First reported 13 Dec 2013•Latest report 24 Nov 2025
Definition
What this concern includes
Includes failures to consider, offer, arrange or provide psychiatric hospital admission when a person's mental state, risk, symptoms or clinical needs indicate that admission should be considered or provided, including failure to admit despite patient or family requests where admission is clinically indicated.
Not included
Excludes general hospital-admission delays or bed-capacity shortages unless the assertion specifically concerns a clinically indicated psychiatric admission decision or provision.
Excludes failures in psychiatric assessment, treatment, observation, discharge or follow-up where psychiatric admission is not the deficient control.
Excludes refusals or non-admission decisions where the report does not identify that psychiatric admission was clinically indicated.
Excludes failures confined to referral or crisis-team access when the unsafe condition is not failure to offer or provide psychiatric admission.
Reports
12
Distinct published reports
Individual concerns
12
A report can raise multiple concerns
Date range
2013–2025
First to latest report issue date
Stated actions
26
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 Care5
NHS England5
NHS Birmingham and Solihull Integrated Care Board2
Avon and Wiltshire Mental Health Partnership NHS Trust1
Birmingham and Solihull Mental Health NHS Foundation Trust1
Birmingham City Council1
Care Quality Commission1
Epsom Hospital1
Greater Manchester Mental Health NHS Foundation Trust1
Health and Care Professions Council1
Health Services Safety Investigations Body1
NHS Greater Manchester Integrated Care Board1
NHS South West London Integrated Care Board1
Norfolk and Suffolk NHS Foundation Trust1
North London NHS Foundation Trust1
NHS trust8
Executive non-departmental public body6
Ministerial department5
Integrated care board4
Education sector body1
English metropolitan district council1
Health and care professional regulator1
Health and social care service regulator1
Healthcare site1
Police force1
Private limited company1
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.
Inner North London
Concerns raised1
Failure to consider hospital admission for a patient presenting significant suicide risk
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.
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
Implement measures across all Crisis Teams and Crisis Houses to address the identified concerns.
Stated by North London NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 1 June 2015.
Manchester City
Concerns raised1
Delays in admission to an appropriate mental health bed
This report raised 8 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.6
Action
Maintain the changed inpatient-bed access process, under which service users requiring admission do not have a waiting list.
Stated by Greater Manchester Mental Health NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Action
Operate daily bed-management calls, weekly delayed-discharge teleconferences and weekly mental-health inpatient-capacity meetings with relevant partners.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Action
Purchase additional inpatient capacity in neighbouring NHS facilities and through the charitable sector.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Action
Monitor out-of-area placements and bed availability daily and weekly to support rapid allocation or repatriation and prevent unnecessary waiting.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Action
Review and maintain the escalation protocol enabling use of private-sector beds when Trust capacity is unavailable.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Action
Implement the inpatient capacity management plan to improve patient experience, bed flow and joint working across stakeholder organisations.
Stated by NHS Greater Manchester Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 13 December 2013.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Acute beds should already be available without waiting for patients clinically deemed to need them.
Stated by Department of Health and Social CareExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The Trust disputes that inpatient bed availability creates a local waiting-list risk, stating that its revised access arrangements left no service users awaiting admission.
Stated by Greater Manchester Mental Health NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Decisions about admitting and discharging mental health patients rest with the provider NHS Trust, not the commissioning organisation.
Stated by NHS Greater Manchester Integrated Care BoardRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Existing escalation, monitoring and capacity-management arrangements are considered appropriate and robust for managing inpatient bed availability and out-of-area placements.
Stated by NHS Greater Manchester Integrated Care BoardExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
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Includes failures to consider, offer, arrange or provide psychiatric hospital admission when a person's mental state, risk, symptoms or clinical needs indicate that admission should be considered or provided, including failure to admit despite patient or family requests where admission is clinically indicated.
