When someone is in hospital, we trust the healthcare team to recognise when their condition is changing and make sure they receive the right care.
But what happens if a patient, family member or carer notices that something isn’t right and feels their concerns aren’t being heard?
This is where Martha’s Rule comes in.
Martha’s Rule is a major NHS patient safety initiative designed to make sure concerns about a patient’s deterioration are listened to and acted upon. It isn’t about blaming or criticising our hard-working healthcare professionals, but about creating an additional layer of safety, making sure concerns are heard and giving patients and their families a voice when something doesn’t feel right.
Who was Martha?
Martha Mills was 13 years old when she was admitted to hospital after falling from her bicycle and suffering a pancreatic injury.
While in hospital, Martha developed sepsis and her condition deteriorated. Her parents raised concerns about her worsening condition, but those concerns were not acted upon as they should have been.
Martha died in 2021.
A coroner later concluded that Martha would probably have survived if she had been transferred to intensive care earlier.
Following Martha’s death, her parents, Merope and Paul Mills, campaigned for change, determined that other families should have a stronger voice when they were worried about a loved one’s condition. Merope shares Martha’s heartbreaking story and explains how their devastating experience led to the campaign for Martha’s Rule on the NHS England website: Martha’s Rule – NHS England
What is Martha’s Rule?
At its heart, Martha’s Rule is about listening to patients and the people who know them best.
It gives patients, families and carers a way to request an urgent review by another healthcare team if they are worried that a patient is becoming more unwell and feel that their concerns are not being responded to.
It also gives healthcare staff a route to request a rapid review if they have concerns about a patient’s condition or feel that the appropriate response is not happening.
Martha’s Rule is based around three core components:
- Patients, families and carers should be asked at least daily about changes in a patient’s condition and whether they have any concerns.
- Staff should have access to a rapid review from a different team when they are concerned about a patient who is deteriorating.
- Patients, families and carers should also have access to a rapid review if they are worried about deterioration and their concerns have not been responded to.
The aim isn’t to encourage people to question every clinical decision. It is about creating an additional safety net when someone is becoming seriously unwell.
Martha’s Rule is being rolled out across England
The first phase of Martha’s Rule began in 2024 at 143 NHS sites.
Following positive early results, the programme was expanded to the remaining acute inpatient sites providing adult and paediatric care. NHS England says full implementation across acute inpatient services is expected during 2026/27, although hospitals may be at different stages of introducing it.
In 2026, the rollout has also expanded into other areas.
Martha’s Rule is now being introduced across maternity services in England, following the publication of the Ockenden Review and concerns about missed opportunities to recognise deterioration and concerns from women, families and staff.
NHS England is also testing the approach in other areas including neonatal services, mental health and community settings.
Is Martha’s Rule making a difference?
Early figures from the NHS suggest that yes, it is helping identify concerns and, in some cases, leading to changes in treatment.
Between September 2024 and June 2026, more than 19,000 Martha’s Rule calls were made. Of the calls relating to acute deterioration, thousands resulted in changes to treatment, including hundreds of transfers to higher levels of care such as intensive care or high dependency units.
Importantly, not every call is about a life-threatening emergency. Martha’s Rule has also helped address concerns about medication, investigations, communication and discharge planning.
This is an important point. Speaking up isn’t necessarily about proving that something has gone wrong. It can simply be about saying:
“I’m worried. Something has changed.”
What should you do if you are worried about someone in hospital?
If you’re visiting a family member or caring for someone in hospital and notice that they seem significantly different from usual, don’t be afraid to raise your concerns.
You may notice things such as:
- They seem much more confused or unusually sleepy.
- Their breathing has changed.
- They appear much more unwell than earlier.
- Their behaviour or responsiveness has changed.
- You feel that something isn’t right, even if you can’t put your finger on exactly what it is.
Trust your gut. Tell the healthcare team what you have noticed.
Be specific about what has changed and when you first noticed it.
If you remain concerned and feel that your concerns about deterioration aren’t being responded to, ask the hospital staff about Martha’s Rule and how to access the rapid review process.
The exact process can vary between hospitals, so NHS England recommends checking the hospital or NHS trust website or asking staff whether Martha’s Rule is available and how to use it. Here in Norfolk, the Norfolk and Norwich University Hospital (NNUH) has its own Call for Concern service as part of Martha’s Rule. If a patient, relative or carer remains worried that someone is becoming more unwell and feels their concerns haven’t been addressed, they can request an urgent review by the hospital’s specialist team.
Speaking up can be an important part of patient safety
Martha’s Rule represents an important change in the way we think about patient safety.
Healthcare professionals have specialist knowledge and experience, but families and carers can also provide valuable information because they know what is normal for the person they care about.
Sometimes, they are the first people to notice that something has changed.
Recognising deterioration, communicating concerns and knowing when to ask for further help can all play an important role in keeping people safe.
Martha’s Rule is intended to make sure that when patients, families, carers or healthcare staff are worried about deterioration, there is a clear route for those concerns to be heard and acted upon.
Martha’s Rule is a reminder that speaking up matters. Whether you’re a healthcare professional, a family member, a carer or simply someone who notices that something isn’t right, recognising deterioration and knowing when to seek help can be incredibly important.
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