A new national study will evaluate how Martha’s Rule is being implemented across NHS hospitals in England, aiming to identify the best ways to ensure patients, families and healthcare staff are heard when they have concerns about a patient’s deterioration.

The study will bring together leading patient safety researchers, clinicians, patients and public contributors to examine how Martha’s Rule is working in practice and its impact on patient outcomes, healthcare inequalities and NHS services.

The three-year research programme is being led by the National Institute for Health and Care Research (NIHR) Central London Patient Safety Research Collaboration (CL PSRC) based at UCLH and delivered by “SafetyNet”, a collaborative network of the six NIHR Patient Safety Research Collaborations (PSRCs). Funded by the NIHR, the PSRCs carry out research to improve patient safety across England, with a collective goal to address and reduce inequalities in health and social care.

Martha’s Rule was introduced following the campaign led by Merope Mills after the death of her daughter Martha. It is designed to give patients, families and healthcare staff a clear route to report their wellness and illness and to seek an urgent clinical review if they are worried that a patient’s condition is worsening.

The study will provide the first comprehensive national evaluation of the initiative, generating evidence to inform the future development of Martha’s Rule across the NHS.

 Researchers will analyse data from all acute NHS hospitals implementing Martha’s Rule to understand how different approaches to implementation affect patient safety outcomes, including rates of clinical deterioration, escalation of care, intensive care admissions and mortality.

Alongside this national analysis, researchers will undertake detailed work in 16 NHS trusts across England in a wide range of hospital settings, patient populations and regions. Through observations, interviews and detailed case studies, the team will explore how Martha’s Rule is being delivered on the ground and how it is experienced by patients, families and healthcare professionals.

A central focus of the study will be understanding whether Martha’s Rule helps address inequalities in patient safety. Researchers will investigate how the initiative works for people who may face barriers to having their concerns heard, including people with communication difficulties, cognitive impairment, language barriers and those from underserved communities.

The programme will also assess the wider impact of Martha’s Rule on NHS services, examining how it affects clinical workloads, specialist review teams and healthcare resources. Health economists will evaluate whether the initiative represents good value for money while also considering its potential contribution to reducing healthcare inequalities.

Importantly, patients and family members with lived experience of serious deterioration and patient harm will play a central role throughout the study. Working alongside researchers as equal partners, they will help shape the research, interpret findings and ensure the evaluation remains focused on what matters most to patients and families.

The findings will be shared with NHS organisations, policymakers and healthcare professionals throughout the life of the project, helping to support the ongoing implementation of Martha’s Rule and improve patient safety across England.

UCLH nurse consultant John Welch, one of two co-chief investigators of the study, said:

“Every patient and family should feel confident that their concerns will be listened to and acted upon. This study represents a unique opportunity to understand how Martha’s Rule is working across the NHS, identify what works best, and ensure that the benefits are felt by all patients, regardless of their background or circumstances.

UCLH consultant and UCL Professor Ramani Moonesinghe, the other co-investigator of the study, added: “By combining national data with detailed insights from patients, families and frontline staff, we will generate practical evidence that can help improve patient safety and support better outcomes across the health service. We also hope to generate insights which will support the roll out of Martha’s Rule to other clinical areas such as maternity and mental health settings.” Professor Moonesinghe is also director of the NIHR Central London PSRC.

Professor Rebecca Lawton, director of the NIHR SafetyNet, said: “Patients and families are not bystanders in care, they know what is normal for them and when something is not right. Martha’s Rule has huge potential in giving all patients, families and staff permission to flag concerns and prevent deterioration. 

“The NIHR SafetyNet team have a unique opportunity to find out how Martha’s Rule is working in practice by observing teams delivering Martha’s Rule, talking to patients, family and staff and measuring outcomes. We are very excited to be working together across the six NIHR PSRCs to undertake this vital national evaluation.”

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