NHS England has published new core standards to support the rollout of Martha’s Rule, a patient safety initiative designed to ensure concerns about deteriorating patients are recognised and acted upon quickly.
The guidance provides a framework for hospitals to assess how effectively the rule is being implemented and to identify areas for improvement. It also supports organisations in meeting a national requirement under the NHS Standard Contract.
All NHS trusts and foundation trusts are required to fully implement Martha’s Rule by 31 March 2027, setting a clear deadline for nationwide adoption.
At the centre of the policy are three core components, which hospitals must put in place:
- A daily patient wellness check: Asking patients a structured question about how they are feeling, helping to identify early signs of deterioration
- A staff escalation route: Allowing healthcare professionals to request a rapid clinical review if they are concerned
- A patient and family escalation route: Enabling patients and loved ones to directly raise concerns and trigger additional review
Martha’s Rule is based on the principle that patients, families and frontline staff may notice subtle changes in condition before they are reflected in clinical observations.
Alongside these three components, NHS England has now set out six core standards describing what organisations should have in place to ensure safe, effective and reliable implementation. These standards require:
- Clear escalation processes: Concerns can be raised easily at any time and are acknowledged and acted on promptly
- Timely clinical review: Patients receive a rapid response from an appropriately skilled clinician when concerns are escalated
- Patient and family awareness: People are informed about Martha’s Rule and supported to speak up about concerns
- Staff awareness and empowerment: Staff are trained, supported and confident to escalate concerns and request additional review
- Monitoring, data and learning: Organisations use data, reflection and review to assess performance and identify improvements
- Governance and accountability: Leadership oversight ensures the rule is implemented consistently and effectively
These standards are supported by structured self-assessment, using reflection questions and local data to help organisations evaluate delivery and identify gaps.
The guidance also emphasises the need for a cultural shift across the NHS, creating an environment where raising concerns is encouraged and taken seriously.
With rollout already underway, the introduction of these six core standards — alongside the 2027 deadline — marks a significant step in embedding Martha’s Rule into everyday clinical practice, with the aim of improving early intervention and overall patient safety.
Source: NHS England
Join us for our upcoming Martha's Rule CPD Conference on Thursday 24th September 2026 for a comprehensive and practical guide to seamlessly integrate Martha’s Rule into your daily practice.
The conference will also discuss the new approach to managing acute physical deterioration through the prevention, identification, escalation, response – PIER approach, which is currently being implemented.
The 2026 six core Martha’s Rule core standards will be discussed and we will explore using the core standards to self-assess and obtain assurance on Martha’s Rule implementation or identify gaps for focused improvement.
Book your place: www.healthcareconferencesuk.co.uk/virtual-online-courses/marthas-rule-patient-safety
