What is Martha’s Rule?
Martha’s Rule is a patient safety initiative currently being piloted in England which aims to empower all staff, patients and their families to seek an independent medical review if they feel their concerns about a patient’s care are not being adequately addressed. Named after Martha Mills, a 13-year-old girl who tragically died in 2021 following missed opportunities to treat sepsis, the rule is being introduced to ensure better safeguards against preventable harm in healthcare settings. The rule is designed to give families the ability to directly request an expert review by a senior clinician not within the immediate care team, potentially identifying critical issues before they result in harm.
By establishing this right to an independent review, Martha’s Rule improves our ability to recognise and respond to deterioration by incorporating parents and families as part of the team. It formalises an escalation route for parents, carers and families to use to ensure their concerns are listened to and acted on and encourages transparency and collaboration. Similar schemes, such as Queensland’s Ryan’s Rule in Australia, have demonstrated they can have a real positive impact on patient safety and outcome.
Process
NHS England sets out that Martha’s Rule consists of three separate but related parts:
- Patients (or families/carers) 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.
Implementation
Martha’s Rule is currently being tested in 143 pilot sites across England, with the intention of adopting Martha’s Rule to all sites in England over the coming years. So far, approximately half of the pilot sites have included paediatric wards in their scope. RCPCH continues to engage with NHS England to push for this figure to be increased in order to ensure that children and young people have equitable access to this patient safety initiative.
NHS England’s webpage on Martha’s Rule sets out further information on implementation, outcomes measurement and next phases.
RCPCH work
RCPCH contributed to the early working groups for Martha’s Rule, sharing our members expertise on the unique and complex paediatric environment, in particular highlighting the challenges associated with paediatric ICU availability, the need for workforce training and capacity building in order to implement this important patient safety initiative.
We continue to engage with NHSE as data from the pilot sites emerge, and are committed to ensuring our members are provided with up to date information as paediatric roll out continues. This webpage will be updated regularly to provide updates on the roll outs and to signpost to useful resources.
You can read more insight from two RCPCH Officers on their patient safety spotlight on this topic in February 2025.
This web page will be updated regularly to provide updates on the roll outs and to signpost to useful resources.