Call 4 Concern safety initiative rolled out across Royal Surrey NHS Foundation Trust

Royal Surrey NHS Foundation Trust is extending its Call 4 Concern patient safety initiative, which enables staff, patients, carers and family members to raise concerns about the deterioration of a patient. After being piloted in adult inpatient areas at the trust’s Guildford hospital, the service is now being expanded to adult inpatients at Milford Hospital, as well as paediatric patients and maternity service users.

The initiative was introduced in 2024 as part of Martha’s Rule, a national patient safety programme established following the death of 13-year-old Martha Mills despite her family’s concerns that her condition was worsening. Martha’s Rule recognises that patients, carers and relatives may identify early signs of deterioration and should have a clear process for escalating those concerns. Call 4 Concern is delivered by the Critical Care Outreach Team (CCOT), a specialist team of nurses who respond to concerns raised by patients, relatives, carers and staff.

Caroline Munday, Critical Care Outreach Team Lead, said: “We recognise that family members and carers can be among the first to spot signs of deterioration in a loved one’s condition, making it essential that their concerns are heard and acted upon.

“If you have already raised concerns with ward staff about a change in a patient’s condition and remain worried, you can contact the Critical Care Outreach Team directly through Call 4 Concern. The service is available 24 hours a day, seven days a week, providing an additional route for patients, families and carers to ensure their concerns are heard.”

When and how to make a Call 4 Concern

If you have a concern around the deterioration in a patient’s condition:
Text or call 07970 446991 and leave a message

They will 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 it will be necessary to gain consent from the patient before speaking to you.

How will CCOT respond?

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

They may do a physical review of the patient and will look at all the health documentation and treat accordingly. They may also involve other teams if it’s felt 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 story

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.