Major national study launched to evaluate Martha’s Rule across NHS hospitals

Leicester researchers are among those conducting a major study to investigate how a patient safety rule introduced to ensure patients and their families are heard is making a difference. 

The three-year national research programme is being funded by the National Institute for Health and Care Research (NIHR). 

Martha’s Rule is an initiative introduced following the teenager’s death at King’s College Hospital in 2021.

It is named in memory of Martha Mills, who died after a failure to escalate her care led to her death from sepsis.

The rule is designed to give patients and families the opportunity to report daily how they are feeling and if their condition has changed, and to seek an urgent review from an independent team if they have concerns about a patient’s worsening condition. It is currently being put in place by all NHS Trusts across England following a pilot phase across dozens of hospitals. 

Now, a major review is being launched to investigate how well the rule is being implemented and where improvements could be made. 

It brings together leading patient safety researchers, clinicians, patients and public contributors to examine how Martha’s Rule is working in practice. 

The national evaluation is being led by the NIHR Central London Patient Safety Research Collaboration (PSRC) and delivered by SafetyNet, through a collaboration between all six NIHR PSRCs which carry out research to improve patient safety across England. 

The three-year research programme brings together expertise from across the network under the leadership of Professor Ramani Moonesinghe and John Welch, both consultants at University College London Hospitals (UCLH) and leaders within the NIHR Central London PSRC.

The NIHR Greater Manchester PSRC, alongside researchers from the universities of Leicester and Manchester, will play a key role on the qualitative and health economic workstreams of the Martha’s Rule evaluation, including how patients, families and staff are supported and empowered to speak up for safety and raise concerns about care.

The qualitative workstream of the evaluation will be co-led by Professor Nicola Mackintosh with support from Dr Liz Sutton, from the University of Leicester’s Division of Public Health and Epidemiology.

Together they have a portfolio of related work conducted over the past 10 years in patient and family involvement in safety, and in the design of safety tools to enable the rescue of deteriorating patients on hospital wards.

Professor Mackintosh said: “We know that patients and family members can play a central role in contributing to timely management of deterioration. Martha’s Rule offers a way for their voices to be routinely heard. The qualitative workstream will enable us to understand how Martha’s Rule is being implemented across different settings, its influence on local cultures of safety, and factors that shape equitable provision of Martha’s Rule for all.”

The Martha’s Rule evaluation also draws on health economics expertise from the NIHR Greater Manchester PSRC team, led by Professor Rachel Elliott and Dr Thomas Allen from The University of Manchester. The evaluation will help determine the cost implications and economic benefits for hospitals implementing Martha’s rule.

Professor Darren Ashcroft, Director of the NIHR Greater Manchester PSRC, said: "Martha's Rule has the potential to strengthen patient safety by ensuring that patients and families have a clear route to raise concerns when a patient's condition is deteriorating. This evaluation is an important opportunity to understand how the policy is being implemented in practice, what works well, and where further improvements may be needed. 

“By drawing on our expertise in qualitative research and health economics, we are delighted to contribute to this important national study and help build the evidence needed to support safer care for patients and families."

Martha’s mum, Merope Mills, who is behind the nationwide Martha’s Rule initiative, visited University of Leicester Medical Students earlier this year to see how empathy training is being woven into their studies. She also spoke to experts from the University’s Stoneygate Centre for Empathic Healthcare which aims to improve patients' lives by pioneering a new approach to medical education and training that places empathy at the heart of healthcare.

Concerns raised by Merope over Martha’s hospital care at the time were not listened to and a coroner later ruled that Martha would probably have survived if she had been transferred earlier to intensive care and given appropriate treatment.