A groundbreaking initiative called Martha’s Rule has shown early signs of success in improving patient care and saving lives, as revealed by NHS England. Data from the first months of the scheme’s rollout indicate that nearly one in eight calls made under the rule has led to a potentially life-saving change in treatment.
The scheme is designed to empower patients and their families to request an urgent review from a critical-care outreach team if they feel that a patient’s condition is rapidly deteriorating and their concerns are being ignored. If a patient’s situation appears critical, the team is able to step in quickly, potentially adjusting treatment plans to prevent a deterioration in health.
Martha’s Rule was created following the tragic death of 13-year-old Martha Mills, who died from sepsis in 2021 after her condition was not quickly recognised and treated. Martha had been admitted to King’s College Hospital in London after a cycling accident led to a pancreatic injury. Her mother, Merope Mills, began campaigning for change after an inquest revealed that an earlier change in care could have saved Martha’s life. Martha’s family was represented by Ewan Lockhart of Davies and Partners during the inquest and subsequent civil claim.
The campaign for Martha’s Rule gained momentum after Merope Mills realised that without systemic change, preventable deaths like Martha’s would continue to occur. As a result, she and her family pushed for a scheme that would allow families to request an urgent review when they felt their loved one’s health was deteriorating too quickly. Martha’s Rule, launched in April 2024, is now being rolled out in 143 NHS hospitals across England.
In just two months of operation—September and October—286 calls were made under the rule, resulting in 50% of the cases receiving a critical-care review. In 57 of those cases, patients had their treatment plans adjusted, which included changes in medication or the administration of oxygen. Additionally, 14 patients were transferred to intensive care units for more urgent treatment. These early results are encouraging and demonstrate the potential of Martha’s Rule to improve patient outcomes and prevent avoidable deaths.
Merope Mills, who has tirelessly campaigned for the scheme, expressed her satisfaction with the early data, highlighting the fact that people were now learning from past mistakes. She also noted that many skeptics of the program had been proved wrong, as the evidence showed that most calls were made for genuine concerns, not trivial complaints.
Merope’s advocacy for Martha’s Rule has not been without challenges, but seeing the impact of the scheme has been a source of hope for her family. As she told the BBC, “Losing a loved one in a preventable way compounds your grief and devastation, but if nobody learns from it, nothing changes.” She added that she hoped Martha’s Rule would be expanded nationally, just as people are familiar with emergency numbers like 999 and 111.
The success of Martha’s Rule could have far-reaching consequences for improving patient safety across the NHS. Recent statistics show that over 15,000 preventable deaths occurred in the UK in 2023. Martha’s Rule could play a critical role in reducing this number, according to health experts. Professor Sir Stephen Powis, NHS national medical director, noted that early evidence suggests the rule is starting to have a “transformative effect” on patient safety.
Dr Henrietta Hughes, England’s Patient Safety Commissioner, also expressed her optimism, calling the early data “very encouraging” and “exciting.” She said she was hopeful that the initiative would be expanded across the country. NHS England has indicated that the scheme will be expanded to include more hospitals in 2025 and 2026, with further developments to refine the program where necessary.
Similar initiatives are also being piloted in Wales and considered in Northern Ireland. In Scotland, 2019 legislation already grants NHS patients the right to request a second opinion.
We can look overseas to see if similar schemes have had a beneficial impact and are improving patient safety. Ryan’s Rule is a patient-initiated escalation process introduced in Queensland, Australia, in 2013. It allows patients, families, and carers to request an immediate clinical review if they feel a patient’s condition is deteriorating or not improving as expected. The rule was established following the tragic death of Ryan Saunders, a young boy who died from an undiagnosed streptococcal infection in 2007.
Usage Statistics
• Annual Activations: Since its inception, Ryan’s Rule has been increasingly utilised. In 2021, it was activated approximately 1,600 times, averaging 31 times per week. This represents a 25% increase from 2020 and a 145% rise compared to 2016.
• Cumulative Activations: By 2021, the process had been used over 7,300 times in Queensland public hospitals.
Effectiveness and Impact
While specific data on lives saved directly due to Ryan’s Rule is limited, several indicators suggest its positive impact
• Clinical Outcomes: A study analysing Ryan’s Rule activations found that less than 1% of cases (0.8%) met early warning criteria for deterioration, and only 0.5% required admission to the Intensive Care Unit (ICU).
This suggests that the majority of activations may address concerns before severe deterioration occurs.
• Patient and Family Empowerment: Ryan’s Rule empowers patients and families to voice concerns, potentially leading to earlier interventions. There are anecdotal reports of lives being saved due to timely escalations initiated by the rule.
• System Improvements: The increasing number of activations indicates growing awareness and trust in the system, reflecting its role in enhancing patient safety and encouraging a culture where concerns are promptly addressed.
Martha’s Rule will no doubt mirror the success of Ryan’s Rule.
Davies and Partners is proud to have supported Martha’s family in their journey through the inquest and civil claim process. The legal team, led by Ewan Lockhart, has been instrumental in ensuring that lessons were learned from Martha’s tragic death. The ongoing success of Martha’s Rule is a testament to the Mills family’s commitment to transforming patient care and ensuring that no other families experience what they went through. The progress made so far is a beacon of hope, and we look forward to seeing the scheme expand and continue to save lives.