Martha's Rule: Giving NHS Patients and Families a Voice

When someone is seriously ill in hospital, their family often knows when something is wrong. They may notice small changes in their loved one's condition or feel that their health is getting worse.

But what happens when they raise concerns and feel nobody is listening?

Martha's Rule is a patient safety initiative that gives patients and their families a way to ask for an urgent review of their care. It aims to ensure that healthcare staff hear and act on concerns about a patient’s health before it becomes too late.

Martha's Rule was introduced following the tragic death of 13-year-old Martha Mills in 2021. Her story has helped bring about an important change in how NHS hospitals respond to patients and families.

What Is Martha's Rule?

Martha's Rule allows patients, families and carers to ask for an urgent review if a patient's health is getting worse and their concerns have not been heard.

A different clinical team carries out the review, rather than the staff already treating the patient.

NHS England introduced Martha's Rule to improve patient safety. It also makes it easier for people to speak up when they feel something is wrong.

The rule has three main aims:

• Help staff identify changes in a patient's health.

• Allow hospital staff to request a rapid review.

• Give patients and families a way to seek an urgent second opinion.

  
  

Above all, Martha's Rule aims to ensure that people take concerns seriously.

The Story Behind Martha's Rule

Martha Mills died in 2021 after developing sepsis while being treated at King's College Hospital in London.

She was admitted to hospital after suffering a pancreatic injury in a cycling accident.

As Martha's condition got worse, her parents became worried about her care. They raised concerns with hospital staff, but they felt hospital staff did not listen to their warnings.

A coroner later found that Martha would probably have survived if doctors had moved her to intensive care earlier.

Her parents continued to campaign for change so that other families would have a clear way to raise urgent concerns.

Their efforts led to the introduction of Martha's Rule across NHS hospitals in England.

How Does Martha's Rule Work?

If you notice signs of deterioration in a patient, you should first speak to the medical team caring for them.

This may mean talking to the nurse in charge, a senior nurse or the doctor responsible for their treatment.

If you still feel concerned about the patient's condition, you can ask for a review under Martha's Rule.

A separate medical team will assess the patient’s health and decide whether the patient needs further care or treatment.

This may involve a critical care outreach team. These specialists help care for patients whose condition is worsening or who may become seriously unwell.

Where Martha’s Rule is in place, the service operates 24 hours a day, seven days a week.

Hospitals should explain how to use the service and provide a contact number.

When Should You Use Martha's Rule?

Patients and families should feel able to speak up if they believe someone's condition is getting worse.

Warning signs may include:

• Sudden confusion or changes in behaviour

• Trouble breathing

• Severe or increasing pain

• Unusual tiredness or drowsiness

• Changes in skin colour

• A sudden decline in general health

These signs do not always mean that something has gone wrong with a patient's care. However, they may mean that someone needs urgent medical help.

If you are worried about a loved one's condition, tell the medical team straight away.

If your concerns are not addressed, you can request a review under Martha's Rule. Do not delay urgent care while waiting for a review.

Is Martha's Rule Available in All NHS Hospitals?

NHS England began introducing Martha's Rule in 2024, starting with 143 hospital sites.

The patient safety initiative has since expanded to more hospitals across England, with further work planned during 2026/27.

Martha's Rule mainly covers patients staying in hospital. NHS England is also testing how it can work in other areas. These include maternity and emergency care.

Not every hospital department may offer the service yet.

Patients and families can ask hospital staff whether Martha's Rule is available and how to access it.

What Is the Difference Between Martha's Rule and PALS?

Most NHS hospitals have a Patient Advice and Liaison Service (PALS).

The Patient Advice and Liaison Service helps patients and families with questions, concerns and complaints about NHS care.

However, Martha's Rule has a different purpose.

PALS offers advice and support. Martha's Rule lets people request an urgent medical review. They can do this if they feel a patient's health is worsening.

If someone is seriously unwell, you should raise your concerns with the medical team at once rather than wait for a reply from PALS.

Can Martha's Rule Help Prevent Medical Negligence?

Martha's Rule aims to reduce avoidable harm by helping medical teams spot and respond to changes in a patient's health.

It also gives patients and families a stronger voice in decisions about their care.

However, the rule cannot prevent every medical error.

Doctors and nurses still have a duty to provide safe and suitable care. This includes checking symptoms, responding to concerns and acting when a patient's condition gets worse.

If poor hospital care causes avoidable harm, you may be able to make a medical negligence claim. 

However, treatment that does not go as expected is not always a sign of medical negligence.

How Graystons Solicitors Can Help

At Graystons Solicitors, we understand how upsetting it can be when hospital staff do not take your concerns seriously.

Our medical negligence solicitors can explain your rights and help you determine if you can make a claim.

If poor hospital care has harmed you or a family member, we are here to listen. We can offer advice and help you take the next step.

Contact Graystons Solicitors today to discuss your concerns and find out how we may be able to help.