The landmark moment in patient safety has now been rolled out at all hospitals in North Cumbria Integrated Care NHS Foundation Trust.
North Cumbria Integrated Care NHS Foundation Trust has officially rolled out Martha’s Rule (known as Call for Concern) across its hospital sites.
Martha Mills died in 2021 after developing sepsis in hospital. Her family’s concerns about her deteriorating condition were not addressed, and in 2023, a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.
Call for Concern was initially piloted on four wards across the Cumberland Infirmary and West Cumberland Hospital, before becoming accessible to all wards.
Call for Concern has now been in place since the start of the year, with posters around the hospital sites directing people to call Cumberland Infirmary or West Cumberland Hospital if a patient’s condition is deteriorating. The Trust has said that the call will be answered by the critical care team, who will arrange for an urgent review.
“Call for Concern gives a voice to patients and their loved ones. We know families know their loved ones better than anyone; they can spot when something isn’t right in ways that even experienced doctors might miss,” said Jon Sturman, consultant anaesthetist at the Trust.
“It’s ultimately another method of escalation, where concerns are highlighted and responded to, which can only make the care we provide safer for everyone,” he continued.
Significant implications
In September, NHS England extended Martha’s Rule to all 210 acute hospitals in England, following a successful pilot across 143 sites. This interventional rule enables patients, families, carers, and even hospital staff to request a rapid independent review by a different clinical team when concerns arise about deteriorating or inadequate care.
By April 2024, the rule’s phased rollout had begun: initially targeting 100 acute hospitals with mature critical-care outreach structures. Regulators – GMC, NMC, and CQC – joined in endorsing the principle of listening to patient and family concerns and safeguarding the right to a second opinion.
Neil Rowe, head of practice at Maulin Law, explains that for lawyers, risk managers and indemnifiers, Martha’s Rule carries “significant implications in clinical negligence” and that it marks a “defining moment” in patient safety.
“By embedding a formal escalation process grounded in real-time awareness of patient risk, hospitals can better defend against allegations of failure to act,” he continued.
TMLEP’s lead healthcare investigator Nina Vegad agrees, calling the rule a “landmark moment”.
“It demonstrates a commitment to listening to patients and families, acting decisively to prevent harm, and fostering a culture of accountability,” she says.
