HSE Evaluates Martha's Rule for Irish Hospitals as Patient Safety Escalation System Proves Its Worth in England
The Health Service Executive is evaluating how the principles of "Martha's Rule" — a patient safety policy that gives patients and families a formal right to request a rapid clinical review if they are concerned about a deteriorating condition — could be adapted for the Irish healthcare system, as data from England demonstrates that the escalation system has made a significant contribution to patient safety since its introduction in 2024.
Background
Martha's Rule takes its name from Martha Mills, a 13-year-old girl who died in a London hospital in 2021 after her parents' concerns about her deteriorating condition were not acted upon in time. The subsequent inquiry found that Martha's death might have been prevented if there had been a formal mechanism for her family to escalate their concerns to a senior clinician. The rule, which was introduced in England in May 2024 and has since been expanded to all adult and paediatric acute inpatient services, gives patients, families, and carers a formal right to request a rapid clinical review — typically from a critical care outreach team — if they are concerned that a patient's condition is worsening and they are not satisfied with the current response.
The policy addresses a well-documented problem in hospital care: the gap between what patients and families observe at the bedside and what is captured by formal clinical assessment tools. Standard Early Warning Scores, which are used to identify patients at risk of deterioration, are based on objective physiological measurements and can miss the subtle changes in a patient's condition that are often first noticed by those who know them best. Martha's Rule provides a mechanism for that knowledge to be acted upon, even when the formal clinical indicators do not yet show cause for concern.
Ireland does not currently have an equivalent policy, and the HSE has been monitoring the rollout of Martha's Rule in England with a view to assessing whether a similar approach could be implemented in the Irish system. The HSE's Patient Safety Digest for the first half of 2026 noted that the organisation is considering how the principles underpinning Martha's Rule could be supported within the Irish healthcare context.
Key Developments
Data from the English programme indicates that the escalation calls triggered by Martha's Rule have made a significant contribution to patient safety, with a substantial percentage of calls leading to transfers of care or changes in treatment in cases where standard Early Warning Scores would not have necessitated an escalation. The evidence suggests that the rule is identifying patients at risk of deterioration who would otherwise have been missed by the formal clinical assessment process.
The HSE's evaluation is being conducted in the context of a broader programme of patient safety initiatives, including the use of research networks like EQUIPS and data repositories like Lenus to improve safety surveillance. The organisation has also been examining the experience of Wales, which is implementing a "Call4Concern" system, and Scotland, which is piloting similar measures, as part of its assessment of the options available for the Irish system.
The International Conference on Communication in Healthcare, which is being held in Belfast from 14 to 18 September 2026, has provided a forum for the exchange of evidence and experience on patient safety escalation systems, with researchers and clinicians from across the world sharing their findings on the effectiveness of different approaches. The conference, which focuses on optimising patient outcomes through improved communication, is directly relevant to the Martha's Rule debate.
Why It Matters
Patient safety is one of the most important and most challenging issues in modern healthcare. Despite significant advances in clinical knowledge and technology, preventable harm to patients remains a significant problem in health systems across the world, including in Ireland. The HSE's own data shows that adverse events — incidents in which patients are harmed by their care rather than by their underlying condition — occur at a rate that, while comparable to international norms, represents a significant burden of preventable suffering. Martha's Rule addresses one specific but important category of preventable harm: the failure to recognise and respond to deteriorating patients in time. The evidence from England suggests that it works, and the HSE's evaluation of whether it can be adapted for the Irish system is therefore a matter of genuine patient safety significance. The challenge is to implement the principle in a way that is appropriate for the specific characteristics of the Irish health system, including its mix of public and private provision and its particular staffing and resource constraints.
Local Impact
For patients and families in hospitals across Ireland, the prospect of a formal escalation mechanism similar to Martha's Rule would be a significant reassurance. The experience of families who have lost loved ones in circumstances where their concerns were not acted upon in time is a recurring and painful theme in Irish healthcare, and the introduction of a formal right to escalation would provide a practical safeguard against the most serious consequences of communication failures. In hospitals across Dublin, Cork, Galway, Limerick, and Waterford, the implementation of such a system would require training for clinical staff, the establishment of rapid response teams capable of responding to escalation calls, and the development of clear protocols for how escalation requests are handled. The HSE's evaluation is expected to address all of these practical questions as part of its assessment of the feasibility of implementing the policy in Ireland.
What's Next
The HSE is expected to publish the findings of its evaluation of Martha's Rule before the end of 2026, with a recommendation on whether and how the policy should be implemented in the Irish system. If the recommendation is positive, a pilot programme in a small number of hospitals is likely to be the first step, with a view to a national rollout if the pilot demonstrates the expected benefits. The Department of Health is expected to be involved in the decision on implementation, given the resource implications of establishing rapid response teams in hospitals across the country. Patient advocacy groups, including the Patient Advocacy Service and the Irish Patients Association, have been calling for the introduction of Martha's Rule in Ireland and are expected to engage actively with the HSE's evaluation process.
