County hospitals are helping trailblaze NHS plans to listen to concerns about patients

The NGH Call4Concern team

Last week (Wednesday February 21) NHS England announced a plan to roll-out ‘Martha’s Rules’ to at least 100 NHS sites to give patients and families/carers access to a critical care team for a second opinion if a patient may be deteriorating.

It is called Martha’s Rule in memory of 13-year-old Martha Mills who died at King’s College Hospital in London from sepsis in 2021.

Her parents, Merope and Paul, said that they were not listened to when they expressed concern about Martha’s deterioration and called for national changes to make it easier to ask for a second opinion.

Northampton General Hospital has been one of seven hospitals taking part in the NHS England Worry and Concern pilot scheme which has been testing methods for raising concerns since April 2023, prior to last week’s roll out announcement.

At NGH the pilot – launched across all inpatient wards in May 2023 - has been called Call4Concern and involves the Critical Care Outreach Team being on hand 24/7 to receive calls from any patients or family members/carers worried about deterioration to support a review of that patient.

Kettering General Hospital was an even earlier pioneer of the Call4Concern concept setting up its scheme on very similar lines in February 2022 – a service later shortlisted for HSJ Patient Safety Awards in two categories.

Tina Taylor is NGH’s Critical Care Outreach Service Lead and has been supporting NHS England’s pilot scheme.

She said: “It is fantastic to see a commitment from the NHS to further develop this kind of critical care support for families/carers and patients who may need additional support.

“At NGH we launched the scheme in May 2023 and publicised it across all our inpatient wards so that patients and their families/carers understood there was an escalation they could take to ask for a second opinion review if they felt more might need to be done for their loved one.

“We have had a very positive response from the families/carers and patients we have supported since the launch with many saying they felt reassured by the actions our team took.

“It has also helped us to understand why patients and families/carers sometimes feel the need for a second opinion and what we can do on our wards to improve communication with patients and families.”

At KGH the hospital’s Acute Illness Response (AIR) team deliver Call4Concern. The team are made up of expert critical care outreach practitioners, resuscitation officers and sepsis nurses, who assist ward teams in the early recognition and management of acutely ill deteriorating adult patients.

Senior AIR Team Practitioner Michelle Nichol said: “We set up our Call for Concern© in February 2022 for people who have concerns about an adult patient becoming critically ill while in hospital.

“We know that relatives will often have much greater awareness of what is normal, or not, for a patient and hence may spot subtle signs of deterioration that ward staff would not be aware of.

“Patients or their families can contact the Acute Illness Response team directly through the Call4Concern© service and our team will then determine the best course of action. This may be a to visit the ward to discuss the concerns with the patient and/or their relative or carer and then assess what needs to be done.

“If a patient is found to be deteriorating we can identify the need for an urgent clinical review and then liaise with key clinicians, the ward staff, and other healthcare professionals as needed, to ensure a robust plan is in place to address the clinical concern.”

The ultimate aim of both NGH’s and KGH’s Call4Concerns services is to give patients and their families/carers a voice in preventing deteriorating health, avoiding critical care admissions, and improving the experience of patients, relatives and carers.

Feedback from patients and from other staff members to the existing NGH and KGH initiatives has been overwhelmingly positive.

NHS England say evaluation of the initial NHS roll-out to at least 100 trust sites during 2024/25 will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to government funding.

NHS teams will also identify ways to roll out an adapted Martha’s Rule model across other settings, including community and mental health hospitals, where the processes may not apply in the same way.