Patient safety
of Martha’s Rule, ahead of scale up to the remaining sites in England in the following years. The focused approach at the initial provider
sites will inform the development of wider national policy proposals for Martha’s Rule that can be expanded in a phased way across the NHS from 2025/26. NHS England will also identify ways to roll out an adapted Martha’s Rule model across other settings including community and mental health hospitals where the processes may not apply in the same way.
Other measures Martha’s Rule will build on the evaluation of NHS England’s Worry and Concern Improvement Collaborative which involves seven regional pilots and began in 2023. They have been testing and implementing methods for patients, families and carers to escalate their concerns about deterioration and to input their views about their illness into the health record. The introduction of Martha’s Rule comes alongside other measures to improve the identification of deterioration, including the rollout last November of a new Paediatric Early Warning System, built on similar systems already in place for adult, newborn, and maternity services.2 To ensure that Martha’s Rule is effective as it can be, it will be implemented as part of an integrated programme to improve the management of deterioration using the ‘PIER’ framework, which helps systems to Prevent, Identify, Escalate and Respond to physical deterioration. This work will improve how the NHS supports staff to manage deterioration and encourage greater involvement from patients, families, and carers. This escalation process will be available 24/7
Our daughter was quite something: fun and determined, with a vast appetite for life and so many plans and ambitions – we’ll never know what she would have achieved with all her talents. Hers was a preventable death, but Martha’s Rule will mean that she
didn’t die completely in vain. Merope Mills.
to patients, families and NHS staff, and will be advertised throughout hospitals, making it quickly and easily accessible.2 Commenting on the introduction of Matha’s Rule, Merope Mills and Paul Laity, Martha’s parents, said: “We are pleased that the
implementation of Martha’s Rule will begin in April. We want it to be in place as quickly and as widely as possible, to prevent what happened to our daughter from happening to other patients in hospital. “We believe Martha’s Rule will save lives. In
cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t; their knowledge should be recognised as a resource. We also look to Martha’s Rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged. We call on all NHS clinicians to back the initiative: we know that the large majority do listen, are open with patients and never complacent – but Martha’s doctors worked in a different culture, so some situations need to change. “Our daughter was quite something: fun
and determined, with a vast appetite for life and so many plans and ambitions – we’ll never know what she would have achieved with all her talents. Hers was a preventable death, but Martha’s Rule will mean that she didn’t die completely in vain.” As part of Martha’s Rule, health staff at
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