This site has been optimized to work with modern browsers and does not fully support your version of Internet Explorer.

Martha’s Rule

Martha’s Rule’ gives patients and their families round-the-clock access to a rapid review from an independent critical care team if they are worried about their or a loved one’s condition, is named in memory of thirteen-year old Martha Mills.

Martha tragically died after developing sepsis in hospital due to a failure to escalate her to intensive care and after her family’s concerns about her deteriorating condition were not responded to promptly.

Extensive campaigning by her parents Merope and Paul, supported by the cross-party think tank Demos, has seen widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.

This national programme will build on NHS England’s Worry and Concern pilots launched at seven trusts last year, which developed and tested escalation methods for patients’ and families’ concerns.

Work to support the delivery of Martha’s Rule builds on the existing managing deterioration activity delivered by the Health Innovation Network’s 15 regionally-based Patient Safety Collaboratives (PSCs) to support the National Patient Safety Improvement Programme (NatPatSIP) – a key part of the NHS Patient Safety Strategy and commissioned through NHS England patient safety team.

Since 2019, PSCs have engaged with systems to support the implementation of deterioration tools in order to provide staff with the training and confidence to recognise and escalate concerns around physical deterioration in a number of settings such as acute hospitals, community, mental health, and ambulance trusts and more recently care homes across England. This work is part of the Managing Deterioration Safety Improvement Programme (ManDetSIP) and is part of a wider programme of work exploring a whole system and pathway approach to the management of deterioration.

NHS England has recruited over 100 provider sites to take part in the first phase of Martha’s Rule implementation.

For more information on PSC support for Martha’s Rule, contact