Urgent care pathways

232 items 2 sources

Deficiencies in urgent care pathways for serious but non-immediately life-threatening conditions, leading to delays and poor outcomes.

Cross-Source Insight

Urgent care pathways has been flagged across 2 independent accountability sources:

2 inquiry recs 230 PFD reports

This issue has been identified by multiple independent accountability bodies, suggesting it is a recurring systemic concern.

Chloe Ulett
11 Feb 2026 · Birmingham and Solihull
Concerns: There is a lack of routine ammonia testing for acutely confused adults, and current RCEM guidelines for metabolic disorders are not well-embedded or sufficiently clear, especially for postpartum women.
Pending
Kallum Reed
05 Feb 2026 · West London
Concerns: Unacceptably long waits for ASD/ADHD services and mental health crisis team gate-keeping failures led to patients being denied crucial in-person assessments and ongoing close care.
Pending
Lauren Moret-Dell
04 Feb 2026 · Suffolk
Concerns: Hospital staff lacked proficiency in timely TIA Clinic referrals. Additionally, out-of-hours stroke care lacked commissioned stroke consultant input, adversely impacting patient treatment outcomes.
Pending
Robert Gracey
06 Jan 2026 · Greater Lincolnshire
Concerns: Despite national recommendations, Lincolnshire lacks an established protocol to treat suspected Acute Behavioural Disturbance (ABD) as a medical emergency. The NHS Pathways system also inadequately categorises ABD cases.
Response: NHS England noted the concerns regarding Acute Behavioural Disturbance protocols and NHS Pathways, stating that East Midlands Ambulance Service (EMAS) will respond directly to these specific issues. NHS England also …
Response: The Trust will continue its participation in the Police Regional Clinical Governance Forum and work with partners to explore the development of a single joint operational framework for Acute Behavioural …
Overdue
Theo Tuikubulau
06 Jan 2026 · Devon, Plymouth and Torbay
Concerns: Two distinct triage systems for 999 and 111 calls create a two-tiered ambulance categorisation for similar urgent breathing complications, potentially delaying critical responses based on the system used.
Overdue
Jake Hartwright
05 Jan 2026 · Nottinghamshire
Concerns: The urgent care pathway poorly serves non-immediately life-threatening systemic illnesses, as detailed 111 information is unreliably used by EMAS, families are uninformed of ambulance cancellations, and transfer criteria between services are unclear.
Response: NHS England acknowledges the concerns and notes that a system-wide After-Action Review has been facilitated by the Integrated Care Board, with outcomes to be monitored by various governance bodies. They …
Response: East Midlands Ambulance Service has implemented several changes, including deploying senior clinicians in their Clinical Hub, ensuring clinicians review all information before transferring calls, and ceasing manual ITK push transfers …
Response: NEMS has ceased manually pushed calls, updated its Clinical Triage Guideline, introduced daily reviews of Category 3 calls, and established a Clinical Triage working group. They are also developing a …
Response: The ICB facilitated a system-wide After-Action Review, ceased some automatic call transfers to NEMS, reviewed and redefined the Urgent Care Clinical Hub service specification, and developed new analytics capabilities for …
Responded
Adam Hussain
05 Jan 2026 · Nottinghamshire
Concerns: The urgent care pathway poorly serves serious systemic illnesses like sepsis, with critical patient information not reliably used by ambulance staff, leading to unnotified ambulance cancellations and unsafe call transfers.
Response: NHS England acknowledges the concerns and notes that a system-wide After-Action Review has been facilitated by the Integrated Care Board, with outcomes to be monitored by various governance bodies. They …
Response: East Midlands Ambulance Service has implemented several changes, including deploying senior clinicians in their Clinical Hub, ensuring clinicians review all information before transferring calls, and ceasing manual ITK push transfers …
Response: NEMS has ceased manually pushed calls, updated its Clinical Triage Guideline, introduced daily reviews of Category 3 calls, and established a Clinical Triage working group. They are also developing a …
Response: The ICB facilitated a system-wide After-Action Review, ceased some automatic call transfers to NEMS, reviewed and redefined the Urgent Care Clinical Hub service specification, and developed new analytics capabilities for …
Responded
Lina Piroli
04 Dec 2025 · Inner North London
Concerns: Elderly and complex patients, especially those with dementia, suffer detrimental delays in overcrowded A&E departments unequipped to provide specialist care, due to a lack of available ward beds.
Response: NHS England outlines its national Urgent & Emergency Care plans to improve patient flow and reduce ED waits. Locally, the Trust is developing its frailty team, creating a dedicated frailty …
Response: The Department for Health and Social Care outlines the Government's 10-Year Health Plan and the Urgent and Emergency Care Plan for 2025/26, committing to investments (e.g., £250m) and initiatives to …
Responded
Thomas Morrell
17 Nov 2025 · Newcastle and North Tyneside
Concerns: Failure to promptly recognise heart failure and the absence of a HOCM patient referral SOP delayed specialist transfer. A lack of regular cardiac monitoring also meant deterioration was missed, losing intervention opportunities.
Response: York Scarborough Hospital circulated a message to relevant clinicians regarding the importance of timely referral to a transplant centre. However, the Trust maintains that Mr Morrell’s overall management was appropriate, …
Responded
Margaret Crooks
14 Nov 2025 · Manchester South
Concerns: Confusion among stroke clinicians about the level of overnight expert support available led to delays in time-critical advice for stroke complications, potentially affecting patient outcomes.
Response: Greater Manchester Integrated Care has reviewed its Comprehensive Stroke Centre service specification and Standard Operating Procedure. Following this, the network plans to add further detail to the SOP to clarify …
Responded
Liliane Bowden
11 Nov 2025 · Hampshire, Portsmouth and Southampton
Concerns: Significant ambulance delays, caused by high demand and prolonged hospital handovers, led to extended waits for Category 3 calls. This poses a serious risk to elderly and vulnerable patients needing prompt attention.
Response: South Central Ambulance Service disputes the report being issued to them, stating the core issue of handover delays lies with hospital trusts. They acknowledge the problem is widespread and explain …
Responded
Kathleen Ward
03 Nov 2025 · East Riding and Hull
Concerns: The emergency department faces persistent overcrowding with patients awaiting ward beds, leading to delays in appropriate emergency care and risking repeat incidents due to insufficient bed capacity.
Response: Hull Royal Infirmary is strengthening escalation processes for end-of-life patients and reinforcing compassionate communication. They plan a further rollout of Comfort Observations across the organisation, including the Emergency Department, and …
Responded
Brian Lloyd
03 Nov 2025 · North London
Concerns: Patients with two failed catheter insertion attempts are not being transferred to hospital promptly, creating a risk of delay in necessary medical intervention.
Response: High Meadows Care Home has updated its catheterisation policy, created and disseminated a new Catheter Emergency and Escalation Protocol, and provided staff training. They also reconfigured their telephone system and …
Response: High Meadows Care Home has implemented an 'Escalation Protocol for Team Leads' (Version 1.0, implemented 23/10/2025) outlining how staff must recognise, respond to, and promptly escalate clinical concerns, specifically referencing …
Responded
Patricia Genders
28 Oct 2025 · West Sussex, Brighton and Hove
Concerns: Over-reliance on A&E for mental health crises due to inadequate dedicated placements creates an unsuitable and insecure environment, risking patient deterioration and abscondment.
Response: NHS England has initiated a pilot program for 24/7 neighbourhood mental health centres and implemented a 24/7 Mental Health Crisis Pathway. They have also published updated guidance for mental health …
Response: The Department for Health and Social Care has introduced a mental health option via NHS 111 and expanded 24/7 liaison mental health teams. It plans to deliver 200 more mental …
Responded
Lewis Garfield
28 Oct 2025 · Northamptonshire
Concerns: Ambulance service communications were inadequate, leading to delayed clinician review and escalation. Lengthy hospital handover delays severely impact ambulance availability and emergency department flow.
Response: EMAS's Incident Review Group has discussed the concerns, and they are now implementing dynamic strategic conveyance daily and proactively initiating rapid handover requests during high demand. They are also actively …
Response: SCAS conducted an audit of the 999 calls, identifying one non-compliant call with documentation errors for which corrective action has been taken and learning shared directly with the call handler. …
Response: The Department for Health and Social Care has published an Urgent and Emergency Care Plan for 2025/26, committing nearly £450 million of capital investment and implementing additional surge capacity and …
Response: University Hospitals of Northamptonshire has implemented numerous initiatives since January 2025, including front door streaming, SDEC, Frailty services, discharge lounges, and Rapid/Acute Assessment Units. They have also introduced a NerveCentre …
Responded
Ann Laskowsky
07 Oct 2025 · West Yorkshire Western
Concerns: Inadequate first aid training for police officers in assessing patient conditions and poor awareness of a dedicated medical advice line led to a failure to recognise severe medical needs.
Response: The College of Policing revised its First Aid Learning Programme (FALP) in 2023, expanding content and training time to include advanced casualty assessment and recognition of acute alcohol intoxication, now …
Response: West Yorkshire Police has updated its operational briefings and guidance to reinforce the use of the YAS Partner Triage Line, and has tasked a team with monitoring its usage. They …
Response: The NPCC confirms a full review of the Police First Aid Learning Programme (FALP) was conducted in 2023 and implemented this year, mandating assessment of breathing and responsiveness. They have …
Responded
Zara Cheesman
25 Sep 2025 · Nottingham and Nottinghamshire
Concerns: Emergency medical services lacked detailed understanding of child assessment issues, relied on incorrect physiological scoring, and had insufficient audit, monitoring, and professional development for staff on paediatric guidelines.
Overdue
Honoria Culshaw (1)
24 Sep 2025 · Manchester South
Concerns: Critical information regarding the need for pacemaker extraction was not adequately communicated between specialist and local hospitals, nor to the patient's GP, delaying essential treatment for infection.
Responded
Margaret Bailey
03 Sep 2025 · Manchester South
Concerns: Care agencies lack a clear triage algorithm for non-medical call handlers and carers cannot perform basic observations, hindering effective client monitoring and response to illness.
Overdue
Ricky O’Connell
20 Aug 2025 · Manchester South
Concerns: Ambulance response times are severely impacted by significant delays in clearing emergency departments and high demand for services, exacerbated by challenges in primary care access and regional turnaround issues.
Responded
Joanne Stones
30 Jul 2025 · North Yorkshire and York
Concerns: The hospital failed to prioritise a seriously ill patient, overlooking critical medical alerts and existing diagnoses, and neglected to consult specialists, leading to significant delays and inappropriate treatment.
Responded
Jordan Babb
25 Jul 2025 · Milton Keynes
Concerns: Failures in a walk-in centre to escalate abnormal vital signs, conduct structured risk assessments for pulmonary embolism, and properly apply clinical decision tools indicate a lack of clear protocols and training.
Overdue
Madeline Reding
21 Jul 2025 · East London
Concerns: Delayed and disorganised staff emergency response, including failures to promptly raise alarms or call 999, coupled with inadequate CPR due to a misunderstanding of Do Not Resuscitate orders, led to critical care gaps.
Responded
Kaine Fletcher
17 Jul 2025 · Nottinghamshire
Concerns: A critical lack of shared understanding and adherence between emergency services regarding local policies and working standards for Section 136 detentions creates significant risks for vulnerable individuals.
Overdue
Noreen McGlynn
11 Jul 2025 · Inner North London
Concerns: There was a lack of capacity for community healthcare teams and GPs to offer home rehydration for a dehydrated patient, leading to unwanted hospital admission despite family preferences for home care.
Responded
Peter Ramsden
08 Jul 2025 · City of Kingston Upon Hull and the County of the East Riding of Yorkshire
Concerns: A legal lacuna prevents police, paramedics, or fire services from forcing entry for welfare checks if a medical problem is suspected, hindering prompt, potentially life-saving treatment for incapacitated individuals.
Responded
Elaine Tarbuck
07 Jul 2025 · Manchester West
Concerns: The "Right Care, Right Person" policy led to misclassification of a "concern for welfare" call, causing significant delays in emergency services forcing entry and resulting in inappropriate first responder attendance.
Responded
Norma Campbell
16 Jun 2025 · East London
Concerns: Whipps Cross A&E experiences severe overcrowding, inadequate staffing, and insufficient resuscitation beds, leading to critically ill patients receiving substandard care in corridors or less equipped areas.
Responded
Valerie Hill
13 Jun 2025 · South Wales Central
Concerns: Long-standing, systemic ambulance handover delays in Wales persist at intolerable levels, with risks remaining due to a disconnect between ambulance service rostering expectations and actual hospital capacity.
Responded
Michelle Mason
02 Jun 2025 · Lancashire and Blackburn with Darwen
Concerns: Lancashire lacks a 24/7 thrombectomy service and a clear plan for its delivery, compounded by non-stroke specialists' misunderstanding of service availability and a lack of regional mutual aid.
Responded
Charlotte Werner
02 Jun 2025 · Inner North London
Concerns: A lack of clear communication led to a misunderstanding that a dietetic service treated eating disorders, highlighting a need for clarification that it is not a mental health service.
Overdue
Dean Bradley
28 May 2025 · Teesside and Hartlepool
Concerns: Current resources for safeguarding intoxicated individuals with mental health illnesses are insufficient, as assessments cannot occur until sobriety, leaving vulnerable people at risk.
Responded
Abdirahman Afrah
27 May 2025 · East London
Concerns: A&E had excessive waiting times and lacked timely medical triage, risking critical patient deterioration. Follow-up calls were made without full clinical information or clear advice, and essential patient results were not sent to the GP due to staff unfamiliarity with the process.
Responded
Emily Stokes
19 May 2025 · North East Kent
Concerns: Private ambulance staff at a music event lacked adequate training for drug-affected patients and standard equipment, with unclear responsibility for pre-alert calls to hospitals for seriously unwell individuals.
Responded
Jake Lawler
09 May 2025 · Manchester South
Concerns: Clinicians frequently misinterpret ECGs and lack clear national guidance for paediatric exercise-induced syncope. The national asthma scoring system is insufficient, leading to misdiagnosis and missed cardiac conditions in children.
Responded
John England
09 May 2025 · Cornwall and Isles of Scilly
Concerns: The ambulance service's dispatch system lacks nuance for specific abdominal complaints, leading to an inappropriately low emergency category and delaying critical care for a potential surgical emergency.
Responded
Paul Burke
02 May 2025 · Hertfordshire
Concerns: Persistent, multi-factorial delays in ambulance response times, coupled with hospital handover issues and system pressures, are causing significant waits for urgent pre-hospital care and pose a risk of future deaths.
Responded
James Masheter
03 Apr 2025 · Lancashire and Blackburn with Darwen
Concerns: The NHS Pathways system's limited mental health triage options inadequately assess serious mental health crises, leading to low priority categorisation and significant delays in ambulance response for at-risk patients.
Responded
Benjamin Compton
19 Mar 2025 · Devon, Plymouth and Torbay
Concerns: A significant gap in care exists for autistic individuals in crisis without a treatable mental health condition, and the Special Allocation Scheme failed to address an autistic patient's specific needs.
Responded
Nicholas Gedge
11 Mar 2025 · West Yorkshire East
Concerns: A significant delay in commencing CPR occurred due to a lack of shared understanding of its urgency and an uncoordinated response among detention officers and a nurse. No clear protocols define emergency roles.
Responded
Matthew Sheldrick
16 Dec 2024 · West Sussex, Brighton and Hove
Concerns: Severe national shortages of mental health beds, especially for autistic and transgender patients, led to dangerously long A&E waits, where the environment was unsuitable and exacerbated mental health conditions.
Responded
Matthew Sheldrick
16 Dec 2024 · West Sussex, Brighton and Hove
Concerns: Critical shortages of mental health inpatient beds, particularly for neurodiverse and transgender patients, led to dangerous A&E wait times and an unsuitable environment, alongside service gaps for high-risk individuals.
Responded
Timothy De Boos
13 Dec 2024 · Suffolk
Concerns: A severe and persistent shortage of mental health inpatient beds, combined with a crisis team overriding the experienced mental health professional, family, and patient's wishes for admission, led to a denied hospitalisation.
Responded
Charles Devos
10 Dec 2024 · Cornwall & the Isles of Scilly
Concerns: Extreme operational pressure on ambulance services, exacerbated by inadequate social care, causes excessive 999 call delays and unallocated calls. This forces call handlers to resort to risky mitigating measures like recommending self-conveyance.
Responded
Amy Butcher
26 Nov 2024 · Suffolk
Concerns: The mental health medication prescribing system is confusing and lacks a single point of contact, requiring patients in crisis to contact multiple services. This is compounded by out-of-hours issues and restrictions on certain medications.
Responded
Frank Ospina
25 Oct 2024 · West London
Concerns: Mismatched healthcare and Home Office interpretations of Rule 35 led to a failure in reporting suicidal intentions, and an inappropriate "closed" visit denied a detainee physical contact and private conversation with family.
Responded
Phyllis Hart
16 Oct 2024 · Staffordshire
Concerns: The County Hospital in Stafford lacked an essential vascular team, meaning urgent vascular opinions could not be obtained, posing a risk to patient care.
Responded
Marina Young
04 Oct 2024 · Lancashire and Blackburn with Darwen
Concerns: In A&E, prolonged patient stays lacked timely alerts to management, care needs were inadequately assessed for complex patients, and nurses lacked essential asthma assessment knowledge without senior escalation.
Responded
John Turner
03 Oct 2024 · Manchester South
Concerns: Overwhelming demand on the Emergency Department led to deviations from triage protocols, delayed medical record keeping, and a reduced ability to identify serious conditions presenting atypically.
Responded
Ryan Campbell
01 Oct 2024 · Manchester South
Concerns: The hospital's lack of a full suite of cardiac diagnostic imaging equipment, specifically CT or MR angiograms, causes diagnostic delays and necessitates risky patient transfers.
Responded
Carol Guest
05 Sep 2024 · South Yorkshire East
Concerns: There are inadequate crisis support systems for mental health patients over 65, as existing services are unavailable by age, and general practitioners provide incorrect referral information.
Responded
Felix Hartley
30 Aug 2024 · West Sussex
Concerns: Neonatology Consultants are not immediately on-site overnight or weekends at two distant hospitals, and variable response times due to travel constraints pose a risk in emergencies.
Responded
Kasey Beech
29 Aug 2024 · London Inner (South)
Concerns: The current STREAMing guidance's focus on chest pain in emergency assessments may delay recognition of other life-threatening conditions, risking sudden patient deterioration.
Responded
Dave Onawelo
27 Aug 2024 · East London
Concerns: Inadequate monitoring of a high-risk patient with sickle cell anaemia, coupled with delayed interventions and emergency department issues like congestion and over-reliance on algorithms, contributed to a fatal outcome.
Overdue
Douglas Armstrong
12 Aug 2024 · Liverpool and Wirral
Concerns: Care agency responders lacked sufficient training to identify a fractured neck of femur, over-relied on patient self-assessment, and inadequately communicated with ambulance services, resulting in a missed diagnosis.
Responded
Michael Huggon
08 Jul 2024 · Cumbria
Concerns: Inadequate handover between GP and out-of-hours services, along with slow, inefficient 111 processes and poor urgent care response, led to significant delays in critical medical assessment and treatment.
Responded
Peter Fanning
07 May 2024 · Birmingham and Solihull
Concerns: Insufficient radiology slots for feeding tube replacements caused week-long delays and suboptimal nutrition for complex patients. There was also a lack of clear procedures for maintaining nutrition during these delays.
Responded
Stevyn Carr
15 Apr 2024 · Gateshead and South Tyneside
Concerns: Inappropriate grading of vulnerable person incidents and severe lack of police resources led to significant delays in response and oversight, failing to provide timely assistance.
Responded
Anne Hawkes
02 Apr 2024 · South Yorkshire East
Concerns: A lack of automatic cardiology referral procedures led to sub-optimal cardiac failure management, and poor inter-departmental communication caused delayed and uncoordinated wound care.
Responded
Maureen Owens
27 Mar 2024 · North Wales (East and Central)
Concerns: There is inadequate knowledge within the Health Board, including clinical and nursing staff, regarding the correct use and operation of the Adult Critical Care Service Cymru for urgent patient transfers.
Responded
Craig Burfield
26 Mar 2024 · South Yorkshire West
Concerns: There is currently no established adult care pathway, transition protocol from childhood to adulthood, or effective review process for patients with hydrocephalus shunts, risking fatal outcomes.
Responded
Christopher Sidle
25 Mar 2024 · Norfolk
Concerns: Concerns remain regarding the crisis team's understanding of comprehensive assessments, mental capacity, and other services. There were also communication failures, insufficient telephone support, and an ongoing national mental health bed shortage.
Responded
Anne Rowland
20 Mar 2024 · Surrey
Concerns: Continuing infrastructure issues at East Surrey Hospital and a local metric for hip fracture surgery exceeding NICE guidelines delay essential operations, increasing patient risk of complications.
Responded
Oliver Beswetherick
21 Feb 2024 · London Inner (South)
Concerns: Mental health teams lack essential contact details for psychiatric liaison services and crisis teams in neighbouring boroughs, leading to repeated patient assessments and delayed urgent support.
Responded
Brian James
07 Feb 2024 · South Wales Central
Concerns: Ambulance service instructions not to call back and inadequate welfare checks during delayed responses risk callers failing to recognize deterioration or feeling unable to re-contact emergency services, missing critical reassessment opportunities.
Responded
Emily Harkleroad
05 Feb 2024 · County Durham and Darlington
Concerns: A new Emergency Department computer system lacks a clear RAG rating for patient acuity, making it difficult for clinicians to quickly identify critically ill patients, especially during peak demand.
Responded
Dennis King
15 Jan 2024 · Suffolk
Concerns: Significant ambulance delays and confusion in transfer categorisation between hospitals, alongside an inadequate action plan, undermined the timely delivery of urgent, centralised cardiac care.
Responded
Claire Briggs
08 Dec 2023 · Manchester South
Concerns: A stalled Joint Operating Protocol between emergency services leaves a critical lack of clarity on roles and escalation procedures for drug overdose incidents, risking patient safety.
Responded
Glyn Ackerley
27 Nov 2023 · Cheshire
Concerns: The NHS Pathways system fails to differentiate between high and low-risk overdoses, potentially delaying urgent treatment for fatal opiate overdoses, and the implementation of proposed changes is unclear.
Responded
Kenneth Heard
23 Nov 2023 · Cornwall and the Isles of Scilly
Concerns: Ambulance response times are severely impacted by extensive and persistent handover delays at Treliske and Derriford hospitals, with patients still waiting over 12 hours in ambulances despite mitigating measures.
Responded
Charlotte Burton
23 Nov 2023 · Cambridgeshire and Peterborough
Concerns: A nationwide shortage of trained cardiologists, particularly out-of-hours, leads to reliance on non-specialist staff, risking delayed or inadequate assessment for patients with suspected cardiac problems.
Overdue
Sarah Read
17 Nov 2023 · Lancashire and Blackburn with Darwen
Concerns: There is no provision for out-of-hours Thrombectomy Service after 5pm in Lancashire, and a lack of regional coordination means this urgent, lifesaving stroke treatment is unavailable when needed.
Responded
Madeleine Savory
15 Nov 2023 · Suffolk
Concerns: There is a national shortage of Tier 4 beds in paediatric mental health facilities, delaying timely access to crucial care for children in need.
Responded
Lynda Blackmore
15 Nov 2023 · South Wales Central
Concerns: Significant ambulance handover delays at hospitals are severely impacting emergency response times, causing patients to wait many hours for treatment or conveyance. These delays pose a critical risk to patient safety.
Responded
Elizabeth Watson
10 Nov 2023 · East Riding and Hull
Concerns: Security staff monitoring a bridge for distressed individuals lack structured training from mental health professionals on identification and interaction. Delays in emergency service response further leave staff unequipped to handle vulnerable people for extended periods.
Overdue
Frances Newbury
10 Nov 2023 · Inner North London
Concerns: Paramedics failed to administer Naloxone despite a patient's reported illicit drug use and clear physical signs. This highlights a missed opportunity for potentially life-saving intervention in opiate overdose cases.
Responded
Christopher Hart
09 Nov 2023 · Suffolk
Concerns: Persistent and significant ambulance non-availability in the East of England region led to extreme delays, where prompt arrival and early treatment could have saved a patient's life.
Responded
Peter Carr
13 Oct 2023 · North London
Concerns: Patients with acute, severe skin conditions are at risk from not receiving consultant dermatology input and biopsy within 24 hours, or continuous consultant oversight throughout their inpatient stay.
Responded
Douglas Nickols
29 Sep 2023 · Surrey
Concerns: The hospital consistently fails to meet NICE guidelines for hip fracture surgery within the recommended timeframe, delaying early mobilisation and increasing patients' risk of complications like pneumonia.
Overdue
John Winsworth
29 Sep 2023 · Norfolk
Concerns: Critical delays in ambulance response times and subsequent long waits for hospital admission to A&E are causing significant risks due to ongoing pressure on emergency services.
Responded
Geoffrey Hoad
13 Sep 2023 · Norfolk
Concerns: Significant ambulance response delays, exceeding 14 hours, stemmed from high call demand and hospital handover issues, despite escalating call categories.
Responded
James Jones
06 Sep 2023 · North West Wales
Concerns: Persistent pressures and insufficient staffing in the A&E department lead to review delays, risking missed opportunities and potential future deaths in life-threatening situations.
Overdue
Stephen Ratclife
01 Sep 2023 · Manchester North
Concerns: The absence of a specialist service for GPs to refer patients with difficult venous access for blood tests led to a missed diabetes diagnosis.
Responded
Harold Pedley
01 Sep 2023 · Blackpool & Fylde
Concerns: Emergency department pressures at OPEL 4 led to extensive triage delays and patient deaths, compounded by GPs not providing a realistic picture of waiting times.
Responded
Edward Rhodes
01 Aug 2023 · Dorset
Concerns: There was a breakdown in communication between GP and an addict regarding mental health referral steps, relying solely on verbal discussions without an automatic referral system or written confirmation, leading to unmet care.
Responded
Jane Wadsworth
17 Jul 2023 · Manchester South
Concerns: Missed critical medication doses, lack of senior medical input during holiday periods, and ineffective communication for ICU referrals and specialist discussions contributed to a patient's deteriorating condition.
Responded
Matthew Phipps
29 Jun 2023 · East London
Concerns: The hospital lacked a contingency plan for providing intensive care when the unit was full, resulting in a patient requiring critical care not being admitted.
Overdue
Keith Nielsen
26 Jun 2023 · Surrey
Concerns: The ambulance service (SECAMBS) is consistently operating at a critical surge level, where demand significantly exceeds resources, leading to a failure to meet target response times and risking future deaths.
Responded
Ginger Wright
26 Jun 2023 · Surrey
Concerns: The ambulance service (SECAMBS) is consistently operating at a critical surge level, where demand significantly exceeds resources, leading to a failure to meet target response times and risking future deaths.
Responded
Stephen Richardson
22 Jun 2023 · Liverpool and Wirral
Concerns: There is an ongoing national shortage of acute psychiatric beds, preventing patients with severe mental disorders from accessing immediate inpatient assessment and treatment, which has not improved since 2019.
Responded
Michael Sullivan
20 Jun 2023 · Manchester South
Concerns: Delays between GP referrals and Crisis Review Team assessments for vulnerable mental health patients highlight unclear processes regarding GP understanding, CRT prioritization, or triage effectiveness, causing patients to become seriously unwell before assessment.
Responded
Joan Corcoran
20 Jun 2023 · Manchester South
Concerns: Widespread, significant ambulance response delays for Category 2 calls, drastically exceeding target times, are caused by multifactorial issues including high demand and prolonged A&E handover times, directly contributing to patient deterioration and death.
Responded
Leonard Harmsworth
20 Jun 2023 · North Wales East and Central
Concerns: Significant ambulance response and hospital handover delays, extending over many hours, persist due to multifactorial issues including social care deficiencies and patient flow, posing a continued risk of future deaths.
Overdue
James Philliskirk
10 May 2023 · South Yorkshire (Western)
Concerns: Junior staff failed to escalate concerns, exacerbated by unclear guidance on chickenpox reinfection, confirmation bias, and inadequate assessment of skin lesions. GP referrals were also not given sufficient weight, delaying crucial treatment.
Responded
Sandra Finch
09 May 2023 · Stoke on Trent and North Staffordshire
Concerns: Rigid ambulance categorization pathways incorrectly classify serious conditions, and an assessment team for lower priority calls without time limits or prioritization creates dangerous delays.
Responded
Louis Rogers
28 Mar 2023 · Surrey
Concerns: Inadequate management and investigation of febrile seizures, including insufficient parental information, deficiencies in paramedic guidelines, and GP assessment, contributed to missed opportunities for timely intervention and specialist referral.
Overdue
Celia Sanderson
10 Feb 2023 · Manchester South
Concerns: Excessive Emergency Department wait times due to staff shortages and lack of 'silver trauma' protocols for elderly patients delayed critical CT scans and transfer to trauma centers.
Responded
Dorothy Jones
20 Jan 2023 · Gwent
Concerns: Ongoing insufficient ambulance resources in Gwent consistently result in unacceptable response times for Amber 1 patients, with chronological allocation lacking clinical consideration and ad hoc interventions not supported by policy.
Responded
Lyn Brind
18 Jan 2023 · Norfolk
Concerns: Critical delays in transferring patients from ambulances to the emergency department are caused by hospital bed shortages, leading to insufficient patient monitoring and significant ambulance handover delays.
Responded
Kyriacos Athanasis
06 Jan 2023 · Norfolk
Concerns: Hospital overcrowding and delays in transferring patients from ambulances to the emergency department led to inadequate safety checks and delayed diagnosis of severe injuries.
Responded