Introducing ‘Martha’s Rule’ – a Step in the Right Direction for Patient Safety..

As of April 2024, hospitals throughout England will be offered funding in order to implement ‘Martha’s Rule’ which aims to give seriously ill patients easy access to a second opinion, should their condition worsen.


Martha’s Rule follows a campaign headed by the parents of Martha Mills, who tragically died in 2021, at the age of 13. Martha developed sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family raised concerns to the doctors about her deteriorating condition but they were ignored.

In 2023, a coroner ruled that Martha would probably have survived had she been transferred to the Intensive Care Unit earlier.

The Rule

Martha’s Rule will establish a system which allows patients and their family members to directly request a rapid review of the treatment being provided from a team of critical-care clinicians, who must be available 24/7. Patients will be informed of this right, and provided with the relevant contact details, by way of posters and leaflets which will be displayed throughout the hospital.

Once contacted, a secondary review will be conducted by senior doctors or nurses from elsewhere in the healthcare facility who specialise in the care of deteriorating and seriously unwell patients. The clinicians will also be required to formally document the families’ concerns and observations of the patient’s condition or behaviour.

The implementation will take a phased approach, beginning with 100 larger hospitals who already have 24/7 critical care outreach services. In the long-term, the plan is to roll out Martha’s Rule across the NHS and to offer an adapted version of the rule across other settings, such as community and mental health hospitals.

How will Martha’s Rule benefit patients?

The aim is to ensure that important concerns of the patient themselves, and of those who know them best, are listened to and acted on appropriately. Oftentimes, the deterioration of a loved one is most obvious to those at the bedside and subtle changes in their condition can go unnoticed by busy clinicians.

Martha’s mother previously said, “We also look to Martha’s rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged.”

Martha’s Rule represents a significant step in the right direction for improving patient safety. However, its success hinges on effective implementation and ongoing monitoring. The British Medical Association has welcomed the initiative but emphasised the importance of addressing workforce shortages to ensure that the critical care teams do not become overwhelmed.


Sadly, despite her family raising concerns, Martha’s sepsis was missed and she tragically lost her life. Sepsis is widely known as a ‘silent killer’ with the symptoms being very hard to spot. In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illnesses every year. Prompt diagnosis and treatment is crucial.

It is hoped that Martha’s Rule will assist patients and their families in similar situations to report concerns and symptoms that may not always be immediately obvious to doctors, and ultimately save lives.

Legal Assistance

At Lanyon Bowdler, we understand the devastating impact that a delay or missed diagnosis can have for a patient and their family. If you have suffered due to poor care, our dedicated team are ready to provide the legal support you need and guide you through the process.

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