HSE learning from ‘Martha’s Rule’ implementation

HSE National Quality and Patient Safety has engaged with the NHS to learn from its experience of implementing ‘Martha’s Rule’, the Medical Independent (MI) has been informed.

Martha’s Rule aims to support the early detection of patient deterioration by ensuring the concerns of patients, families, carers, and staff are listened to and acted upon.

The initiative was developed in response to the death of Martha Mills (13) and other cases related to the management of patient deterioration.

The roll-out of the policy commenced in NHS England in 2024. Full implementation is expected to be complete across all NHS England acute inpatient sites during 2026/27. It is also being rolled out to maternity and neonatal services (and being tested in other settings).

The components of Martha’s Rule are based on recommendations by the Patient Safety Commissioner for England following a stakeholder engagement process.

Under the policy, patients should be asked, at least daily, how they are feeling and if they are getting better or worse, and this information should be acted upon in a structured way. Patients, families, carers, and staff must also be able to request, at any time, an urgent review by an alternative clinical team if they feel their concerns about deterioration are not being addressed. The review is usually conducted by a critical care outreach team/practitioner. Martha’s Rule does not replace hospitals’ existing monitoring and escalation processes.

The HSE’s engagement with the NHS on Martha’s Rule is part of its broader review of the four national early warning systems. Work on a paediatric early warning system in emergency medicine will also be incorporated within this review.

“The following topics will be explored during the review: Process, governance, patient input and activation, safe teams, education and training, audit, digitalisation, and guidance to support effective and sustained implementation,” said a HSE spokesperson.

The spokesperson told MI feedback from NHS colleagues indicated that Martha’s Rule functions as an “important adjunct” to early warning systems. It can help to identify clinical deterioration at an earlier stage, including situations where concern is evident to patients, families, or staff before physiological deterioration is reflected in early warning scores.

See news feature: HSE engages with NHS on ‘Martha’s Rule’ – Medical Independent