Continued backing for Martha's Rule

Health Innovation North West Coast continues to support the implementation of the patient safety initiative Martha’s Rule.

Our team has helped with its implementation since NHS England announced its introduction in May 2024.

We worked with 12 North West Coast trusts as part of the first phase of the scheme in 2024-25 which saw its introduction at 143 pilot sites across England.

And we have continued to support the second phase of the Martha’s Rule implementation, which involves 19 trusts, throughout 2025-26 as part of the Patient Safety Collaborative.

Martha Mills died in 2021 aged 13 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

NHS England has revealed that more than 10,000 calls were made to Martha’s Rule hotlines in the first 16 months of the scheme’s existence.

Health Innovation North West Coast set up a community of practice in the first phase of the implementation which developed, in the second phase, into a collaborative arrangement with several trusts in Cheshire and Merseyside and in particular with Alder Hey Children’s NHS Foundation Trust, whose case study on implementing Martha’s Rule we helped develop.

The collaborative approach aimed to foster peer support and help the Martha’s Rule process become embedded in trust systems while providing opportunities to share learning.

Health Innovation North West Coast has also held check-in calls with participating sites and contributed to health equality work and to national shared learning events. Our team also supported a scoping exercise to help understand digital pathways and midwifery service approaches to implementation.

The team has collaborated with the Lancashire and South Cumbria Operational Delivery Network since the implementation began.

This latest phase of the implementation culminated in a highly successful shared learning event at Alder Hey Children’s NHS Foundation Trust that drew around 60 delegates. Trust teams used the occasion to describe how they implemented Martha’s Rule and overcame various challenges.

Nathan Askew, Chief Nurse at Alder Hey Children’s NHS Foundation Trust and Martha’s Rule Lead for NHS Cheshire and Merseyside, said after the event: “We’re very pleased with the way this highly important measure has been implemented in the region. What I’m struck by at this event is the passion to get things right.

“I’ve been blown away by how much progress we’ve made across the region in the last two years, and one of the reasons for that progress is that people have been brave – they haven’t feared failure, and they have continued to improve their systems to get it right for patients and our workforce.

“Health Innovation North West Coast has played an important role in making sure the different elements of the implementation came together and have supported our trusts every step of the way.

“Without them we wouldn’t be where we are today.”

Verity Mather, Quality Improvement Lead, who led Health Innovation North West Coast’s involvement in the implementation, said: “It’s been a real pleasure to work on Martha’s Rule because it’s highlighted the crucial role of collaboration.

“We wanted to be sure the opportunities for providers to learn from one another’s experiences weren’t missed, and we’ve achieved that.

“We’ve been impressed by the dedication and commitment of all the provider teams who have been so willing to help each other deliver such an important initiative.”

Trusts who shared their learning at the event included Liverpool Heart and Chest Hospital NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, the Walton Centre NHS Foundation Trust, East Cheshire NHS Trust, Warrington and Halton Teaching Hospitals NHS Foundation Trust, and East Lancashire Hospitals NHS Trust.

NHS England plans to extend Martha’s Rule to all providers in the coming years as part of a programme to improve the management of patient deterioration. It will also share learning from maternity, community, A&E and mental health settings with Phase 1 and Phase 2 sites.

• Read A call for concern that made a difference, a case study from East Lancashire Hospitals NHS Trust.

• Blog: From permission to empowerment – read Verity Mather’s reflections on Liverpool Heart and Chest Hospital’s successful implementation of Martha’s Rule.