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Implementing Martha’s Rule

Spotting and responding to deterioration is one of NHS England’s key priorities in improving patient safety.

We’re helping deliver the first phase of Martha’s Rule – a new system where staff, patients and families request an urgent clinical review if they are concerned that signs of deterioration are not being acted upon.

We are working with 16 hospitals to offer support through collaborative events, tailored coaching, site visits and shared resources. This includes working closely with the local and regional Adult Critical Care Operational Delivery Networks and North Thames Paediatric Network, to pilot a national Martha’s Rule solution to improve local hospital escalation procedures for children’s care.

Working with UCLPartners has been invaluable in supporting our local efforts to implement Martha’s Rule. Their ability to connect NHS teams has accelerated progress, resolved challenges, and spread best practices.

Lisa Carrie, Critical Care Outreach Team Nurse and Martha’s Rule Implementation Lead, The Whittington Hospital

National data shows that between September 2024 and February 2025, Martha’s Rule prompted 2,389 calls to escalate concerns about patient deterioration. Nearly half were due to acute decline, with 336 cases leading to changes in treatment and 129 resulting in escalated care, including ICU transfers.

Over the coming year we will lead the national pilot testing Martha’s Rule across maternity and neonatal care, in partnership with Health Innovation North East and North Cumbria.

2389
calls made to escalate deterioration
between September 2024 and February 2025