NHS Rolls Out Martha’s Rule at 143 Sites

The NHS has announced the 143 hospital sites that will test and roll out “Martha’s Rule” in its first year. Named after 13-year-old Martha Mills, who died of sepsis at King’s College Hospital, London following a cycling accident, the rule gives patients and families a way to get an urgent review of a patient’s condition if it is declining.

Confirmation of the first sites to test implementation of Martha’s Rule is the next step in a major patient safety initiative, following the announcement in February of NHS England funding for this financial year.

NHS England is working with Martha’s parents to develop materials to advertise and explain the initiative in hospitals across the country, to ensure it is something that all patients, staff, and their families can recognise.

The initial target was to enrol at least 100 sites, but due to significant interest from frontline clinicians this has been expanded, meaning this first phase of the programme will be in place at 143 locations across the country by March 2025.

Evaluation of how the system works in these sites over the course of this year will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to future government funding.


Martha’s Rule is to be made up of three components to ensure concerns about deterioration can be swiftly responded to.

Firstly, an escalation process will be available 24/7 at all the 143 sites, advertised throughout the hospitals on posters and leaflets, enabling patients and families to contact a critical care outreach team that can swiftly assess a case and escalate care if necessary. Secondly, NHS staff will also have access to this same process if they have concerns about a patient’s condition.

Finally, alongside this, clinicians at participating hospitals will also formally record daily insights and information about a patient’s health directly from their families, ensuring any concerning changes in behaviour or condition noticed by the people who know the patient best are considered by staff.

Extensive campaigning by Martha’s parents, Merope and Paul, supported by the cross-party think tank Demos, saw widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.

Merope Mills and Paul Laity, Martha’s parents, said: “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.”

Professor Sir Stephen Powis, NHS national medical director, said: “Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years, and we are pleased to have seen such interest from hospitals right across the country, all thanks to the moving and dedicated campaigning by Martha’ parents, Merope and Paul.

“That is why today is such an important milestone, with the NHS outlining the 143 sites where this major patient safety initiative will be rolled out later this year, allowing staff, patients and families to immediately raise concerns and bring about an escalation in care in an easily recognisable and fast way.

“The inclusion of daily insights from families about their loved ones’ condition within patient records is also a really significant step and will help staff identify changes and deterioration using insights from those who know the patient best. While thankfully the need for escalation of care will hopefully only be needed in a limited number of cases, this three-step safety net has the opportunity to truly transform patient care and safety.”


NHS national patient safety director and senior responsible officer for Martha’s Rule, Dr Aidan Fowler, said: “Working closely with Martha’s parents and colleagues across the NHS over the last few months on this rollout, I am in no doubt this programme will deliver clear change and it has been so encouraging to see how many hospitals have shown interest in being part of delivering these all-important patient safety measures this year.

“With new processes that enable both patients and staff to raise concerns if they see someone’s condition worsening, and the inclusion of patients and their loved ones’ insights in medical records, these measures can help us better identify and manage deterioration as part of wider work, which is a key priority for us and will no doubt lead to improvements in the care patients receive.”

  • List of sites

    Addenbrooke’s Hospital
    Watford General Hospital
    Princess Alexandra Hospital
    Colchester Hospital
    Bedford Hospital
    Southend Hospital
    Basildon Hospital
    Broomfield Hospital
    Peterborough City Hospital
    Lister Hospital
    West Suffolk Hospital
    Luton and Dunstable University Hospital.
    James Paget University Hospital
    The Queen Elizabeth Hospital
    Norwich University Hospital
    Ipswich Hospital
    University Hospital Lewisham
    The Royal Marsden Hospital , Chelsea
    The Royal Marsden Hospital, Sutton
    Croydon University Hospital
    St Georges Hospital
    Barnet Hospital
    Royal Free Hospital
    Great Ormond Street Hospital for Children
    North Middlesex University Hospital
    University College Hospital
    Kingston Hospital
    Kings College Hospital (Denmark Hill Site)
    Queen Elizabeth Hospital
    Princess Royal University Hospital
    Chelsea and Westminster Hospital
    West Middlesex University Hospital
    Northwick Park Hospital
    Charing Cross Hospital
    Hillingdon Hospital
    St. Mary’s Hospital
    Hammersmith Hospital
    Newham University Hospital
    Homerton University Hospital
    St Bartholomew’s Hospital
    Whipps Cross Hospital
    Royal London Hospital
    The Whittington Hospital
    Ealing Hospital
    Northampton General Hospital
    Kettering General Hospital
    Royal Stoke University Hospital
    New Cross Hospital
    Manor Hospital
    Pilgrim Hospital Boston
    Birmingham Heartlands Hospital
    Good Hope Hospital
    Queen Elizabeth Hospital
    Solihull Hospital
    Birmingham Children’s Hospital
    Russell’s Hall Hospital
    Sandwell General Hospital and City Hospital (two sites)
    Glenfield Hospital
    Kings Mill Hospital
    Kettering General Hospital
    University Hospital Coventry
    Lincoln County Hospital
    Leicester Royal Infirmary
    Leicester General Hospital
    Robert Jones and Agnes Hunt Orthopaedic Hospital
    Sheffield Childrens Hospital
    Barnsley Hospital
    Queen Elizabeth Hospital
    Sunderland Royal Hospital
    South Tyneside District General Hospital
    Huddersfield Royal Infirmary
    York Hospital
    Cumberland Infirmary
    University Hospital of North Durham
    Bishop Auckland Hospital
    Royal Victoria Infirmary, Newcastle
    Freeman Hospital
    James Cook University Hospital
    Darlington Memorial Hospital
    West Cumberland Hospital
    Pinderfields Hospital
    Calderdale Royal Hospital
    Leeds General Infirmary
    Bradford Royal Infirmary
    Airedale General Hospital
    St James’s Hospital
    Countess of Chester Hospital
    Wirral University Teaching Hospital
    Royal Liverpool University
    Southport District General Hospital
    Blackpool Victoria Hospital
    Royal Blackburn Hospital
    Burnley General Hospital
    Royal Bolton Hospital
    Royal Manchester Children’s Hospital
    Alder Hey Childrens Hospital
    The Walton Centre
    Leighton Hospital
    Warrington Hospital
    Preston and Chorley Hospitals
    Royal Blackburn Hospital
    Tameside General Hospital
    The Christie
    Royal Oldham Hospital
    Royal Albert Edward Infirmary, Wigan
    St Mary’s Hospital
    Frimley Park Hospital
    Wexham Park hospital site
    Darent Valley Hospital
    The Tunbridge Wells Hospital
    Maidstone Hospital
    Southampton Children’s Hospital
    Royal Berkshire Hospital
    Stoke Mandeville Hospital
    Conquest Hospital
    Eastbourne District General Hospital
    Royal Sussex County Hospital
    Princess Royal Hospital
    Medway Maritime Hospital
    William Harvey Hospital, Ashford
    QEQM Hospital, Margate
    Queen Alexandra Hospital
    Basingstoke North Hampshire Hospital
    East Surrey Hospital
    Southampton General Hospital
    Bristol Royal Infirmary
    Great Western Hospital
    Salisbury District Hospital
    Cheltenham General Hospital
    Gloucestershire Royal Hospital
    Dorset County Hospital
    Royal Bournemouth Hospital
    Poole Hospital
    Torbay Hospital
    Derriford Hospital
    Musgrove Park Hospital
    Yeovil District Hospital
    Weston General Hospital
    Southmead Hospital
    Bristol Royal Hospital for Children
    Royal United Hospital, Bath
    Treliske Site – Royal Cornwall Hospital

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