Martha’s Rule

About Martha

Martha Mills, daughter of Merope Mills and Paul Laity, was on a family holiday in Wales in 2021 when she sustained an injury while riding her bike.  She was transferred to King’s College Hospital London where she developed sepsis and sadly died approximately one month later.

Martha’s mother, Merope, stated that her family were not listened to by senior doctors on several occasions during her daughter’s time in the hospital, and were “not given the full picture” about Martha’s deteriorating condition; leaving them unable to speak up for better treatment.

A coroner has since ruled that Martha would most likely have survived had her doctors moved her to intensive care earlier.

Merope wants hospitals around the country to bring in ‘Martha’s rule’, which would give parents, carers, and patients the right to call for an urgent second clinical opinion from other experts at the same hospital if they have concerns about their current care.

You can read more about Martha’s story here.

Martha’s Rule

In response to Martha’s and other’s cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implementing ‘Martha’s Rule’; to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

The first phase of the introduction of ‘Martha’s Rule’ was formally implemented in the NHS in April 2024. The scheme has been introduced in over 140 hospitals, with work ongoing to roll it out nationally. Once fully implemented, patients, families, carers, and staff will have round-the-clock access to a rapid review from a separate care team if they are worried about a patient’s condition.

You can read further details on the three proposed components of ‘Martha’s Rule’ by clicking the yellow box:

Phased implementation

The implementation of ‘Martha’s Rule’ in the NHS is taking a phased approach, beginning with at least 100 adult and paediatric acute provider sites that already offer a 24/7 critical care outreach capability.

This first phase took place during 2024/25 and focused on supporting participating sites to devise and agree on a standardised approach to all three elements of ‘Martha’s Rule’, ahead of a scale-up to the remaining sites in England over the following years.

If you have any concerns ask your child’s healthcare team about ‘Martha’s Rule’ when in the hospital.

Other measures to improve the identification of deterioration

The introduction of ‘Martha’s Rule’ comes alongside other measures to improve the identification of patient deterioration, including the rollout l of a new early warning system for staff treating children, built on similar systems already in place for adult, newborn, and maternity services.

To ensure that ‘Martha’s Rule’ is as effective as it can be, it will be implemented as part of an integrated programme to improve the management of deterioration using the ‘PIER’ framework:

Prevent

Identify

Escalate

Respond

This work will improve how the NHS supports staff to manage deterioration and encourage greater involvement from patients, families, and carers.

Further Information

• The NHS Patient Safety Strategy describes how the NHS will continuously improve patient safety, building on the foundations of a safer culture and systems. You can read the NHS Patient Safety Strategy documents and get updated on the progress that has been made here >> NHS England » The NHS Patient Safety Strategy.
• The NHS patient safety involvement work aims to ensure that patients, staff, and partners have the skills and opportunities to improve patient safety. This framework guides how the NHS can involve people in their own safety as well as improve patient safety in partnership with staff >> NHS England » Framework for involving patients in patient safety.

The information in this article was correct at the time of publication but may be subject to change. 

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