Martha’s Rule; the right to an urgent review for hospital inpatients
In September 2025, Martha’s Rule is being rolled out across all English hospitals delivering acute or short-term treatment, providing a way for patients, families and carers to access an urgent review if they are concerned about their care.
This patient safety initiative is to help detect earlier when a person’s condition deteriorates by ensuring the concerns of patients, families, carers and hospital staff are listened to and acted upon.
The initiative is the result of a campaign by the parents of 13-year-old Martha Mills who died in 2021 after serious failings in her care. Martha developed sepsis in hospital after being admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier. Evidence from an NHS England pilot of Martha’s Rule across 143 sites suggests that it is saving lives. Almost three-in-four (71.9%) calls have been from families seeking help, with 720 calls leading to changes in care, including patients receiving a new medication such as an antibiotic.
What is Martha’s Rule?
Martha’s Rule recognises that those who know a patient best may be the first to notice changes in their condition that could be an early sign of deterioration. The initiative recognises the importance of listening to and acting on the concerns of patients, families and carers. It is being implemented in hospital inpatient settings across England and has three core components:
- Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse. This information will be acted on.
- All hospital 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.
When to use Martha’s Rule
You know yourself or your loved one better than anyone. If you’re worried about a health condition getting worse while in hospital, or a noticeable change occurs, it is recommended that you first speak to the team caring for you or your loved one.
If, after speaking to the care team, you remain worried and feel your concerns are not being addressed, you should call for a rapid review.
Each hospital has a dedicated phone number for a team who specialise in the care of critically ill patients. The phone number should be prominently displayed on posters around the hospital. If you cannot find the phone number, you should ask a member of hospital staff about ‘Martha’s Rule’ or look on the hospital’s website.
The difference between Martha’s Rule and second opinions
A second opinion involves getting the views of an independent specialist clinical team or healthcare professional about your, or your loved one’s, treatment.
Martha’s Rule gives inpatients, families, carers, and staff access to an urgent review if their concerns about the worsening condition of a patient is not being heard.
Martha’s Rule is a patient safety initiative; it is not a second opinion.
AMMF has information about requesting a second opinion, here.
Martha’s Rule and cholangiocarcinoma
It is important for everyone to be aware of Martha’s Rule, including those with cholangiocarcinoma (CCA) and their families who may, during a hospital stay, experience or be aware of deterioration that is not being picked up by the care team.
Those with CCA who are undergoing chemotherapy or have biliary stent/s should ensure that they and their families are aware of the signs of biliary infections as these can be serious and lead to sepsis.
The signs and symptoms of biliary infection are:
- High temperature/fever
- Jaundice
- Chills/shivering
If these symptoms develop, it is important to contact the doctor or Clinical Nurse Specialist (CNS) as soon as possible for advice. Antibiotic treatment may be needed, and, if caused by a blocked or infected stent, this may need to be replaced.
If you or a loved one are in hospital, you may notice small changes that could be early warning signs of deterioration. If you are worried about a health condition getting worse, speak to the care team.
If, after speaking to the care team, you remain worried and feel your concerns are not being addressed, use Martha’s Rule and call for a rapid review.
Wales, Scotland and Northern Ireland
The Welsh Government is introducing a scheme that is like Martha’s Rule, called Call4Concern, which is expected to be rolled out to all hospitals by the end of 2026. You can read more about this, here.
The Scottish Government is testing a number of Martha’s Rule pilots and considering developing a “more consistent, nationwide approach”.
The Department of Health in Northern Ireland said it was “committed to improving patient safety” and whilst there were no immediate plans to introduce Martha’s Rule there, it would continue to monitor the roll-out and impact in England.
