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Acclaim for Martha’s Rule - but when will maternity services be included?
Kirsty Allen
I am extremely pleased to see the continuing roll-out in the UK of Martha’s Rule (see our previous articles on this topic here, here and here) and that a recent NHS England report demonstrates that the rule is having a very positive impact. Patient empowerment and clear communication, the embodiment of this rule, are critical components in avoiding medical accidents and poor outcomes. I am particularly keen to see the implementation of this rule being extended to maternity and neonatal settings, an area where, as a specialist birth injury lawyer, I see avoidable harm all too often.
NHS England defines Martha’s Rule as 'a patience safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon'.
The campaign to bring in the rule has been led by the parents of 13-year-old Martha, who died in 2021 as a result of developing sepsis in hospital following her admission for a pancreatic injury. Martha’s family felt that their concerns about her deteriorating condition were not listened to or responded to and a coroner found that Martha would probably have survived had she been moved to intensive care earlier. Sepsis is a life-threatening emergency that occurs when the body's response to an infection damages vital organs. This can happen very fast and getting the right treatment immediately is imperative.
The three core components of Martha’s Rule are:
- Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
- All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
- This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.
The roll-out of Martha’s Rule began in 2024 and now all acute trusts in England are working to put the rule in place with full implementation expected to be complete across all acute trust inpatient services during 2026/27. A future ambition is to roll it out to maternity, neonatal and emergency departments. According to NHS England, they are testing Martha’s Rule in a small number of these services 'but the initiative is generally not yet available in these settings or service areas.'
How is this working in practice?
Martha’s Rule recognises that patients themselves and their family members are in a position where they may see signs and symptoms that are early indicators of deterioration before this is picked up by routine medical checks. If they feel that their concerns are not being addressed by those caring for the patient, Martha’s Rule means that they can call a dedicated telephone number to request a rapid review from a different team.
As matters stand, there is no single Martha’s Rule phone number. Each hospital has its own dedicated contact number and, according to NHS England, patients should look for the specific Martha’s Rule contact number for the relevant hospital by:
- checking the hospital’s website
- looking for posters displayed in the hospital
- asking hospital staff
New NHS England data reveals that more than 10,000 calls have been made to the helplines in the first 16 months of the scheme and that one that one in three calls ‘identified rapid worsening of a patient’s condition, helping the NHS to identify concerns more quickly and make crucial interventions to care.’ This led to 1,885 patients receiving changes in treatment, including 446 potentially life-saving interventions.
Merope Mills, Martha’s mother, has said: "The process is not being overused and has obviously met a need, giving patients and families real agency. We look forward to its thorough implementation in maternity departments ..."
The evidence is clear that listening more effectively to patients and their families saves lives. Maternity services are, in my view, crying out for the implementation of this rule.
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About the author
Kirsty Allen is a highly experienced medical negligence solicitor who undertakes a wide variety of cases with particular specialisms in child cerebral palsy and adult brain injury cases, fatal claims, loss of sight cases, as well as failure to diagnose cancer and gynaecological claims.
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