A "rapid expertise" scheme at hospitals in Durham and Darlington has been praised after a new national rule was rolled out following the tragic death of a 13-year-old. 

NHS in England is currently beginning to roll out a pilot for a new service, across hospitals, giving patients, their loved ones and those caring for them, the option to seek very prompt additional clinical expertise when there’s a concern the patient may be deteriorating. 

This round-the-clock access to a rapid review from a separate care team is known as Martha’s Rule, named after 13-year-old Martha Mills who tragically died in 2021 having developed sepsis in hospital where she had been admitted after falling heavily off her bike.

Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

Whilst the new service is just beginning a national pilot, patients across County Durham and Darlington have been able to access this additional rapid expertise for over three years. County Durham and Darlington NHS Foundation Trust, introduced Call 4 Concern in 2021, putting the trust "well ahead" of almost all other NHS trusts.

Gemma Nelson, the Trust’s joint Martha’s Rule implementation nurse lead, comments, “Patients and those close to them know better than anyone if there’s a noticeable change in their condition.

"Loved ones will also spot sooner than anyone else if the patient is unusually confused or has deteriorated – perhaps there’s some tell-tale signs in the way they look or are behaving. They know the patient inside out.

"These non-clinical signs aren’t always picked up or easy to spot as part of the regular monitoring that’s undertaken by those caring for the patient, or recognised as significant.

“In recognition of this, in March 2021, we introduced Call 4 Concern as a way for patients, relatives, visitors and staff to seek a rapid review of the patient’s clinical condition. We were the first in the region to have anything of this kind and only the second trust nationally.

“We display posters prominently across wards and departments, with phone numbers for our acute intervention team, which we established several years ago.

"The acute intervention team responds to assess, treat, prescribe and plan care for acutely unwell or deteriorating patients, such as when a patient has a cardiac arrest or other medical emergency.

"So they are well placed to respond to Call 4 Concern enquiries. The team is available 24 hours a day, seven days a week at our three main sites; University Hospital of North Durham, Darlington Memorial Hospital and Bishop Auckland Hospital.

"We’re also in the process of extending the service to cover our community hospitals, no mean feat as these are spread across the wide geography of County Durham.

"These highly skilled clinicians also form part of the palliative care emergency team, providing knowledge and support to staff caring for patients who may be in the last days or hours of their lives.

“Call 4 Concern isn’t about criticising ward staff, all of whom are experts and focused on giving their patients the very best quality care – we work closely with them and they support our role. Often, when a concern is raised with them, the patient will have observations such as blood pressure and heart rate assessed – which may still be in normal range.

"The acute intervention team attends promptly and is able to focus their specialist skills on that one patient, to determine not only what is happening with them but also what should happen.

"Not only does this patient then receive the care they need, the ward staff are able to focus on the many other poorly patients they’re looking after.

“Since introducing Call 4 Concern, we have received just over 100 calls. In one case the patient was transferred to our intensive treatment unit and in another case we recommended a transfer to the regional specialist renal unit due to a pre-existing condition the patient had.

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"In most cases, however, after carefully assessing the patient and undertaking appropriate diagnostic tests, we are able to reassure them and their loved ones that their condition hasn’t deteriorated and the care they’re receiving is appropriate.

"This reassurance in itself can be a huge relief to families at a worrying and emotional time and offering it is a key part of our role – we totally understand when people are worried.

“The NHS has recently stated its intention that the right to this kind of rapid review will become part of the NHS Constitution with this and other proposed changes currently out for consultation. Call 4 Concern works for us and we hope it will work just as well across the Country.”