Martha’s Rule is named after 13-year-old Martha Mills, whose tragic death from sepsis in 2021 highlighted the need for better escalation protocols across the NHS
The rule enables patients and their families to directly ask for a second opinion of a patient’s condition if they feel they are getting worse and their concerns are not being addressed.
The initiative is part of a national effort to improve patient safety across the NHS, and The QEH is proud to be chosen as one of the leading hospitals in the East of England to implement the rule.
Between September and December 2024, The QEH has seen clear results from this pioneering approach.
In this time period 17 calls were made by concerned families requesting a second onion of a loved one’s care.
In over half of the cases reviews were carried out with three of the calls leading to patients having their care changed, illustrating the practical impact of this potentially life-saving system.
Mike Albert, Deteriorating Patient Lead at The QEH, said: “The introduction of Martha’s Rule has been well received by both families and clinical teams. It gives patients and their loved ones a voice in their care and ensures that their concerns are always taken seriously.
“The benefits of this scheme are already clear, with patients receiving more timely interventions that can make all the difference in their recovery. It empowers families to partner with clinicians in safeguarding patient well-being, ultimately improving care outcomes.”
The QEH’s involvement in Martha’s Rule is part of a wider, NHS England-funded patient safety programme. The hospital, alongside James Paget and Norfolk and Norwich University Hospitals, is helping to pilot this innovative approach, with full nationwide implementation expected later in 2025.
An important part of the rollout includes the hospital introducing visible and accessible information, like posters and leaflets, to ensure that patients, visitors, and staff know how to raise a concern quickly.
The hospital has implemented a Call for Concern (C4C) service, which allows patients and families to contact the Critical Care Outreach Team 24/7 via a dedicated phone or text line when it is felt deterioration concerns have not been addressed by the team looking after the patient.
This service provides a direct line of communication for patients and their families to ensure that any escalating concerns are heard and acted upon promptly.
Pippa Street, Chief Nurse at The QEH, said: “We are proud to be part of the roll-out of Martha’s Rule and are already seeing its positive effects. The feedback from patients and families so far has been overwhelmingly positive, and we are committed to ensuring this service continues to make a real difference.”
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Background information
Paul Laity and Merope Mills, the parents of Martha Mills, expressed their support for the initiative: “We are pleased that the roll-out of Martha’s Rule is off to a flying start and that the need for it has been so widely recognised. It will save lives and encourage better, more open, communication on hospital wards, so that patients feel they are listened to, and partners in their healthcare.”
The rollout of Martha’s Rule is in alignment with NHS England’s long-term strategy to enhance patient safety, improve communication across the healthcare system, and ensure that patients and families are active partners in care. With these efforts, The QEH is making the charge to create a more responsive, transparent, and safer environment for all patients.
What is Martha’s Rule
Martha’s Rule is to be made up of three components to ensure concerns about deterioration can be swiftly responded to.
- 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 second opinion 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.
To download the press release and photos, click here.
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