Putting patient safety at the heart of care

Recognising and responding to deterioration remains one of the most important safety challenges in hospitals. Martha’s Rule gives patients, families and staff a clear route to request an urgent clinical review when they are worried that deterioration is not being acted on.

This year, we led two major programmes to help turn Martha’s Rule from national policy into everyday practice. This drew on our patient safety implementation expertise: helping clinical teams adapt national guidance to local pathways, build confidence, and embed new ways of escalating concerns into everyday care. 

First, we led the national pilot in maternity and neonatal services across 10 acute NHS trusts, working with Health Innovation North East and North Cumbria. We delivered implementation coaching, gathered insights from pilot sites and patients, and shared learning to inform the national rollout. 

Alongside this, we worked with eight acute trusts to embed Martha’s Rule across adult and paediatric inpatient services. Across 17 sites, we delivered more than 80 tailored coaching sessions and six community of practice events. These helped teams adapt Martha’s Rule to their local context, build confidence and share practical learning. 

National data shows why this work matters. Between September 2024 and March 2026, 4,336 Martha’s Rule escalation calls were related to acute deterioration. Of these, 574 resulted in transfers to higher levels of care. 

In June 2026, it was announced that Martha’s Rule would be rolled out across all maternity and neonatal wards in England.  

Royal Free London NHS Foundation Trust, one of the acute trusts we worked with, has also been shortlisted for the Nursing-led Patient Safety Initiative of the Year award at the 2026 HSJ Patient Safety Awards.