In April 2024, NHS England began implementing and testing Martha’s Rule in 143 hospital sites across England, as part of a major patient safety initiative aimed at protecting patients during their hospital stay. The initiative ensures that patients’ insights and concerns about their illness and recovery are consistently heard and acted upon. Tragically, some patients die in hospital because their concerns are not acknowledged or addressed. Martha’s Rule requires that patients are asked daily about how they are feeling, and it also enables patients, families, and staff to seek expert help in managing serious illness if a patient’s condition deteriorates and they feel their concerns are not being adequately responded to.

Although Martha’s Rule has been widely implemented, many unanswered questions remain about the most effective ways to implement it and whether it reduces patient deterioration across all groups. In response to an NIHR funding call to evaluate the impact of Martha’s Rule on patient safety improvement, the network of all six NIHR Patient Safety Research Collaborations (PSRCs) recently came together to submit a research plan proposal for a large-scale summative evaluation of the initiative. This was done in close collaboration with the Policy Research Unit for Quality, Safety and Outcomes team, who are leading the early (formative) evaluation of the implementation of Martha’s Rule.

This is a unique and exciting opportunity to bring together leading patient safety researchers, patient and public representatives, frontline doctors, nurses, and administrators from all six Patient Safety Research Collaborations across the ‘SafetyNet’ to address a national gap in the evidence base. Each PSRC will study how Martha’s Rule is working in its own region and share findings nationally. This collaborative approach will enable us to analyse data from all hospitals implementing Martha’s Rule (143 so far) to assess the programme’s impact on patient outcomes and costs.

The Martha’s Rule Summative Evaluation will be conducted by SafetyNet, under the leadership of the NIHR Central London PSRC. 

About Martha’s Rule

Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

In response to this, and other cases related to the management of deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’ – a patient safety initiative as part of a wider NHS strategy to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

Martha’s Rule is intended to give patients, families, carers and staff, 24 hours access to rapid review from a critical care outreach team (CCOT) or paediatric critical care outreach team, if they are worried about a person’s condition.

Martha’s Rule includes three components:

1. The NHS must introduce a structured process to gather daily feedback from patients and families about their condition (initially for all in-patients in acute and specialist Trusts).
2. All staff must have 24/7 access to a CCOT for concerns about patient deterioration;
3. All patients, families, carers, and advocates must have access to the same 24/7 CCOT review, via well-publicised mechanisms;

In April 2024, NHS England introduced the implementation and testing of Martha’s Rule in 143 hospital sites across England. 

Read more on https://www.england.nhs.uk/patient-safety/marthas-rule/

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