Managing Deterioration Safety Improvement Programme

 

Managing deterioration’ refers to identifying that a person’s physical condition is worsening and responding appropriately to support best health outcomes, keep them safe and provide a positive experience of care.

 

 

East Midlands Patient Safety Collaborative (PSC) is delivering the Managing Deterioration Safety Improvement Programme (ManDetSIP), commissioned by NHS England

The aim of the programme is to reduce deterioration-associated harm in physical healthcare.

The programme is part of the National Patient Safety Improvement Programme and is aligned to the NHS Patient Safety Strategy.

The focus of the Managing Deterioration Programme is to implement ‘Martha’s Rule’ to enhance the safety of care for deteriorating patients in an acute hospital setting  

This programme builds on the existing managing deterioration improvement activity delivered by HIEM and the Health Innovation Network’s 14 other regionally based Patient Safety Collaboratives (PSC).

 

Martha’s Rule

“Martha’s Rule is a major patient safety initiative for inpatient hospital care, providing patients and families with a way to seek an urgent review if their or their loved one’s condition deteriorates, and they are concerned this is not being responded to.”

NHS England

There are three components to Martha’s Rule:

1. Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way.
2. All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
3. This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.

Health Innovation East Midlands is supporting NHS trusts to implement Martha’s Rule. We cannot take direct referrals. Follow the below links for the relevant hospital to find out more.

 

Martha’s Rule in the East Midlands:

Health Innovation East Midlands is working with all acute hospital sites across the East Midlands to implement Martha’s Rule.

How does the programme work?

Hospitals are being supported to test and implement Martha’s Rule. In the East Midlands, our hospitals are split into two phases of testing and implementation of Martha’s Rule.  Phase one hospitals started on the programme in 2024, and Phase two hospitals began in 2025.

 

The hospitals in Phase One of the Martha’s Rule implementation are:

United Lincolnshire Teaching Hospitals NHS Trust

• Lincoln County Hospital
• Pilgrim Hospital Boston

University of Leicester NHS Trust

• Leicester Royal Infirmary
• Leicester General Hospital
• Glenfield Hospital

University Hospitals of Northamptonshire NHS Group

• Kettering General Hospital
• Northampton General Hospital

Sherwood Forest Hospitals NHS Foundation Trust

• King’s Mill Hospital (in raising concerns section)

Patients and families who are concerned about deteriorating health while in the hospital, can escalate their concerns by calling a dedicated number to a specialist team for review and appropriate action.

 

Phase 2 hospitals are:

Chesterfield Royal Hospital

Nottingham University Hospitals

• Queen’s Medical Centre
• City Hospital

University Hospitals of Derby and Burton

• Royal Derby Hospital
• Queen’s Hospital Burton

United Lincolnshire Teaching Hospitals NHS Trust

• Grantham and District Hospital

 

How we work as a Midlands region

Health Innovation East Midlands (HIEM) works in close partnership with Health Innovation West Midlands (HIWM). Together, we take Midlands wide approach to the implementation of Martha’s Rule.

HIEM and HIWM facilitate a monthly Community of Practice (CoP) for staff will help teams to share and learn from each other – both those who are developing their plans and those who have already established elements of Martha’s Rule. 

Working in partnership with Health Innovation West Midlands, we are also leading the national pilot to test and understand how Martha’s Rule can be spread into Community Hospital settings.

 

Case studies

Patient wellness questionnaire

 

How to learn more about the EMPSC and this programme of work:  

The East Midlands Patient Safety Collaborative takes an evidence-based approach to enabling patient safety improvement and offers expertise in quality improvement, project management, human factors, research, innovation and clinical practice.

If you would like to get involved with any aspect of East Midland’s patient safety work, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..