HCA Healthcare UK -
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 UK
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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.
Responses linked to these concernsEach 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
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Action
Require Independent Visitor volunteers to follow a safeguarding code and health-and-safety procedure specifying when concerns must be reported or disclosed.
Stated by Calderdale Borough Council
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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.
Responses linked to these concernsEach 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
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Action
Maintain clear protocols for identifying unwell residents and escalating concerns to district nursing teams and digital health coordinators.
Stated by The Lakes Care Centre Limited
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The assessment found no issues with escalation systems or staff understanding, and digital health services were generally used appropriately.
Stated by Care Quality Commission
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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.
Responses linked to these concernsEach 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
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Action
Develop, govern and secure approval for a revised night-time Internal Escalation Policy.
Stated by Royal Berkshire NHS Foundation Trust
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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.
Responses linked to these concernsEach 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
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Action
Engage the Society of British Neurological Surgeons and NHS nurse specialists to develop an action plan and national guideline for external ventricular drain management.
Stated by NHS England -
Action
Obtain permission to share the Plymouth EVD management SOP with clinical leads on request.
Stated by The Society Of British Neurological Surgeons
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Position
Existing local policies, educational materials and professional guidance address EVD care, while locally relevant policies remain appropriate for individual neurosurgical units.
Stated by NHS England
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Position
Individual Trusts are responsible for reviewing or developing local EVD standard operating procedures where necessary.
Stated by The Society Of British Neurological Surgeons
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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.
Responses linked to these concernsEach 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
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Action
Implement an organisational welfare-check procedure defining routine and increased checks, authorisation, duration and recording requirements.
Stated by Depaul UK
Data last updated 7 September 2026