As Martha’s Rule expands across NHS Trusts in England, a landmark three-year national evaluation funded by the National Institute for Health and Care Research (NIHR), as reported by Healthcare in Europe, is underway to examine how the patient safety mechanism operates on ward floors. Among those leading key aspects of this study are researchers from the University of Leicester, who are analysing how the initiative influences hospital safety cultures, patient empowerment, and health economics.
Named in memory of 13-year-old Martha Mills, who sadly lost her life to sepsis at King’s College Hospital in 2021 following an unaddressed failure to escalate her care, Martha’s Rule gives patients, families and carers a guaranteed right to request an urgent review from an independent critical care team when a patient's condition declines. A coroner later ruled that Martha would likely have survived had she been transferred earlier to intensive care.
Inside the National Evaluation
The three-year research programme is led by the NIHR Central London Patient Safety Research Collaboration (PSRC) in partnership with University College London Hospitals (UCLH) under co-chief investigators Professor Ramani Moonesinghe and John Welch. Delivered by SafetyNet, a collaborative network of all six NIHR PSRCs across England, the study brings together academic researchers, clinicians, health economists and patient advocates with lived experience.
Researchers from the University of Leicester, alongside the NIHR Greater Manchester PSRC and the University of Manchester, are leading critical qualitative and economic workstreams:
Co-led by Professor Nicola Mackintosh and Dr. Liz Sutton from the University of Leicester’s Division of Public Health and Epidemiology, the qualitative workstream examines how Martha's Rule shapes local hospital cultures, supports staff to escalate concerns, and ensures equitable access across diverse patient populations.
Led by Professor Rachel Elliott and Dr. Thomas Allen from The University of Manchester, the health economics evaluation will assess the cost implications, clinical workload impacts and economic benefits for hospitals implementing formal escalation pathways.
Professor Nicola Mackintosh emphasised the core role of family oversight: "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.".
From Voluntary Guidelines to Standardised Rights
Professor Darren Ashcroft, Director of the NIHR Greater Manchester PSRC, noted that Martha's Rule has the potential to significantly strengthen patient safety by establishing a clear, standardised route for escalation when a patient deteriorates.
Under medical negligence law, a failure to rescue a deteriorating patient often traces back to hierarchical communication barriers or a failure to listen to relatives who notice subtle changes before vital signs trigger automated systems. By formally evaluating how Martha's Rule changes staff behaviors and bedside culture, researchers are building the empirical foundation needed to eliminate ‘failure to listen’ from hospital care.
Translating Research into Irish Reform
As Ireland advances its own clinical governance framework under the Patient Safety Act 2023, adopting a statutory, named Patient Safety Rule across Irish acute and maternity services remains a vital priority.
Relying on informal, voluntary open-door policies is insufficient during acute medical crises. Establishing a formal, evaluated right for patients and carers to trigger an independent clinical review removes institutional friction, ensures equal access regardless of background, and guarantees that warning signs are addressed before catastrophic harm occurs.
Has your family experienced an unaddressed clinical deterioration in hospital care?
Contact Whelan Law today to discuss your experience with our specialised medical negligence team.