Martha’s Rule: Enhancing Patient Safety in Hospitals

On 4 September 2025, NHS England announced the rollout of Martha’s Rule to all acute hospitals in England.

Martha’s Rule is a patient safety initiative designed to support the early detection of deterioration by ensuring patients and families are listened to and their concerns acted upon.

The initiative was developed following the tragic death of 13-year-old Martha Mills in 2021 and other cases where deterioration was not escalated appropriately in hospital settings. Its central principle is the right of patients and their families to request a rapid review and second opinion if they feel a condition is worsening and their concerns are not being addressed.

Martha’s Case

Martha Mills was admitted to King’s College Hospital, London, after sustaining a pancreatic injury in a cycling accident. Despite her parents raising repeated concerns about her deteriorating condition, she remained on the ward under the care of the paediatric liver team. On 31 August 2021, just before her 14th birthday, Martha died of septic shock.

A hospital investigation found at least five missed opportunities to transfer her to paediatric intensive care (“PICU”), where she would likely have survived. A coroner later ruled that had Martha been moved to PICU and given appropriate treatment, her death could have been avoided.

What is the rule?

Martha’s Rule recognises that families, carers and friends often spot early signs of deterioration in their loved ones. It places emphasis on listening to those voices and the key role they can play in escalating a patient’s care.

According to NHS England’s website, the three core components of Martha’s Rule are:

• 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.

Does it work?

Since April 2024, Martha’s Rule has been piloted at 143 hospital sites in England. NHS England released the following data collected between September 2024 and June 2025:

• 4,906 calls have been made, 71.9% by family members.
• 2,132 calls (43%) related to acute deterioration. Of these, 241 resulted in life-saving escalations such as transfer to intensive care.
• A further 720 calls led to significant changes in care, such as new medications, investigations or specialist input.

Used alongside other measures to improve response to deteriorating patients, Martha’s Rule is a success.

What are the Implications for Medical Negligence Litigation?

The Personal Injury team at Lester Aldridge regularly advise clients on cases involving medical negligence, and often we are contacted by friends or relatives who feel they have to advocate on behalf of their loved one because signs of deterioration were not spotted.

At Lester Aldridge, we anticipate that Martha’s Rule will play an important role in medical negligence litigation moving forward.

With widespread implementation, Martha’s Rule is likely to set a benchmark for reasonable clinical practice. Failure to offer or facilitate a second opinion when concerns are raised may, in time, be argued as evidence of a breach of duty on the part of the NHS.

In cases where deterioration could have been prevented by earlier escalation, Claimants could point to the absence or misuse of Martha’s Rule as a missed opportunity for intervention. Expert evidence might, in the future, also argue that if a second opinion had been sought under the rule, harm would likely have been avoided.

What about maternity care?

There is widespread acknowledgment that the cost of birth injury cases is escalating and the founder of Martha’s Rule, Martha’s mother Merope Mills was quoted in the press saying that the availability of Martha’s Rule in maternity care would give women and their partners a “greater voice”.

This is something that Lester Aldridge wholly supports. We hear so often from Mums and their partners that during antenatal care and labour, their concerns were dismissed, that in the face of obvious and frightening deterioration for Mum and baby, they were made to feel that they were unnecessarily concerned. This is particularly common with first-time parents.

So often these are the cases that succeed because Mum wasn’t wrong, she knew her body, had carried her baby during pregnancy and felt strongly that something was not right. Similarly with partners / friends / family who have supported Mums through pregnancy and then into labour. They often know the subtler signs of deterioration before they show as a clinical emergency.

Conclusion

Martha’s Rule reinforces the importance of listening to patients and families / advocates and in medical negligence cases the Courts are increasingly attentive to whether patients were adequately informed in respect of their care and engaged in the process.

Martha’s Rule is a significant step forward for patient safety, already demonstrating improvements in outcomes and satisfaction. Martha’s Rule could also help to reshape the landscape of medical negligence litigation by creating a clearer duty on clinicians and Trusts to listen to patient and family concerns and provide a formal escalation pathway. Whether or not the rule was explained, accessible and followed could become a significant factor in establishing breach of duty and causation.

If you have any questions regarding the above or wish to speak with one of our specialist medical negligence solicitors, please email online.enquiries@la-law.com or call 0344 967 0791.