When a loved one is unwell in hospital, you are often the first to notice that something has changed. Martha’s Rule exists so those observations are acted on – and, where they are ignored, it can shape how a later negligence claim is examined.
What is Martha’s Rule?
Martha’s Rule, sometimes referred to as Martha’s Law, is a patient safety initiative designed to ensure that concerns about a patient’s deterioration are listened to and acted upon.
In practice, a call under the rule brings in clinicians from outside the treating team, usually the critical care outreach service, to assess the patient urgently. That is different from asking for a routine second opinion on a non-urgent diagnosis, which follows the ordinary referral route.
For patients and their families, the purpose of Martha’s Rule is straightforward, as it provides a recognised escalation route when something appears wrong, and the usual clinical response does not seem to reflect the level of concern being raised. This may involve a dedicated phone number or local process at the hospital through which an urgent review can be requested.
Importantly, it does not replace ordinary clinical care or mean that every concern will amount to negligence; however, it does create a more formal structure for identifying and responding to concerns about deterioration.
Why Martha’s Rule was introduced
It was introduced following the death of 13-year-old Martha Mills, who developed sepsis while in hospital after suffering a pancreatic injury. Her family raised concerns about her worsening condition, and a coroner later concluded that she would probably have survived if she had been moved to intensive care earlier.
Martha was being treated at King’s College Hospital in London, and her parents, Merope Mills and Paul Laity, had specifically warned staff that they feared sepsis. After the inquest, they campaigned for families to have a formal right to escalate, which became the basis for Martha’s Rule.
Additional resource: The Diagnosis Management of Sepsis
Where does Martha’s Rule apply?
The rule is being implemented across NHS Trusts in England to give patients, families, carers, and staff a clear route to request a rapid review by a different clinical team where they believe a patient’s condition is getting worse and their concerns are not being addressed. NHS England has also announced that Martha’s Rule will be expanded to all hospital accident and emergency departments, with a phased rollout expected to be completed by March 2028.
The pilot phase ran across 143 hospital sites between September 2024 and March 2025. Martha’s Rule now operates in 221 acute adult and paediatric inpatient sites, while maternity and neonatal units are also expected to adopt it by March 2028.
Plans for A&E, announced on 22 September 2026, followed an eight-month pilot in seven NHS trusts. During that trial, some calls led to patients having urgent surgery or being transferred to intensive care.
Because implementation is still under way, coverage is not yet universal. If you are unsure, ask ward or department staff whether a Martha’s Rule number is in place.
How to request a rapid review
Martha’s Rule works through three linked stages:
- Daily check-ins: staff should ask patients and families, at least once a day, how they feel the patient’s condition is changing.
- Raising it on the ward: if you are worried, speak first to the nurse or doctor in charge of care.
- Calling for a rapid review: where concerns remain unaddressed, you can phone the hospital’s dedicated number, which operates 24 hours a day.
Staff can also request a review themselves if they are uneasy about a patient’s progress. Each call is logged, which becomes relevant if questions later arise about how the concern was handled. Take-up has grown steadily, with a record 1,678 calls made in July 2026.
How Martha’s Rule may affect clinical negligence claims
Clinical negligence claims are assessed by looking at whether the care provided fell below the standard reasonably expected of a competent healthcare professional or organisation, and whether that breach caused avoidable injury or loss.
Does Martha’s Rule create a new legal right?
Martha’s Rule is not a new cause of action. A patient would still need to prove breach of duty and causation in the usual way.
It is an NHS England patient safety initiative, not an Act of Parliament. The standard of care is still judged by the Bolam test – whether a responsible body of medical opinion would have acted the same way – as refined in Bolitho, which requires that opinion to stand up to logical analysis.
However, the rule may become relevant when considering whether concerns about deterioration were appropriately escalated, investigated, and documented.
Claims involving missed deterioration
Many clinical negligence cases involve allegations that signs of deterioration were missed or not acted upon quickly enough. Examples can include:
- Sepsis
- Paediatric deterioration
- Maternity complications
- Post-operative decline
- Delays in emergency treatment
In these circumstances, the key questions often include what symptoms were present, what concerns were raised, whether observations were recorded, whether senior review was obtained, and whether earlier intervention would probably have changed the outcome.
How escalation evidence can affect breach of duty
Martha’s Rule may assist with those questions because it sets out an identifiable process for escalation. If a patient, family member, carer, or member of staff asks for a rapid review and that request is not actioned in line with the relevant hospital process, this may be examined when considering whether there was a breach of duty.
On the other hand, if a hospital can show that concerns were recorded, escalated, and reviewed promptly by an appropriate clinician, that evidence may assist in demonstrating that reasonable steps were taken.
The existence of Martha’s Rule may therefore affect both sides of a clinical negligence claim.
For claimants, it may provide a clearer factual framework for showing when concerns were raised and what should have happened next.
For NHS Trusts and other healthcare providers, it may provide a structured audit trail showing how the concern was handled.
The legal aspect will depend on the facts of each case, the medical evidence and whether any failure made a material difference to the outcome.
Evidence, records, and causation
Good records are essential to clinical negligence investigations. Martha’s Rule is expected to encourage clearer documentation of patient and family concerns, escalation requests, clinical reviews, and decisions made following those reviews.
That may include the time a concern was raised, the nature of the concern, who reviewed the patient, what findings were recorded and whether treatment plans changed.
From a legal perspective, that information can be important. A claim does not succeed simply because a patient outcome was poor or because a family felt unheard. The claimant must usually show that there was a negligent failure and that the failure caused harm which, on the balance of probabilities, would have been avoided with appropriate care.
If an earlier review would probably have led to quicker treatment and avoided some or all of the injury, the records made under Martha’s Rule could help show whether the delay made a real difference to the outcome.
On the other hand, if the records show that concerns were taken seriously, that a rapid review was carried out, and that the care provided was clinically reasonable, those records may make it more difficult to establish that the hospital was negligent.
Martha’s Rule does not automatically help one side more than the other. Its main value is that it can make the facts clearer: what concerns were raised, when they were raised, how the hospital responded, and why particular decisions were made.
Obtaining medical records
You can request copies of hospital records, including notes of any Martha’s Rule call, by making a subject access request under the UK GDPR and the Data Protection Act 2018. There is normally no fee, and the trust should respond within one month. Keeping your own timeline of events while memories are fresh can also be valuable.
Time limits for bringing a claim
Most clinical negligence claims must be started within three years, running either from the injury or from when you first realised it may have been caused by poor care, under the Limitation Act 1980. For a child’s claim, that period does not begin until their 18th birthday, and it may not run at all for someone who lacks mental capacity.
Where a patient has died, families may be able to claim under the Fatal Accidents Act 1976, usually within the same three-year window, measured from the death or from learning about the possible negligence.
Reducing harm and encouraging earlier intervention
The primary aim of Martha’s Rule is patient safety. By giving patients, families, and staff a formal way to ask for another review, the rule is intended to reduce the risk that deterioration is missed or that concerns are dismissed.
Earlier recognition and escalation may help avoid serious harm in some cases. It may also improve communication between families and clinical teams, particularly when relatives feel they know something has changed but cannot get that concern acknowledged.
Whether Martha’s Rule will reduce the number of clinical negligence claims over time remains to be seen. It may prevent some adverse outcomes by supporting earlier intervention. It may also lead to better records, which can help all parties understand what happened. In some cases, clearer escalation records may resolve concerns at an earlier stage. In others, they may highlight missed opportunities to act.
Speaking to a clinical negligence solicitor
Whether you suspect A&E negligence or delayed treatment on a hospital ward, contact NHS Negligence today to discuss whether you may have a claim.
Contact NHS Negligence today to discuss what happened and whether you may have a claim.