Please contact your local hospital directly if you need to place a Martha’s Rule call
Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition 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.
In response to this, Martha’s Rule is being implemented across the NHS in England. It is a patient safety initiative designed to give patients and their families a way to seek an urgent review, if they are concerned about a patient’s deteriorating condition. It ensures that patient and family concerns are listened to and acted upon when a patient’s condition worsens.
There are three components of Martha’s Rule:
-
- 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.
- 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.
- This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.
This national programme builds on NHS England’s Worry and Concern pilots launched at seven Trusts in 2023, which developed and tested escalation methods for patients’ and families’ concerns. Phase 1 of the Martha’s Rule programme pilot started in 2024, in 143 acute NHS hospitals. Phase 2 was launched in 2025 and aims to:
-
- Support the adoption and spread into more clinical areas within phase 1 sites, including Paediatrics, Emergency Departments, and Maternity and Neonatal Units.
- Begin implementing in other acute NHS hospitals.
- Pilot Martha’s Rule for in-patients in Community Hospitals and Mental Health Hospitals.
Our PSC is supporting the regional pilot in acute Trusts (phase 1 and 2), through supporting shared learning and quality improvement. We are also leading the national Mental Health pilot (phase 2). This involves nine Mental Health NHS Trusts from across England. More information about the Mental Health pilot can be found via this link.
Those working in the NHS can access resources through the sites below (initial registration is required for both):
Martha’s Rule website within the NHS Futures platform.
Communications toolkit within the Department of Health & Social Care campaign centre website.
For more information on PSC support for Martha’s Rule, contact patientsafety@healthinnovationoxford.org
Please note that Health Innovation Oxford and Thames Valley is supporting NHS trusts to implement Martha’s Rule. We cannot take direct referrals. These should be made directly to the relevant hospital where you or a family member are an inpatient.
The links below give more information on the Trusts using Martha’s Rule in our region. (The service is named Call 4 Concern in two of these Trusts).
Call 4 Concern – Royal Berkshire NHS Foundation Trust (this is the same service as Martha’s Rule)