Blog: Implementing Martha’s Rule in nursing and midwifery care: why it matters

As professionals it is vital that we reflect on why Martha’s Rule is being introduced across England, why it matters to all of us, and how it reflects the key principles of our Code.

Martha Mills suffered a serious pancreatic injury after falling off her bike. Although her parents repeatedly expressed concerns about Martha’s deteriorating health, these concerns were not listened to or acted upon in a timely manner. At the inquest into Martha’s death in 2022 a coroner ruled that Martha would probably have survived had she been moved to intensive care sooner.

In the hope that no other family would go through what they did, Martha’s parents sought change. Working with the Patient Safety Commissioner and leaders across the NHS in England, including nurses, they helped to develop a patient safety initiative in which people who use services, families and carers can get a timely second opinion when they have concerns about deteriorating health.

England’s health system has responded at pace. 143 sites have signed up to roll out Martha’s Rule by March next year, as part of phase one of the intervention.

Once fully implemented, patients, families, carers and staff will have 24/7 access to a rapid review from a critical care team if they are worried about a person’s condition. Details of who to contact will be advertised around the hospital and staff in those Trusts will have access to this same rapid review.

The NHS must implement a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least daily. In the first instance, this will cover all inpatients in acute and specialist trusts.

For professionals implementing Martha’s Rule this means emphasising the importance of prioritising people and preserving safety, being person-centred and involving people and families in their care, which are all intrinsic to our Code.

Making it easier for people, families, and carers to escalate concerns in a timely manner will reinforce the partnerships and relationships we make with the people in our care. As we emphasised in our joint statement with the General Medical Council and Care Quality Commission, we welcome the way that Martha’s Rule emphasises effective teamwork, mutual respect, and open communication.

As nurses, midwives, and nursing associates, the Code sets our professional standards to uphold in our day-to-day practice. Martha’s Rule applies to both children and adults. We encourage you to ensure that you are familiar with your local processes that enable you to escalate concerns relating to patient safety to ensure that Martha’s Rule is embedded in practice.

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