Recurring concern
Failure to maintain clear clinical responsibility for patient care
- Reports that mention this concern
- 39
- Times this concern has been raised
- 42
- Stated actions linked to this concern
- 54
What this concern includes
Includes failures of an explicitly clinical care responsibility arrangement in which clinicians or senior clinical staff do not retain, clearly assign or actively oversee responsibility for patient care, including during private hospital stays, community care and post-discharge care.
What is not included
- Excludes generic delegation or supervision failures not tied to responsibility for the patient’s overall clinical care.
- Excludes administrative, incident-investigation or governance responsibility failures that do not concern ongoing clinical responsibility for patient care.
- Excludes individual delays, omissions or treatment failures unless they arise from the failure to retain or clearly assign clinical responsibility.
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 39 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised1
Lack of identified consultant oversight of diabetic and gynaecological aspects of high-risk pregnancy care
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Lack of communication between hospital departments about responsibility for patient care
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 of North Midlands 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.3
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University Hospitals of North Midlands NHS Trust
Agree the renal admission pathway with advice clarifying the reason for referral.
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University Hospitals of North Midlands NHS Trust
Amend Trust Internal Professional Standards to reduce failures caused by misunderstanding between departments.
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University Hospitals of North Midlands NHS Trust
Escalate and document patients requiring specialty care through Emergency Department huddles and the Huddle Log.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
University Hospitals of North Midlands NHS Trust
The absence of consultant review was not a separate error because existing senior-review mechanisms were robust; it resulted from misunderstanding responsibility for the patient.
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Concerns raised1
Failure to assign clear responsibility for discharge decision making
This report raised 9 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Doncaster and Bassetlaw Teaching Hospitals 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
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Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Implement a CDU standard operating procedure defining responsibility across the patient pathway.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
A CDU consultant made the discharge decision and identified the patient as medically fit for discharge, subject to specified conditions.
-
Concerns raised1
Failure to assign overall responsibility for asthma care
This report raised 23 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- NHS England
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
-
NHS England
Share examples of effective asthma-service practice through the clinical networks.
-
Concerns raised1
Failure to establish clear responsibility for PEG feeding assessment and key decisions
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Care Quality Commission
- Department of Health and Social Care
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
-
Care Quality Commission
Complete an inspection addressing the reported concerns, including end-of-life care and Mental Capacity Act arrangements.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
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Care Quality Commission
CQC does not prescribe how providers should improve; the provider or registered manager decides the appropriate actions.
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Care Quality Commission
CQC does not publish detailed standards for specific conditions because this would duplicate expert sources and be impractical to keep updated.
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Department of Health and Social Care
The Care Quality Commission, as regulator, is expected to consider and respond to concerns about the services provided in this case.
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Concerns raised1
Failure to assign clear responsibility for coordinating and delivering care before discharge
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Failure to assign overall management responsibility for care
This report raised 24 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Unclear post-procedure clinical accountability
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Lack of clear allocation of a named keyworker or lead nurse for community care coordination
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
-
Concerns raised1
Failure to assign clinical leadership and psychiatric monitoring during interim care pending Mental Health Act assessment
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Oxleas 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
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Oxleas NHS Foundation Trust
Specify the Home Treatment Team’s expected risk-management role in referrals made while clients await Mental Health Act assessment.
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Oxleas NHS Foundation Trust
Hold thrice-weekly zoning meetings for high-risk individuals and minute agreed risk-mitigation actions.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026