Martha’s Rule is a new patient safety measure that has been introduced in the NHS and has had a transformative effect on patient care. It gives patients and families the right to call for an urgent review, known as a Call For Concern, form a critical care team, if they feel that a patient’s condition is deteriorating but their concerns are not being addressed by the Ward.

From April 2024, Martha’s Rule would be rolled out across 143 pilot sites across the country, with plans to extend to all providers in the coming years. In Kier Starmer’s remarks on the NHS on 6 January 2025, he described

It’s about a shift in the balance of power away from a passive deference to doctors and towards patients being able to get that second opinion.

Play a greater role in deciding their care and treatment.

And the early results of Martha’s Rule are in.

Lives of some of the sickest patients in our care:

Transformed, extended, saved.

And so it’s a rule that’s now being recognised as a potentially groundbreaking innovation.

The initiative was developed by the parents of Martha Mills who died aged 13 from sepsis in 2021. A coroner later concluded Martha, who had been taken to hospital following a fall from her bike, would likely have survived if she had been moved to intensive care earlier as her condition deteriorated. Her parents’ concerns were not acted upon in time, and an inquiry found that if a critical care review had been triggered earlier, her life could probably have been saved.

Her parents Paul Laity and Merope Mills have campaigned extensively for a change in how independent reviews are sought by families who raise concerns around deterioration, leading to widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital.

In response to this and other cases related to the management of deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implement Martha’s Rule as part of a wider NHS strategy to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

The 3 components of Martha’s Rule are:

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.

As part of a Call for Concern:

• Patients, parents or carers can directly escalate concerns to a dedicated team.
• This review is independent of the ward team currently treating the patient
• The process is 24/7 and accessible, ensuring that families do not feel powerless when they think something is going wrong.
• It is designed to complement, not replace, speaking to the bedside team first.

Early data showed that Martha’s Rule had led to a change in the treatment plan in 20% of patients who exercised their right for a urgent review. This will undoubtedly have saved lives. Prof Sir Stephen Powis, NHS England’s national medical director, said: “The introduction of Martha’s rule represents one of the most important changes to patient care in recent years, and we are really encouraged to see the impact it is already having for patients in this first phase.”

We wholeheartedly support Martha’s Rule being implemented and can see the positive change that it is bringing; however, there is a long way to go before Martha’s Rule is implemented by all providers. Therefore, there will still be patients whose concerns are not being addressed and will be suffering the consequences of this.

If you or a loved one feel that there has been a failure to escalate care and heed concerns and a worse outcome has been suffered as a consequence, you may be able to bring a claim for clinical negligence. Please contact our experienced team on (01482) 323697 to discuss how we may be able to help.