Martha’s Rule: why listening to patients and families can be vital
When a patient or their family says that something is wrong, listening to their concerns can be vital.
That principle sits at the heart of Martha’s Rule, the NHS patient safety initiative introduced following the death of 13-year-old Martha Mills.
The NHS has now announced that Martha’s Rule will be extended to A&E departments across England. This gives patients, loved ones and NHS staff another way to raise concerns when someone’s condition appears to be deteriorating and they feel those concerns are not being adequately addressed.
The phased rollout is expected to be completed by March 2028.
Why was Martha’s Rule introduced?
Martha Mills died in 2021 after developing sepsis while being treated at King’s College Hospital in London for a pancreatic injury sustained in a cycling accident.
Her parents, Merope Mills and Paul Laity, had raised concerns about their daughter’s deteriorating condition. A coroner later concluded Martha would probably have survived, if she had been transferred to intensive care earlier and received appropriate treatment.
Martha’s Rule was developed to give patients, families, carers and staff a clear route to escalate concerns about deterioration. Where it is available, they can request a rapid review if they believe a patient is getting worse and their concerns are not being adequately addressed.
Its expansion into A&E follows an eight-month pilot across seven NHS trusts, during which 69 calls were made to dedicated Martha’s Rule numbers. In some cases, patients subsequently underwent urgent surgery or were transferred to intensive care.
Professor Aidan Fowler, National Director of Patient Safety at NHS England, described the ability to raise concerns about deterioration and trigger a rapid review as “essential”. He said the A&E expansion would give patients, families and NHS staff “a critical new lifeline”.
Families can provide an important warning
Those closest to a patient can provide valuable information about changes in their condition. A relative may recognise changes in behaviour, appearance or symptoms, while patients themselves may know that something does not feel right.
The latest NHS England data illustrates how important that voice can be.
Between September 2024 and June 2026, 17,490 Martha’s Rule escalation calls were recorded. Almost three quarters, 72%, came through the family or carer escalation process.
Of all calls, 5,299 related to acute deterioration. In 685 of those cases, the patient was transferred to a higher or specialist level of care, while a further 2,489 resulted in another change in treatment.
Health Minister Baroness Merron summed up the principle behind the initiative simply: “Martha’s Rule is about making sure patients and their loved ones are heard when they raise concerns about their care.”
When concerns about deterioration are not heard
As medical negligence lawyers, we frequently speak to families who tell us they raised concerns about a loved one’s deterioration but felt dismissed, were reassured that everything was fine or were unable to obtain a further review.
A poor outcome does not automatically mean that medical treatment was negligent. However, when concerns about deterioration are raised, it is important that they are listened to and appropriately assessed.
NHS England’s data provides another striking insight into why the patient and family voice matters. Between June 2025 and June 2026, 82% of Martha’s Rule calls relating to acute deterioration would not have triggered escalation through the standard early warning score alone.
This does not mean clinical monitoring systems are failing. It demonstrates why listening to patients and those who know them best can provide another important layer of information alongside clinical observations.
Speaking up when something does not feel right
Questioning medical care can feel difficult, particularly when you are worried or frightened.
If you are concerned that your own or someone else’s condition is deteriorating, raise this with the healthcare team. Where Martha’s Rule is available and you feel those concerns have not been adequately addressed, you can ask hospital staff how to access the escalation process.
The A&E rollout will be phased, so the Rule will not immediately be available in every emergency department. Patients and families can check their NHS trust’s website or ask hospital staff whether it is currently operating locally.
Martha’s story is a powerful reminder of why this matters. When a patient or relative says something is wrong, their concerns may contain important information about a change in condition that needs further assessment.
How we can help
If you believe that concerns about your or a loved one’s deteriorating condition were not appropriately addressed and that this may have resulted in avoidable harm, our specialist Medical Negligence team can help.
We can listen to what happened, explain your options clearly and advise whether there may be grounds to investigate the care you or your loved one received.
Contact our Medical Negligence team to discuss your circumstances in confidence.
