Routes for escalation and speaking up

Raise concerns to the person or process that can take action. Which route to use depends on urgency, the type of concern and local policy.

Choosing the right route

Some issues need immediate clinical action. Others require a manager, complaints lead, information governance lead, safeguarding lead or the incident-reporting process. If local routes fail to resolve a concern, Freedom to Speak Up or external advice may be necessary.

Frontline staff should be given clear, visible routes and supported when they are unsure which to use.

Possible routes

• Immediate safety: duty clinician, safeguarding, emergency or manager route.
• Incident or near miss: local incident reporting and senior review.
• Confidentiality issue: information governance or data protection route.
• Culture or unresolved concern: manager, partner, Freedom to Speak Up or whistleblowing route.

Match urgency to route

Immediate risk to a patient cannot wait for a routine meeting. Issues that show a pattern, such as unclear scripts, can be raised at a team review. Culture concerns usually need a speaking-up route. Staff should know which routes are urgent, routine, confidential or external.

Keep a backup route

Have a clear alternative if the usual manager is absent, the duty clinician is unavailable, or the concern involves someone senior. A route that only works on a good day is not sufficient.

Escalation is only complete when someone with authority has accepted ownership.

External routes