I understand Martha’s Rule is currently limited to NHS hospital settings, but I’m wondering whether any care providers or local authorities have adopted similar principles. In some cases, families notice subtle signs of deterioration—preventable gaps in care, unaddressed health needs, emotional withdrawal, or repeated delays in routine support—and while these concerns may be noted, they aren’t always followed by meaningful action.
I’m aware that safeguarding is often cited as the route for raising serious concerns, but it’s a reactive framework. It doesn’t always apply when wellbeing is visibly declining but hasn’t yet met a formal threshold for harm. I’m asking whether there’s a proactive mechanism—something that allows families to escalate concerns before they become safeguarding issues.
Would be grateful to hear if anyone’s seen this in practice—or tried to request it.
Your beloved government (aka NHS at a distance) says,
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.
This is defacto a government driven initiative. It has been rolled out very carefully, so not ‘everybody’ will have the ‘right’. That’s important. Why? Cuz the health services would melt down with requests for ‘rapid reviews’ that cannot be supplied.
I have not seen anything like Martha’s Rule in (or for) care homes - and I do work with care homes on many occasions.
I’m afraid I am unable to say more, because that would lead me into political analysis, which is banned from this site.
Thanks Captain Walker. I understand the limits around political analysis, so I won’t press further. But I do wonder—if care homes had a way to escalate early concerns before they reached safeguarding thresholds, could it help prevent avoidable harm?
By “proactive escalation mechanism,” I mean something simple: a documented concern log, a named liaison, a feedback loop. Not a replica of Martha’s Rule, but a lawful route for families to act when distress is visible but not yet classified as harm.
I’d be interested to hear if others have seen anything like this—not as policy debate, but as practical reflection.
I have no factual information on that. I’ve not seen or heard of it, so I’m inclined to think it doesn’t exist. But then again there are loads of things I don’t see and hear about.
Great idea. But my observation is that ‘political poultices’ haven’t found the resources to deliver the quality required in health services, so I have to wonder about resources outside of health services.
My expectation based only on experience, is that ‘rapid review’ is likely to become yet another tick box, wherever it’s implemented. Do not be influenced by my views because I have worked in all the wrong places, mostly in the bottom one-third of the recent ‘league of tables’. My perceptions cannot be reasonably generalised.
What people need is hope - even blind hope will do.