Martha’s Rule: A Simple Guide for Patients and Loved Ones
Anyone who knows me personally may already be aware that my dad was involved in a
serious accident earlier this January and was admitted to hospital. As his condition began to
deteriorate, I felt increasingly concerned that my worries were not being fully heard. Making
the decision to activate Martha’s Rule was incredibly difficult, but it became the first crucial
step towards saving his life.
Even for those with medical training, feeling listened to within healthcare can make all the
difference, especially when someone you love is unwell. Martha’s Rule is a vital patient
safety initiative introduced across hospitals in England to ensure that patients, families and
carers can escalate concerns when they believe a condition is worsening and their voice is not
being heard (NHS England).
Where Did Martha’s Rule Come From?
Martha’s Rule is named after Martha Mills, a 13-year-old girl who sadly died in hospital from
sepsis after her family’s concerns about her rapidly deteriorating condition were not
responded to in time. Her tragic experience highlighted a gap in how deteriorating health was
recognised and managed and became the driving force behind a new approach to patient
safety.
What Is Martha’s Rule?
At its heart, Martha’s Rule gives patients, families and carers the right to request an urgent,
independent clinical review if they think someone is getting worse and their concerns haven’t
been acted on.
Many of us instinctively notice subtle changes in how our loved ones are feeling, things that
might not show up immediately in clinical measurements. Martha’s Rule acknowledges that
you may spot the earliest signs of deterioration, and that your voice should matter.
How Does It Work?
Martha’s Rule is designed to be straightforward and accessible:
Daily check-ins: Patients are asked at least once a day how they are feeling, whether
they feel better or worse. This feedback becomes part of how their condition is
monitored.
Escalation route: If you’re worried a patient’s condition is worsening and frontline
staff haven’t addressed it, you (or the patient) can ask for a rapid review by a
different clinical team.
Available to everyone: This escalation option is there for patients themselves, their
loved ones and carers, and even for hospital staff who may have concerns
Each hospital has its own contact details or phone number for initiating Martha’s Rule,
usually displayed on posters or available from ward staff.
Why Is It Important?
Martha’s Rule helps shift the culture in healthcare towards one where listening and
responsiveness are central to care. It recognises that those closest to the patient often have
invaluable insight that can prompt earlier interventions. (RCPCH)
Early evidence from NHS England shows that Martha’s Rule has already been used
thousands of times, helping to identify situations where additional clinical reviews led to
changes in care that may have been lifesaving. From personal experience, I cannot emphasise
enough how valuable it is to be aware of this rule, should you ever find yourself in a similar
position to my family.
A Tool for Empowerment and Partnership
For many people, even those with years of medical knowledge and experience, navigating the
healthcare system can sometimes feel overwhelming when a loved one’s health is
deteriorating. Martha’s Rule is not about questioning the expertise of healthcare
professionals, but about providing an additional safety net, one that values your instincts,
encourages open communication, and strengthens partnership between families and clinical
teams. (ouh.nhs.uk)
If someone you care for is in hospital and you feel worried about changes in their condition,
don’t hesitate to ask about Martha’s Rule. Your concern could be the prompt that makes all
the difference.