Countess of Chester Hospital reports strong early use of new rapid‑review hotline

New national figures released in the last month suggest Martha’s Rule may have contributed to more than 400 lives being saved across England.

Locally, the Countess of Chester Hospital has published new data showing that patients and families in Chester are also using the hospital’s escalation route at comparative levels to raise concerns early and request a prompt clinical review.

Martha’s Rule is a national patient safety initiative that gives patients and families a clear way to request an urgent clinical review if they feel someone’s condition is deteriorating and this hasn’t been recognised. At the Countess of Chester Hospital (Chester’s main district general hospital), this is delivered through Call 4 Concern, which allows patients, relatives or carers to contact a dedicated team directly when they feel something ‘isn’t quite right’ and hasn’t been spotted by staff.

Call 4 Concern, Chester’s version of Martha’s Rule, was first trialled on three wards before being rolled out across the main hospital in April 2025. Since then, patients and families have used it 107 times, with more than a third of calls (36%) leading to a rapid assessment by the Critical Care Outreach team.

The pilot phase beforehand showed similar levels of engagement, with 33 calls made in the first year, and 21% resulting in a rapid review, showing that patients, families and staff were confident using the process from the outset and was being consistently used.

Since beginning in April 2024, Call 4 Concern calls have been received from a range of inpatient areas. Some were prompted by sudden changes in the patient’s condition; others came from families who felt something wasn’t quite right. Staff say this breadth shows that speaking up early is becoming a normal part of how concerns are raised – and that families feel able to act when something doesn’t seem right.

The patterns seen in Chester are similar to those reported nationally. NHS England’s figures for September 2024 to December 2025 show more than 10,000 calls to Martha’s Rule helplines, with around one third (34%) prompting urgent clinical review.

Andrea Reynolds, Lead Nurse for the Critical Care Outreach team at the Countess of Chester Hospital, said: 

“What matters most is that people are calling us when they are worried. When they do, the outreach team responds – that’s exactly how the system is designed to work. Sometimes the review simply offers reassurance, but in other cases it allows us to assess someone whose condition may be changing. Acting early can make a real difference.”

Dr Nigel Scawn, Executive Medical Director at the Countess of Chester Hospital NHS Foundation Trust, said: 

“National evidence shows that families often notice the earliest signs that something isn’t right. Having a clear, well‑publicised route to raise concerns is an important part of keeping patients safe and in some cases saving lives. If you are worried, we want to hear from you. Families play a vital role in recognising early changes and Call 4 Concern ensures their voices are heard.”

Because families often spot subtle changes before they show up in routine checks, giving them a clear route to escalate concerns is a vital safeguard – and exactly the purpose of Call 4 Concern.

Patients and families are given information on arrival to help them understand how to request a review, and further details are available on the hospital website.