The three-year programme will evaluate how the patient safety rule is being implemented across NHS hospitals in England.

Martha’s Rule has been in the news over the past week as one of the government’s responses to the Ockenden Review last week. 

Following the publication of the excoriating independent review into maternity failings at Nottingham University Hospitals NHS Trust (NUH), led by senior midwife Donna Ockenden, the government has now committed to rolling out Martha’s Rule across maternity and neonatal wards in England to ensure every parent can request a rapid review from an independent medical team if a baby’s or mother’s condition is deteriorating and they are concerned this is not being responded to.

The rule was introduced following the tragic death of 13-year-old Martha Mills from sepsis in 2021. It allows patients, carers, families, or NHS staff to request an independent review when there are concerns that a patient’s condition is deteriorating or that care has not met expected safety standards. Its aim is to ensure that concerns are escalated promptly and acted upon before serious harm occurs.

Although government figures have already shown the rule’s positive effects on patient safety, a new national three-year research programme 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.

“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,” said University College London Hospitals (UCLH) nurse consultant John Welch, one of two co-chief investigators of the study. 

First national evaluation

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 work in 16 NHS trusts across England in a range of hospital settings, patient populations and regions. Through observations, interviews and 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.

“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,” said UCLH consultant Ramani Moonesinghe, the other co-chief investigator of the study. 

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.