1 Background

Martha’s Rule is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.

It has been developed in response to the death of Martha Mills and other cases related to the management of deterioration. Central to Martha’s Rule is the right for patients, families and carers to request a rapid review if they are worried that their or their loved one’s condition is getting worse and their concerns are not being responded to. The three core components of Martha’s Rule are:

1. Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
2. All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
3. This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.

Martha’s Rule can work alongside existing physiological scoring systems to increase the sensitivity of identifying and responding to acute deterioration.

Further information about Martha’s Rule and its implementation can be found here.

This report provides analysis of submissions to the Martha’s Rule Data Collection from September 2024 to July 2025. This data relates to phase 1 pilot sites within NHS acute trusts across England.

2 Response rate

Table 1: Number of valid submissions each month and response rate. The number of valid submissions excludes the submissions that had to be removed due to data quality issues (see Data quality notes). The number of phase 1 pilot sites changed in July 2025 because one organisation moved from reporting once across two sites to reporting once for each site.

3 Summary

The key figures for the Martha’s Rule Programme data across NHS England from September 2024 to July 2025 are:

• In total, 5,583 Martha’s Rule escalation calls have been received.
• The highest percentage of calls came via the family/carer escalation process (72%).
• 2,277 (41%) Martha’s Rule escalation calls related to acute deterioration.
• 265 calls (12% of acute deterioration calls) required transfers of care to ICU/HDU, enhanced levels of care, tertiary centre or referral/transfer to specialists or a specialist ward.
• 793 (35% of acute deterioration calls) required other changes in treatment.

4 Calls analysis

This section examines who made the Martha’s Rule escalation call, calls per region and whether the call related to acute deterioration.

4.2 Call trends over time

Note that this collection is not mandatory, so sites may not respond every month. Please refer to the response rates for context.

Figure 1: Number of Martha’s Rule calls per month by escalation process. Reporting period from September 2024 to July 2025.

 

4.4 Martha’s Rule call flow analysis

Figure 3: Number of calls by escalation process and whether the call was related to acute deterioration. Reporting period from September 2024 to July 2025.

 

Table 4: Flow of calls by escalation process and whether the call was related to acute deterioration. Reporting period from September 2024 to July 2025.

Escalation route	Acute deterioration	Not acute deterioration	Total calls	Percentage of calls that related to acute deterioration
Family/Carer	1,564	2,474	4038	39%
Patient	214	558	772	28%
Staff	499	274	773	65%
Total	2,277	3,306	5583	41%

 

5 Outcomes of Martha’s Rule calls

6 Children and young people

This section specifically focuses on acute deterioration calls related to children and young people (0-18 years old).

Table 6: Calls relating to deterioration in children and young people. Note: Age boundaries changed in the November 2024 data collection template so this only shows data from November 2024 to July 2025.

7 Data quality notes

• This data collection is not mandatory. Therefore, different sites may submit information each month.
• The national data relates to calls made and thus one patient may have used Martha’s rule escalation multiple times.
• This data is true as of the time it was extracted, some of these figures may change subject to sites re-submitting.
• Where data quality issues were identified, these submissions were removed. This impacted 14 different sites over 8 different months (15 submissions in total).

8 Glossary

Table 7: Glossary of terms.

9 Additional information

The Martha’s Rule Programme is led by the National Director of Patient Safety in NHS England. The implementation is being led and facilitated by the National Patient Safety team in partnership with the National Nursing Directorate.

Data source: the Martha’s Rule Data Collection.

10 Future publications

Your feedback is welcome on the format, frequency and utility of this document, so that we can provide reports that are of most benefit. Please contact patientsafety.analysis@nhs.net with any suggestions.