Call4Concern: timelines and responsibilities (WHC/2026/001)

Status:

Action

Category:

Quality and Safety

Title:

Timelines and responsibilities for implementing the patient and family-initiated escalation approach, Call4Concern

Date of Expiry or Review:

Not applicable

Action by:

Local health boards and Velindre University NHS Trust             

For information:

Health Education and Improvement Wales (HEIW), Healthcare Inspectorate Wales (HIW), NHS Wales Performance and Improvement

Required by:

Immediate

Sender:

James Calvert, Deputy Chief Medical Officer, National Clinical Director NHS Wales

Professor Sue Tranka, Chief Nursing Officer, Nurse Director NHS Wales

Welsh Government Contacts:

Tom Warren, Quality and Safety, Quality and Nursing Directorate. Tel: 03000 258109 Email: QualityAndNursing@gov.wales

Enclosures:

None

Dear Colleagues,

The Welsh Health Circular (WHC) ‘Adopting a patient and family-initiated escalation approach’ (WHC/2024/040) sets out our expectation to implement a system which enables patients or their families to call for immediate help and advice if they are worried about deteriorating health.

The NHS Wales approach will be called ‘Call4Concern’ and, to ensure equity and fairness, it will be available to patients and families in all in-patient settings providing adult, paediatric, neonatal and maternity services.

The exemplary work to implement Early Warning Scores (EWS) for all age groups and maternity services in phase one has established a firm basis for building the elements of Call4Concern in phase 2.

The Call4Concern system builds on pilots across NHS Wales and incorporates best practice from international models, such as ‘Ryan’s Rule’ in Australia. It aligns with Martha’s Rule in NHS England and includes:

• Patient Wellness Score/Question/Concern (PWS/Q/C): structured self-reported wellbeing assessment ensuring that the ‘first voice of concern’ belongs to the patient and their family.
• Patient and Family Initiated Escalation (PFIE): mechanisms to quickly address concerns about deterioration firstly in the immediate clinical area and for the patient or family to directly activate senior clinical review.

This WHC sets out our expectations in relation to timelines and responsibilities for the implementation of Call4Concern.

Implementation Timelines

To reduce variation and therefore improve patient safety, all NHS Wales health boards and Velindre University NHS Trust are expected to adhere to the following implementation deadlines:

31 July 2026:

• implement method of documenting ‘patient self-reported wellness/concern’ at least twice per day in allacute hospital in-patient areas

Please note: that the space to record patient or family concern is already integrated on the all-Wales Maternity Early Warning Score (MEWS), Neonatal Early Warning Trigger and Track (NEWTT2) and Paediatric Early Warning Score (PEWS) charts that have been recently introduced.

• implement a patient and family-initiated escalation system including phone numbers to activate senior review in all acute hospital in-patient areas

30 September 2026:

• demonstrate that ‘patient self-reported wellness or concern' is reliably documented at least twice per day in all acute hospital in-patient areas

31 December 2026:

• demonstrate that ‘patient self-reported wellness or concern’ is additionally reliably documented at least once per day in all non-acute in-patient settings
• demonstrate reliable use of the patient and family-initiated escalation system including phone numbers to activate senior review in all acute and non-acute in-patient settings

NHS Wales responsibilities

There is no expectation for organisations to fund new posts for the implementation of Call4Concern. Teams will, however, need the time to work with the NHS Wales Performance and Improvement Acute Physical Deterioration Implementation (APDI) Network to ensure effective adoption of the Call4Concern system and to address the associated cultural change that will be necessary.  

Implementation will require a multidisciplinary team within each organisation including senior medical and nursing leaders and which is representative of all areas and specialities where Call4Concern will be utilised.

To facilitate and coordinate this local implementation team, and to ensure the roll out of Call4Concern is successful, we ask that the executive sponsor and implementation leads, initially identified for the implementation of EWS in response to WHC 2025/002, are reconfirmed for each health board and Velindre University NHS Trust. 

The expectation is that these individuals will be the point of contact for the APDI Network and will have authority, responsibility and accountability for this work. Please forward names and contact details to the APDI Network Manager Christopher.hancock2@wales.nhs.uk no later than 31st January 2026.

The APDI Network will continue to take guidance from the APDI Clinical Reference Group, associated clinical networks and other stakeholders, and to work collaboratively with health boards and trusts to enable system wide improvement.

We would like to congratulate you on the significant achievement of implementing Early Warning Scores across NHS Wales and thank you for your continued hard work and commitment to delivering safer, equitable, person-centred care.

Yours sincerely,

James Calvert, Deputy Chief Medical Officer, National Clinical Director NHS Wales

Professor Sue Tranka, Chief Nursing Officer, Nurse Director NHS Wales