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New ‘Call 4 Concern’ patient safety initiative launched at Lancashire Teaching Hospitals

Call 4 Concern logoA new patient safety initiative has been introduced at Lancashire Teaching Hospitals as part of a UK-wide rollout of Martha’s Rule, which ensures relatives are able to ask for help when they are concerned about a patient’s condition.

‘Call 4 Concern’ (C4C) is an adaptation of the first phase of the introduction of Martha’s Rule which was introduced by NHS England in April 2024, giving patients, families, carers and staff round-the-clock access to an urgent review from a separate care team if they are worried about a person’s condition.

Experience tells us that, for patients in hospital, they, their family members, or carers, can identify the early subtle signs of deterioration often before hospital staff, due to familiarity and awareness of the individual’s normal health and behaviours. Patients and relatives should always discuss concerns with the responsible doctors and nurses on the ward, however C4C enables patients and their relatives to call for help or advice from the Critical Care Outreach Team (CCOT) directly when they are concerned about a patient’s condition, and they feel that their concern is not being heard by the ward team.

Following the call, the CCOT will prioritise the urgency and visit the patient on the ward to assess and discuss the concern, working with families and ward staff to ensure the most appropriate management plan and treatment options are in place to address the specific health concerns.

The new patient safety initiative is a variation of Martha’s Rule, which was developed following the death of Martha Mills in 2021 after she developed sepsis in hospital following admission for a pancreatic injury after falling off her bike.

Martha’s family’s concerns about her deteriorating condition were not responded to promptly and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier. In response to this and other cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’ to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

Sally Fray, Consultant Nurse for Critical Care Services at the Trust, has helped develop the new initiative. She said: “We know that time spent in hospital can be difficult. Sometimes patients or their relatives feel like they don’t know who to contact or raise concerns to about their clinical condition and treatment.

“Call 4 Concern offers patients and relatives the opportunity to contact an independent team for a second opinion if they feel their concerns are not fully understood by the nurses and doctors on the ward.”

The implementation of Martha’s Rule in the NHS will take a phased approach beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability.

The focused approach at the initial provider sites will inform the development of wider national policy proposals for Martha’s Rule that can be expanded in a phased way across the NHS from 2025/26.

Find out more on our Martha’s Rule webpage

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Chorley and South Ribble Hospital

Preston Road



01257 261222

Royal Preston Hospital

Sharoe Green Lane




01772 716565

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