Hospitals across England are implementing Martha’s Rule, a patient safety initiative that allows patients and their families to request an urgent clinical review if they believe a patient’s condition is deteriorating, especially since the family or the individual can understand the changes better at times.
The policy has been introduced by NHS England as part of broader efforts to improve hospital safety and ensure that concerns raised by patients or relatives are taken seriously and acted upon quickly.
Martha’s Rule provides a structured process for escalating concerns within hospitals.
Under the system, patients, families, and carers can request a rapid review by a different clinical team if they believe that a patient’s condition is worsening and their concerns have not been adequately addressed.
The rule includes three main components:
Clear information from patients and families will be collected daily and it will be acted upon.
All staff will be able to ask for an urgent review by a senior clinician or critical care outreach team if they think the condition of the patient is deteriorating.
Patients can also ask this escalation through a dedicated phone number, which will be given individually for an hospital (not a nationalised number)
The goal is to ensure that potential clinical deterioration is recognized and treated as early as possible.
The development of Martha’s Rule was closely linked to the case of Martha Mills, a 13-year-old who died in 2021 after developing sepsis while being treated at King’s College Hospital NHS Foundation Trust in London. Martha had initially been admitted with pancreatic injuries following a cycling accident.
According to her mother, Merope Mills, an editor with The Guardian, Martha developed severe sepsis six days before her death and showed symptoms including significant bleeding from medical tubes, but she remained on the ward instead of being transferred to intensive care.
Mills said the family’s concerns about Martha’s deterioration were dismissed or not acted upon by the treating team, and they were not informed that she had developed sepsis or treated for it.
Coroner's report after her death suggested that the death could have been avoided if the sepsis treatment was started earlier.
Independent investigators, commissioned by the hospital later suggested that reluctance to involve the pediatric intensive care unit (PICU) by the Liver team, was partly due to an “ingrained culture” within the clinical team that seeking outside specialist review from PICU could be seen as a sign of weakness.
Following Martha’s death, Mills wrote publicly about the case in The Guardian in 2022 and later discussed it in a widely heard interview on the BBC Radio 4 Today programme in September 2023, where she called for a formal system allowing families to escalate concerns about a patient’s condition.
The issue was raised in the House of Commons.
The idea was partly inspired by Ryan’s Rule, a similar escalation system used in hospitals in Queensland, Australia.
Within weeks, political parties and several major British newspapers expressed support for the proposed patient safety measure.
See also: UK Woman Loses Four Limbs After Dog Lick Causes Sepsis
According to figures released by NHS England, the policy has already been used 10,119 times during its early rollout across selected hospitals.
Reports indicate that around 446 patients received urgent clinical reviews after concerns were raised, and in many cases the intervention led to changes in treatment or escalation of care.
Health officials say the reviews have included situations where patients required:
admission to intensive care units
additional monitoring
changes in medication or treatment plans
These interventions may help prevent complications by identifying deterioration earlier.
Allowing patients and families to raise concerns directly provides an additional safety layer that may help clinicians respond more quickly.
The policy is currently being implemented in a phased rollout across all acute in patient NHS hospitals in England.
Health authorities plan to expand the program nationwide, with the goal of ensuring that all hospitals including emergency services, maternity and neonatal services are included later.
Officials say that improving communication between healthcare staff and families is an important part of strengthening patient safety systems.
Reference
NHS England. “Martha’s Rule.” NHS England. Accessed March 11, 2026. https://www.england.nhs.uk/patient-safety/marthas-rule/
