PEOPLE FIRST: Escalation

Page last updated: 28 April 2023

This section contains


Integrated care systems should create effective escalation processes with tangible calls to action, so services across the system can effectively carry them out. All staff and services must understand the escalation plan and how it relates to them.

↑ Back to top


Escalation plans can often be poorly executed, unworkable or misunderstood by the wider system.

Integrated care system partners and leaders must work together to create effective, system-wide escalation processes. System leaders need to make sure system partners share escalation information. Providing clear routes for feedback is important too. This helps to establish what level of escalation a system is currently in and what actions services should take.

A regularly updated, coordinated escalation plan will identify risk at all system levels. This is very important if integrated care systems are to going to deliver safe, good quality care. It also helps share risk across services, particularly in a stretched system.

Organisations and staff can become immune to the various levels of escalation if plans are not updated and measured frequently. The best escalation plans are easy to understand and visible to all staff. They show what actions are being taken to mitigate or overcome pressure. This reassures staff that escalation levels are more than a statement of the current status. They are a call to action.

↑ Back to top

↑ Back to top

Examples of good practice and innovation

Cheshire and Merseyside ICS

During the inspection of this ICS, CQC saw direct routes in mental health services that signposted people to the right care as quickly as possible.

They also saw proactive management of escalation processes by the ambulance service. This focused on a system-wide response when there was additional pressure on services.

Read the Cheshire and Merseyside ICS UEC system report

North East London Urgent and Emergency Care Hub 

Clinical and operational teams from across the system meet 3 times a week to discuss flow across the system. The teams include representation from:

  • acute hospital trusts
  • the ambulance service
  • mental health
  • community services.

These regular meetings have improved transparency and accountability between providers. It also provides a space where teams can request or supply mutual aid when needed.

If escalation levels rise any participant can trigger a call at any time. 

↑ Back to top

Next page

Optimising Pathways

Previous page