Martha's Rule

Ashford and St Peter's Hospitals NHS Foundation Trust (ASPH) has introduced Martha's Rule, a national NHS patient safety initiative that gives patients, their families, carers and staff another way to raise concerns if they believe an inpatient's condition is getting worse.

Martha's Rule provides access to an urgent clinical review when concerns about a patient's deterioration have not been fully addressed after speaking with the clinical team caring for them. The initiative is designed to strengthen patient safety by ensuring concerns are listened to, assessed promptly and acted upon where appropriate.

At ASPH, Martha's Rule will be available for adult and paediatric inpatients. It does not currently apply to patients receiving care in the Emergency Department, Maternity or Neonatal Intensive Care Unit (NICU).

How to request an urgent review

You can contact the Martha's Rule service 24 hours a day, seven days a week by calling our switchboard and ask to be put through to the "Martha's Rule Line":

When you call, you will be asked to leave the following information:

• the patient's name
• the ward where the patient is staying
• a brief description of your concerns
• your relationship to the patient
• your contact details

You will hear the following message:

Your call will then be triaged by the Critical Care Outreach Team or Hospital at Night team - the clinical review will remain the priority, and the team will provide an update to the most appropriate person/team to take this forward.

What happens after I call?

A member of the Critical Care Outreach Team / Hospital at Night Team will listen carefully to your concerns and assess the information you provide.

Where appropriate, they will carry out an independent clinical review of the patient and work with the ward team to ensure the patient receives the most appropriate assessment, treatment and ongoing care.

The aim of Martha's Rule is to support earlier recognition of deterioration, improve communication and ensure concerns are acted upon promptly.

Who can use Martha's Rule?

Martha's Rule can be used by:

• hospital inpatients
• parents, relatives and carers
• hospital staff who are concerned about an inpatient whose condition is deteriorating.

When should I not use Martha's Rule?

Martha's Rule is intended specifically for concerns about an inpatient whose condition may be deteriorating.

It should not be used for:

• general enquiries about hospital services
• feedback or complaints about care
• questions about food, parking or other non-clinical matters
• requesting a second opinion about a diagnosis or treatment.

For these types of enquiries, please speak with the ward team or contact the Patient Advice and Liaison Service (PALS).

Martha's Rule and second opinions

Martha's Rule is not the same as requesting a second opinion.

A second opinion involves asking another consultant or specialist to review a diagnosis or treatment plan.

Martha's Rule provides an urgent clinical review when there are concerns that an inpatient's condition is deteriorating and those concerns have not been resolved through the usual clinical processes.

About Martha's Rule

Martha's Rule was introduced by NHS England following the death of 13-year-old Martha Mills in 2021 after she developed sepsis while in hospital. Following campaigning by Martha's family, the initiative was developed to ensure patients, families, carers and staff have a clear route to raise concerns if they believe a patient's condition is deteriorating.

The initiative supports a culture where everyone feels able to speak up, concerns are listened to and patient safety is strengthened through earlier recognition and escalation of deterioration.