Martha’s Rule

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Martha’s Rule is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.

It has been developed in response to the death of Martha Mills and other cases related to the management of deterioration. Central to Martha’s Rule is the right for patients, families and carers to request a rapid review if they are worried that a patient’s condition is getting worse and their concerns are not being responded to.

NHS trusts are working hard to put Martha’s Rule in place in all acute inpatient settings. While it is not available everywhere yet, implementation in these settings is expected to be complete during 2026/27. More details are available in the Implementing Martha’s Rule section below.

If you or a person you care for are admitted to hospital, you can check whether Martha’s Rule is available by:

• Visiting the trust’s website
• Asking staff on the ward

Martha’s story

Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

In response to this and other cases related to the management of clinical deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’ across the NHS.

Empowering patients, families, carers and staff

Martha’s Rule actively encourages patients, families and carers to tell staff if they are worried a health condition is getting worse. They may notice small changes that could be early warning signs of deterioration before they show up in routine measurements.

If, after speaking to the care team, they remain worried and feel their concerns are not being addressed, Martha’s Rule means that they can call a dedicated number to request a rapid review from a different team.

Martha’s Rule also empowers staff to call for a rapid review if they feel their concerns about a patient are not being responded to.

The 3 core components of Martha’s Rule are:

• 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.
• 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.
• This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.