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New roll out

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The NHS has announced the 143 hospital sites that will test and roll out Martha’s Rule in its first year, with 16 of these sites in the East of England.

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.

The initial target was to enrol at least 100 sites nationally, 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 – and 16 in the East of England – 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.

The purpose of Martha’s Rule is to provide a consistent and understandable way for patients and families to seek an urgent review if their or their loved one’s condition deteriorates, and they are concerned this is not being responded to.

The scheme is named after thirteen-year-old Martha Mills, who died from sepsis having been treated at King’s College Hospital, London, in 2021, due to a failure to escalate her to intensive care, and after her family’s concerns about her deteriorating condition were not responded to.

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.

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."

Dr Edward Morris, medical director for the NHS in the East of England, said: “Rolling out Martha’s Rule to 16 hospital sites in the East of England in this first phase represents one of the most important changes to patient care in recent years, and it’s pleasing that there’s been such good interest from our hospitals.

“This major patient safety initiative will be rolled out to these hospitals 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.

“Whilst thankfully the need for escalation of care should only be needed in a limited number of cases, this safety net has the opportunity to truly transform patient care and safety.”

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, 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 her 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.



Notes to editors

  The 16 sites in the East of England to test and roll out Martha’s Rule in its first year are:

  • Addenbrooke’s Hospital
  • Basildon University Hospital
  • Bedford Hospital
  • Broomfield Hospital
  • Colchester Hospital
  • Ipswich Hospital
  • James Paget University Hospital
  • Lister Hospital
  • Luton and Dunstable University Hospital
  • Norfolk and Norwich University Hospital
  • Peterborough City Hospital
  • Princess Alexandra Hospital
  • Queen Elizabeth Hospital King’s Lynn
  • Southend University Hospital
  • Watford General Hospital
  • West Suffolk Hospital


  • The implementation of Martha’s Rule in the NHS will take a phased approach, beginning with the 143 adult and paediatric acute provider sites which already offer a 24/7 critical care outreach capability. These provider sites formally registered expressions of interest in being part of the first phase of the programme. More information about the rollout of Martha’s Rule is available on NHS England’s website.

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