Martha’s Rule was introduced in England in 2024 after the tragic and avoidable death of 13 year old Martha Mills in 2021. The rule is being rolled out across hospitals in England following a pilot at 140 sites and is expected to be complete during 2026/2027.

Martha Mills died after developing sepsis whilst being treated in hospital. Her family repeatedly raised concerns that she was deteriorating but felt those warnings were not acted on quickly enough. A coroner later concluded that she would probably have survived if her parent’s concerns had been heeded and she had been moved to intensive care earlier.

Martha’s parents, Merope Mills and Paul Laity, have thereafter tirelessly campaigned for a major change in how hospitals respond when patients deteriorate. Martha’s Rule supports the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.

Central to it 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. The initiative gives patients, families and staff a formal route to trigger an urgent review when someone in hospital seems to be getting worse.

Martha’s Rule is Martha’s legacy, seeking to avoid other families experiencing such a devastating loss and since its implementation in 2024, it has helped to save more 500 lives.

In the first 18 months of the Scheme, NHS England report that 12,301 calls were made to Martha’s Rule helplines.

4,047 calls related to patients who were identified as deteriorating and 1,786 led to changes in treatment.

The system has already led to more than 500 patients receiving potentially life-saving care including transfers to intensive care or specialist units.

1500 NHS staff have used the rule to raise concerns with over 1,000 cases identifying patients who were rapidly deteriorating.

How to use Martha’s Rule if you are worried on a ward

• Say what you are seeing. Tell the nurse in charge (or the ward team) what has changed and why you are concerned.
• Ask what will happen next. Request a clear plan: observations, review time, tests, pain relief, antibiotics, scans, etc.
• If you are still worried, use Martha’s Rule. Ask staff for the hospital’s Martha’s Rule number/process (or look for the posters) and request a rapid review.
• If it is an immediate emergency, call for urgent help. In hospital, use the emergency bell/ask staff to call an emergency response. Outside hospital, call 999.