Story Highlight
- Martha’s Rule guarantees second opinions in A&E departments across England.
- Patients and families can call a 24/7 helpline for urgent reviews.
- Initiative named after Martha Mills, who died from sepsis in 2021.
- The system aims to improve patient safety and care quality.
- Expansion to maternity and neonatal units expected by March 2028.
Full Story
A new system known as Martha’s Rule is being implemented in A&E departments across England, granting patients, families, and NHS staff the right to request a second opinion on healthcare concerns. The initiative, introduced following the tragic death of 13-year-old Martha Mills from sepsis in 2021, aims to enhance patient safety and ensure that voices are heard in critical moments.
Martha tragically lost her life after suffering injuries during a cycling accident on a family holiday. Following the accident, she developed an infection that led to sepsis, which was not managed adequately, resulting in a coroner concluding that her survival would have been likely had she received timely intensive care. Her parents have argued that their alerts about her declining condition were overlooked.
The new system allows individuals who feel their concerns are not being taken seriously to contact a dedicated helpline, available 24/7, to request an urgent, independent clinical review if a patient’s condition appears to be deteriorating. This follows an eight-month trial involving seven hospitals, set to be fully implemented by March 2028.
Martha’s Rule permits patients and their families to initiate a 24-hour urgent review when they sense their loved one’s condition is worsening without acknowledgement from healthcare professionals. The system provides rapid access to an independent critical care team, distinct from the patient’s ongoing care team. Hospital staff may also utilise this rule if their concerns are being disregarded.
The British Medical Journal cited a situation where the Rule was successfully activated, with a family member alerting the hotline to a patient’s rapid deterioration that had been overlooked during a hectic shift. This culminated in an urgent scan that revealed internal bleeding, leading to immediate surgical intervention.
Martha’s Rule first launched in April 2024, initially piloted in 143 hospitals by May of that same year, following a campaign initiated by Martha’s parents. A report indicated that over 50 calls in the early stages led to emergency transfers to Intensive Care Units when staff failed to escalate care as needed. As of July 2026, there had been 1,678 calls to the helpline, and the expansion of this initiative to maternity and neonatal units is planned for March 2028.
The NHS is extending Martha’s Rule to all hospital A&E departments after successful trials in seven trusts. Professor Aidan Fowler, National Director of Patient Safety at NHS England, remarked that the ability to promptly express concerns about a patient’s decline is vital, especially in A&E, where vulnerable individuals receive care. The initiative has shown promising results in enhancing safety in acute care settings.
Individuals wishing to access Martha’s Rule can find contact information for the emergency hotline on posters or leaflets in hospital wards and waiting areas or on hospital trust websites. While patients are encouraged to communicate their worries to their care teams before calling, it is not mandatory to obtain permission. When the hotline is contacted, an independent Critical Care Outreach Team will be dispatched to assess the patient’s condition promptly.
Health Minister Baroness Merron stated that Martha’s Rule ensures that patient and family concerns are acknowledged when deterioration in care is suspected, making it an integral part of efforts to prioritise patient safety within the NHS.
Source: read the original report.
What this means for your site
In light of the lessons from the tragic case culminating in the establishment of Martha’s Rule, healthcare providers must adopt proactive measures to ensure patient safety. One significant aspect that could have been managed differently is the communication process between healthcare staff and the families of patients. Regular updates and transparent discussions about a patient’s condition could have mitigated the concerns that led to the tragic outcome.
Relevant UK health and safety legislation that applies includes the Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999, which require employers to ensure the health and safety of employees and others affected by their work activities. Additionally, the Care Act 2014 mandates that care providers promote the wellbeing of individuals, highlighting the importance of listening to concerns raised by patients and their families.
To prevent similar incidents, a healthcare site could implement regular training for staff on effective communication and the importance of escalating patient concerns, and establish a clear, user-friendly protocol for families to raise issues. Ensuring these steps are followed diligently will help create a safer environment for all patients.
