Call 4 Concern and Martha’s Rule

Call 4 Concern and Martha’s Rule

Are you concerned about a deterioration in the condition of a patient on one of our wards? 

We know that patients and families/carers often notice subtle changes before anyone else. If you’re worried about a change in a patient’s condition, please speak to the ward nurses and doctors first. 

If you have done this and still have concerns, you can contact the Critical Care Outreach Team (CCOT) directly. This is a Call 4 Concern (C4C). 

Call 4 Concern is a patient safety initiative that we introduced as a result of the national campaign Martha’s Rule. Martha’s Rule recognises that patients, carers and family members may spot early signs of deterioration in the condition of a loved one and there should be a process in place to support them voice their concerns.  We recognise the importance of listening to and acting on those concerns. 

This service complements the other safety initiatives already in place at our hospitals. 

Call 4 Concern is available 24 hours a day, 7 days a week.

When and how to make a C4C

If you have a concern about the deterioration in a patient’s condition, text or call 07970 446991 and leave a message.

We need the following information to help the team prioritise a response:

  • Your name and contact number
  • The name and location (ward name) of the patient you are concerned about
  • Your relationship to the patient
  • A brief outline of your concern 

The CCOT will aim to respond to your call promptly, but at times may be busy looking after unwell patients. 

Please note: in order to update you on a patient’s condition, it will be necessary for us to gain their consent before speaking to you.

How will CCOT respond?

Following your call, a member of the CCOT will prioritise the urgency of the problem. We may visit the ward, make an assessment and liaise with the medical team and other health care professionals as needed. 

We may do a physical review of the patient and will look at all the health documentation and treat accordingly. We may also involve other teams if we feel that care needs to be escalated.

When Call 4 Concern is not the right service

Call 4 Concern exists for when concerns about the deterioration in a patients’ condition have not been resolved through the ward team.

The team does not respond to general concerns including basic nursing care issues for example, food, which is best discussed with the nurse in charge; or general complaints, which should be directed to the Patient Advice and Liaison Service (PALS).

Martha’s Rule

Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

In response to this and other cases related to the management of clinical deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’ across the NHS.