Martha’s Rule: Leveraging technology to empower patients, bridge communication gaps and foster inclusive access to healthcare

According to data from the Office for National Statistics (ONS), over one in five deaths in England and Wales during 2022 were considered avoidable. Some of these avoidable deaths were the result of a failure to recognise and respond to physical deterioration in a timely manner. 

In April 2024, the NHS started to roll out a new patient safety initiative called Martha’s Rule. The rule enables patients and their families to request an immediate reassessment if they believe that their, or their loved ones, deteriorating condition is not being given proper attention.  

The initiative takes inspiration from Martha Mills, a 13-year-old who tragically lost her life to sepsis in 2021 while during treatment at a hospital in London. Sadly, Martha’s condition was not escalated to intensive care, and her family’s concerns regarding her worsening health were not responded to. In honour of Martha, this scheme is dedicated to addressing the shortcomings that led to this heartbreaking outcome. 

In May NHS England announced that 143 NHS hospitals will be operating the scheme by 2025 which provides an internal phone number and the opportunity to request a second opinion from a critical care outreach team.  

A West Yorkshire Trust’s Innovative Approach

A West Yorkshire trust is taking a lead in this scheme. In April 2023, the trust introduced a wellbeing questionnaire, drawing on research conducted by Abigail Albutt from the Research Institute in Leeds. The research explored a simple yet powerful idea: by regularly checking in with patients and understanding how they’re feeling throughout the day, the trust could potentially identify and address any signs of deterioration early on. This proactive approach, Abigail believed, could lead to better outcomes for patients. The method involves a series of questions posed to patients at multiple points throughout the day. These include asking patients to share how they are feeling in the moment, as well as how their condition compares to the previous check-in. By gathering this real-time feedback, staff can quickly identify any signs of patient deterioration and intervene proactively. 

Through the implementation of Martha’s Rule, the West Yorkshire trust has implemented this questionnaire empowering patients to actively participate in their care, while equipping the clinical staff with the insights needed to deliver more personalised and timely interventions. This holistic approach aims to enhance patient safety, improve health outcomes and ultimately, transform the patient experience across the trust. On the wards where the questionnaire is currently in use, there is up to a 70% completion rate, compared with 24% when it was first introduced a year ago. 

The trust identified CardMedic as a way of helping to reduce communication barriers, providing patients with an explanation as to why they were being asked the questions and enhance the completion rate. Patients can use the app to report how they are feeling more regularly, enabling staff to identify deterioration sooner and improve patient safety.  

Fostering Inclusive Healthcare Access

Some of the other trusts taking part in the scheme have also rolled out CardMedic at the same time. The Martha’s Rule content in the app, which is currently available to those trusts taking part in the scheme, includes scripted clinical interactions with information about the rule and specific content that supports the roll out of it. We have also placed the wellness questionnaire created by the West Yorkshire trust on to the app to help staff complete the questionnaire with patients who cannot speak English, and ensure staff are able to identify deterioration more quickly in as many patients as possible. The read-aloud feature helps to bridge language barriers and deliver more personalised care. Many non-English speaking patients may be able to speak in their native language, but struggle with literacy in that language. This function addresses these literacy challenges, empowering these patients to engage more fully with their healthcare.  

Challenging Inequity through Technology and Patient Involvement

We hope the success of Martha’s Rule will initiate a move towards more patient-focused care. What I know from my own clinical practice is that clear communication on processes, procedures and obtaining consent needs to be accessed and easily understood by patients. Technology not only helps with this by providing information in accessible ways, but it can ensure that processes are standardised. I hope the processes in place across the 143 trusts taking part in the scheme will mean that patients will ultimately get a better experience and feel empowered if there is something wrong. 

By bringing together technology and patient involvement in healthcare we can challenge inequity and provide an instant dialogue across any barrier. We hope our collaborative efforts with trusts taking part in the scheme are the start of fostering inclusive access to healthcare and supporting a patient led approach. 


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