The clear concern sentence
State the concern without accusation.
“I remain concerned because this is different from their usual baseline. Please can this be reviewed?”
Third principle
Raising concern is part of safe care.
People often hesitate because they do not want to be difficult. But if a concern remains, silence can create more risk than a calm, specific question.
Important: if someone is severely unwell, deteriorating quickly, unsafe, collapsed, struggling to breathe, having chest pain, stroke symptoms, severe bleeding, a serious allergic reaction, or is in immediate danger, seek urgent or emergency help.
This article is about raising concerns clearly. It does not replace professional care, emergency help or formal complaints processes where those are needed.
The senior review sentence
When the answer is not enough, ask for the right level of review.
“I understand your view, but I remain concerned. Please can the senior person responsible review this today?”
When to raise
Raise when the concern remains unresolved.
The aim is not to escalate everything. The aim is to raise the right concern, to the right person, at the right level, before the risk is missed.
01
Deterioration
If the person is getting worse, more confused, weaker, more breathless, more drowsy or less safe, raise it clearly.
- What has changed?
- How quickly is it changing?
- Who has reviewed them?
02
Unclear plan
If the plan is still unclear after asking, raise the need for a clearer explanation and next step.
- What is happening now?
- Who owns the next step?
- What should happen if things worsen?
03
Dismissed concern
If a concern is brushed aside without explanation, restate it with baseline, timing and risk.
- What was dismissed?
- What evidence or observation supports it?
- What review are you asking for?
04
Medication risk
Raise concerns about side effects, interactions, missed doses, conflicting lists or unclear instructions.
- What changed?
- What symptom or risk followed?
- Who can confirm the current plan?
05
Unsafe discharge
If discharge feels unsafe, raise the practical gap before the person leaves.
- What support is missing?
- What equipment or follow-up is needed?
- Who is responsible after discharge?
06
Decision pressure
If a decision feels rushed or poorly explained, raise the need for informed understanding.
- What are the benefits and risks?
- What are the alternatives?
- What happens if the person waits or declines?
How to raise
Escalation works best when it is specific.
A raised concern is easier to act on when it contains the change, the risk, the request and the level of review needed.
Do not make people guess the concern.
“I am worried” is understandable, but it may not be enough. Stronger wording names the change, gives the baseline, states the risk, and asks for a review.
The WardWise approach is calm escalation: firm enough to be heard, clear enough to be useful.
A raised concern sequence
- NameSay exactly what the concern is.
- CompareExplain how this differs from baseline.
- TimeSay when it started or changed.
- RiskState what you are worried could happen.
- RequestAsk for the specific review, explanation or action needed.
- RecordWrite down who you told and what was agreed.
Examples
Raise the concern in the language of the situation.
Different settings need different wording, but the principle is the same: stay specific, calm and clear about what you are asking for.
Ward
Concern on the ward
Ask the named nurse or ward team for review. If concern remains, ask who is senior and responsible today.
Hospital pathwayMedication
Possible medicine problem
Raise the timing, symptom change and medicine change. Ask whether the plan needs review.
Side effects articleDischarge
Unsafe discharge concern
State the practical gap clearly: mobility, medicines, equipment, support, follow-up or safety at home.
Discharge pathwayConsent
Rushed decision
Raise that understanding is not yet adequate. Ask for benefits, risks, alternatives and consequences to be explained.
Consent pathwayFamily concern
Not being heard
Use baseline and specific changes. Ask for the concern to be documented and reviewed.
Families & carersAppointment
Unanswered question
Return to the unresolved point before the appointment ends. Ask what happens next and who follows up.
ArticlesWords help
Raising a concern does not require heat.
Firm, calm language often works better than apologising, over-explaining or becoming angry.
When the concern remains
“I hear what you are saying, but I remain concerned because ________. Please can this be reviewed?”
When baseline has changed
“This is not normal for them. Usually they can ________. Since ________, they have ________.”
When you need senior review
“Please can this be reviewed by the senior clinician or person responsible today?”
When you need the concern recorded
“Please can you document that this concern was raised and what the plan is now?”
Simple record
Record the concern and the response.
A raised concern should not vanish into memory. A simple record helps continuity and reduces confusion later.
Use a raised concern note.
Concern raised: ____________________
Baseline or change described: ____________________
Person spoken to: ____________________
Review/action requested: ____________________
Response and next step: ____________________
The 6 Rs pathway
Raise leads naturally into Represent.
If the person cannot explain themselves clearly, the next task may be to represent their baseline, wishes, context and practical reality.
RecogniseNotice change, risk or uncertainty.
RespondChoose the next calm, proportionate action.
RaiseSpeak up if concern remains.
RepresentSupport baseline, wishes and context.
RecoverBring the plan back into focus.
RecordPreserve what was said and agreed.
Next step
When someone cannot speak clearly, represent them carefully.
Raising concern is not the end of advocacy. The next article explains how to represent the person’s baseline, wishes and context without taking over their voice.