Martha’s Rule—Learning from others

Summary

Victoria Wilkins, Associate Safety and Learning Lead (North) at NHS Resolution, shares insights from a recent Northern Safety and Learning network meeting where four pilot trusts discussed their progress in implementing Martha’s Rule and shared their learning with other members.

Content

Martha’s Rule implementation

In March 2025, we held a network session on Martha’s Rule focused on four acute trusts implementing the scheme within their acute and paediatric services. Each trust was at a different stage of implementation, but all had valuable learning to share. One year later, we met with them again to hear about their progress. The session was one of our quarterly Northern Safety and Learning network meetings which are there for members to share and learn from one another on selected themes and topics. NHS Resolution facilitates the sessions with appropriate speakers, the sharing of unique claims data insights and best practices to meet the needs of its members on topics chosen by the members. Where possible, we encourage members to share their own work in order to create a psychologically safe learning environment and community of practice.

Martha’s Rule is currently of interest to our members as each acute trust is implementing the Rule as part of the NHS standard contract; with emergency departments, maternity and neonatal also now piloting the Rule. Although Martha’s Rule targets acute trusts, many independent providers, mental health and community trusts have also shown interest and are keen to learn from their neighbouring acute trusts and attend the network to hear first-hand from those involved.

My main takeaway from the March 2026 session was how dedicated and motivated the four trusts' leads remain and this is truly inspiring in the current climate of rapid change and uncertainty felt by many. They each contributed to a discussion style panel session where I asked five key questions to them. The question which prompted the most discussion was ‘what would you do differently in the future’; for most of them, the answer was to have dedicated leads who did not have to do this alongside a day job and could focus 100% on implementation of the Rule. When asked about the challenges, they reflected that the process had been hindered by not knowing what to expect in the beginning and also not knowing how to deal with calls for concern which did not fall within Martha’s Rule.

Improving communication

Those calls that did not fall within Martha’s Rule have also contributed to positive change. For example, communication has been a key theme and is closely linked to claims and complaints. Clear explanations, questions answered, and a shared understanding of what is happening, when and why, can go a long way towards reducing both complaints and claims.[1] Trusts have improved communication by giving patients and families clearer guidance on the routes available to raise concerns that may not relate to Martha’s Rule but are still important to hear. This has created opportunities for wider learning and improvement. As a result, the impact has been broader than originally intended, which can only be positive.

We also heard about the phenomenal work one of the trusts piloting Martha’s Rule had done within their emergency department. By considering the demographics of their population and working in partnership with service users they have created meaningful and accessible products that fit the needs of the population they serve—for example, the majority of the population has a below average reading age, so they tailored their posters and materials accordingly. The amount of work involved has been incredible and it was truly inspiring to hear the lengths they have gone to make sure the pilot is successful, putting the people they serve at the front and centre.

Maternity and neonatal care

We then heard from one of the national leads piloting the Martha’s Rule in maternity and neonatal. It was encouraging to hear how many trusts wanted to take part, and how many are also starting pilots outside the main programme because they recognise the importance of Martha’s Rule and the principles behind it. Maternity and neonatal care have unique challenges. Before birth, there are one or more patients in one body. After birth, babies can be fragile and depend completely on others to notice and raise concerns when they are unwell. For neonates, Martha’s Rule is less about being able to speak up and more about recognising signs and symptoms of deterioration, similar to paediatric care.

Continuing the journey

It was excellent to see people sharing learning and offering to stay in touch after the session. This is exactly what we want from our network meetings. Overall, this was a truly fantastic session with people at the end asking to reconvene in another year to see how the leads are getting on and how the pilots have become reality. This will happen and I personally cannot wait to hear more from them and help them to share their stories and journeys. We can support each other, network and share learning across the North region—just as the network is intended to do.

Reference

1. NHS Resolution. Behavioural insights into patient motivation to make a claim for clinical negligence. NHS Resolution, England; 2018.

Further reading on the hub:

• Martha's Rule: A valuable patient safety tool facing new challenges

About the author

Victoria Wilkins is a registered Midwife and joined NHS Resolution as the Associate Safety and Learning Lead – North in February 2023. Victoria continues to work clinically as a midwife for her local trust, undertaking shifts in triage, community and ward areas.

Victoria’s previous portfolio included extensive clinical experience from Midwifery, particularly community midwifery, working in rural and urban settings. Within this role, Victoria worked in collaboration with several local and regional partners on projects such as Together for Childhood, led by the NSPCC and with the local maternity and neonatal system to improve care provided. Victoria also led a successful move to new premises for a rural satellite service and received second place in the Trust Stars Awards for her efforts.

In February 2024, Victoria became a Freedom to Speak up Guardian for NHS Resolution and endeavours to help people work out the solution which works for them in a way which allows the organisation and the workforce within it to improve, grow and become great.