NHS patient safety initiative: 143 hospitals across England to roll out Martha’s Rule

This programme has the opportunity to truly transform “patient care and safety”

NHS England has confirmed the initial sites that will test and implement Martha’s Rule in the first phase of the programme.

This follows the announcement in February regarding NHSE funding for the major patient safety initiative for this financial year.

The scheme is named after Martha Mills, who died from sepsis at the age of 13 in 2021. She had been treated at King’s College Hospital, London, where a failure to escalate her to intensive care and a lack of response to her family's concerns about her deteriorating condition contributed to her death.

Martha’s Rule aims to provide a consistent and understandable way for patients and families to seek an urgent review if their or their loved one’s condition deteriorates and they are concerned this is not being responded to.

NHS England on Monday (27 May) announced that the scheme will be implemented at 143 hospital sites across the country by March 2025.

Professor Sir Stephen Powis, NHS national medical director, said: “Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years.”

Initially, the target was to enroll a minimum of 100 sites, but due to considerable interest from frontline clinicians, this has been expanded, all thanks to the extensive campaigning by Martha’ parents.

“While thankfully the need for escalation of care will hopefully only be needed in a limited number of cases, this three-step safety net has the opportunity to truly transform patient care and safety,” Powis added.

Martha’s parents, Merope Mills and Paul Laity, said: “We are pleased that the roll-out of Martha’s Rule is off to a flying start and that the need for it has been so widely recognised.

“It will save lives and encourage better, more open, communication on hospital wards, so that patients feel they are listened to, and partners in their healthcare.”

How the system will work

Martha’s Rule will consist of three components designed to ensure prompt response to concerns regarding deterioration.

1. A 24/7 escalation process will be available at all 143 sites, enabling patients and families to contact a critical care outreach team that can swiftly assess a case and escalate care if necessary.
2. NHS staff will also have access to this process to raise concerns about a patient’s condition.
3. Clinicians at participating hospitals will formally record daily insights from patients' families, ensuring any concerning changes noticed by those who know the patient best are considered in their care.

The NHS is working with Martha’s parents to develop materials to advertise and explain the initiative in hospitals across the country.

NHS national patient safety director and senior responsible officer for Martha’s Rule, Dr Aidan Fowler, is confident that this programme will deliver clear change.

He said: “With new processes that enable both patients and staff to raise concerns if they see someone’s condition worsening, and the inclusion of patients and their loved ones’ insights in medical records, these measures can help us better identify and manage deterioration as part of wider work, which is a key priority for us and will no doubt lead to improvements in the care patients receive.”

Martha’s Rule may be expanded further across all acute hospitals, subject to future government funding and assessment of the system's performance at these sites throughout the year.

Find the names of hospitals rolling out ‘Martha’s Rule’ at NHS England website.