Martha’s Rule in Action: Daniel’s Story

Martha’s Rule is a patient safety initiative empowering patients, families and carers to raise concerns if their loved one’s condition is getting worse and their concerns are not being responded to. It is also for staff to ask for a review if they are concerned a patient is deteriorating, and they are not being responded to. Now being rolled out across all acute hospitals in England, every acute site in the country is working to offer access to this important service.

As the implementation partner for Martha’s Rule, the Health Innovation Network supports its delivery through the regional Patient Safety Collaboratives. In the East of England, Health Innovation East has been working with NHS hospitals to test, implement and share learning to help shape national policy on Martha’s Rule.

Here, Daniel’s family share their experience of calling Martha’s Rule into action.

Daniel’s story

Daniel is a typical three-year-old. A devoted mummy’s boy, he loves his food, dressing up, splashing in puddles and getting into mischief with his big sister. To everyone who meets him, Daniel is a lively, affectionate little boy full of personality.

Daniel was born prematurely and has complex medical needs, including chronic lung disease. As a result, he is more vulnerable to serious illness than other children his age and often takes longer to recover when he becomes unwell. Over time, his family have become highly skilled at recognising the early signs that something is not quite right and managing his care.

A sudden deterioration

One day, Daniel became unwell at preschool and was sent home early. His mum took him to see the GP, who prescribed antibiotics and sent him home. However, shortly after the appointment, Daniel’s condition began to deteriorate rapidly. Alarmed by how quickly he was becoming more unwell, Daniel’s mum and nan decided to take him to A&E.

While in A&E, Daniel’s condition worsened further. He was rushed to the resuscitation area, where doctors worked urgently to stabilise him. This marked the start of a week-long hospital stay, during which Daniel required intravenous antibiotics and medication to support his recovery.

An uncertain and stressful recovery

Daniel’s progress throughout the week was unpredictable. His condition improved and declined several times, creating a constant sense of uncertainty. For his mum and nan, this was an extremely distressing time, filled with worry about Daniel’s wellbeing.

During the admission, Daniel’s mum raised several concerns about his care, with his signs of distress obvious to his mum and nan – those who know him best. Despite raising concerns with ward staff, both Daniel’s mum and nan felt their worries were not being listened to.

Using Martha’s Rule

Feeling they had exhausted other options, a relative contacted the hospital’s Martha’s Rule number on Daniel’s mum’s behalf. The call was made to raise concerns about Daniel’s care and the family’s difficulty being heard.

Following the call, an outreach nurse came to speak with Daniel’s mum. She was taken to a private space and given the time to openly share her concerns. This conversation revealed a breakdown in communication between the clinical team and Daniel’s family – something ward staff were not previously aware of.

A clear plan for the future

As a direct result of the Martha’s Rule call, steps were taken to improve communication and address the family’s concerns. Crucially, a new care plan was created for Daniel to guide any future hospital admissions. This includes arrangements to minimise time spent waiting in A&E, recognising Daniel’s increased risk of infection and serious illness.

During Daniel’s next hospital admission, the difference was clear. His family felt listened to and taken seriously. Communication with staff was much improved, with clearer explanations about Daniel’s condition and treatment. They were also given more detailed guidance on administering his medication after discharge.

Building trust and looking ahead

For Daniel’s family, Martha’s Rule provided reassurance at a time when they felt overwhelmed and unheard. It helped rebuild trust, strengthened communication, and ensured Daniel’s needs were better understood and planned for.

Looking ahead, the family’s goal is simple but important: to keep Daniel out of hospital for a whole year, so he is well enough to travel abroad on a family holiday. With a clear care plan and improved communication in place, they feel more confident and supported in working towards that goal together.