Martha's Rule and the NHS

Martha's Rule is a major patient safety initiative providing patients and families with a way to seek an urgent review if their or their loved one's condition deteriorates and they are concerned this is not being responded to.

Background.

Martha Mills tragically died in 2021 after developing sepsis in hospital. She had been admitted to hospital having suffered an injury to her pancreas after falling off her bike. Martha's family raised concerns about her deteriorating condition but these 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.

Subsequently, 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 patients and those who know them best are heard and acted upon.

How does it work?

There are 3 components of Martha's Rule:

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.

How can it help?

1. Empowers Families to Speak Up
Often, families know their loved ones best. Martha's Rule validates their insights and instincts, reinforcing that their concerns deserve attention.

2. Bridges Communication Gaps
Miscommunication between medical teams and families can delay critical care. A structured escalation process improves dialogue, potentially catching issues earlier.

3. Prevents Medical Oversights
Second opinions can be life-saving. By making it easier to access one, Martha's Rule helps catch misdiagnoses or overlooked symptoms at an earlier stage.

4. Reduces Medical Harm
The law aims to prevent avoidable deaths by ensuring a safety net is in place when frontline care falls short.

5. Builds Trust in Healthcare
Knowing there is a formal mechanism to escalate concerns fosters greater trust between patients, families, and healthcare providers.

Progress.

In May 2024, NHS England announced the implementation of Martha's Rule across 143 pilot sites across the country. Data from the pilot sites will help in planning the strategy for wider implementation in the years ahead.