Background
‘Martha’s Rule’ was named after Martha Mills, a 13-year old who tragically died in 2021 from sepsis following a pancreatic injury sustained in a bicycle accident. Despite her parents’ repeated concerns about her worsening condition, Martha was not transferred to intensive care. A coroner later concluded that she would have likely survived had action been taken sooner.
Motivated by their loss, Martha’s parents campaigned for a system that would empower families and staff to escalate concerns when they feel something is wrong. Their efforts gained swift cross-party support and led to NHS England committing to implement the rule in early 2024.
What is Martha’s Rule?
Martha’s Rule gives patients, families, carers, and staff the right to request an urgent clinical review by a different team if they believe a patient’s condition is deteriorating and their concerns are not being addressed. It rests on three core components:
- Daily structured inquiry into patient well-being.
- 24/7 access for staff to request peer review.
- 24/7 access for patients and families to trigger a rapid review via helplines and clearly advertised escalation routes.
Current status
Following a successful pilot across 143 hospitals, the rule was expanded to all acute inpatient sites in England in September 2025. Between September 2024 and June 2025, nearly 4,906 calls were made under Martha’s Rule, with 241 potentially life-saving interventions trigged. These included ICU admissions, transfers to specialist care, and urgent changes in treatment.
Expected impact
Martha’s Rule is already reshaping hospital culture. It encourages openness and validates the insights of families who often know their loved ones best. Clinicians report that while the process can be challenging, it ultimately leads to better, safer care.
From a legal perspective, the rule may also reduce clinical negligence claims by ensuring timely documentation and response to concerns. NHS England is now exploring its extension into maternity, neonatal, emergency, and mental health settings.
Comment
Martha’s Rule marks a meaningful step forward in improving patient safety and responsiveness within the NHS. By formalising a clear pathway for escalation, it empowers families and staff to act when they feel something is wrong, potentially preventing avoidable harm. As hospitals continue to embed the rule into everyday practice, its success will depend on sustained awareness, training, and a culture that values listening as much as clinical expertise.
Authors: Sharny Richards and Rachel Thompson
