Written by: Soniya Hajare, MPharm
Reviewed and Fact-Checked by: Vikas Londhe, MPharm
The UK government has recently introduced ‘Martha’s Rule,’ a new policy that allows patients and their families to directly request a rapid second medical opinion when someone’s condition is worsening or when there is disagreement about their care. This rule was created following the tragic death of Martha Mills, a a 13-year-old girl who tragically died of sepsis at King’s College Hospital in August 2021. Despite multiple warning signs—fever, rash, fluctuating vitals, and parents’ repeated concerns—the pediatric liver team failed to transfer her care to intensive support.
Martha’s Rule, implemented in NHS hospitals across England in April 2024, is a patient safety measure aimed at ensuring timely medical intervention when a patient’s condition worsens. It gives patients, their families, caregivers, or healthcare staff the right to request an urgent review by a critical care outreach team if they are worried about a patient’s health or feel their concerns are not being adequately addressed.
Martha’s Rule also serves as a cultural shift in healthcare, aiming to reduce hierarchical barriers, improve open communication, and empower patients and families to take an active role in medical decisions. Early reports from its initial rollout, shared in December 2024, suggest that the policy is already leading to better patient outcomes by preventing avoidable harm and deaths.
Background
In the summer of 2021, 13-year-old Martha Mills suffered a pancreatic injury after a bicycle accident during a family holiday in Wales, due to seriousness of injury she transferred to King’s College Hospital in London, a specialist centre for paediatric pancreatic trauma under the supervision of paediatric hepatology team. Although her health condition showed signs of worsening (high BPEWS score), she remained on a general paediatric ward and tragically succumbed to septic shock on 31 August 2021.
Investigations and Inquests
Following Martha’s death, a detailed internal investigation by King’s College Hospital found five missed opportunities to involve the intensive care unit, despite ICU beds being available at the time. In March 2022, the coroner concluded that Martha would likely have survived if she had been transferred to the intensive care ward earlier when worsening signs started appearing.
The inquest also highlighted systemic issues, such as the continued use of paper-based observation charts, poor communication between departments, and an absence of a well-defined ICU escalation protocol.
In May 2025, the General Medical Council (GMC) conducted a tribunal into the conduct of the senior consultant overseeing Martha’s care. He was found guilty of professional misconduct, including giving inaccurate and outdated information about Martha’s condition during a critical stage of her illness. Despite these findings, the tribunal decided not to impose any formal sanction, citing his long-standing career, previous good record, and the complexity of the situation.
The Five Missed Opportunities
- Failure to escalate to high-dependency or ICU beds early enough
- Ignoring early sepsis indicators
- Communication breakdown and team culture issues
- Misdiagnosis of rash on 29 August
- Absence of senior consultant reviews during critical deterioration
Implementation
Martha’s mother, Merope Mills, a senior editor at The Guardian, used her platform not just to share her grief but to campaign for change. She didn’t seek blame; she wanted reform. Her stand was simple: families should have a formal right to escalate concerns if they believe something is wrong. This led to the creation and rollout of Martha’s Rule
After the heart-rending and preventable death of 13-year-old Martha Mills, a series of reforms and actions were taken in response to the findings of the investigation and public pressure from her family. The most significant and systemic change was the implementation of ‘Martha’s Rule’ across all NHS hospitals in England. Below is a detailed summary of the key implementations:
Introduction of “Martha’s Rule”
Martha’s Rule is a national policy designed to give patients and families direct access to a second clinical opinion or critical care review when they are concerned that a patient is deteriorating and not being properly heard.
Core Features
24/7 access for patients and families to request a rapid clinical review from a critical care team (separate from the patient’s current care team)
Hospitals must prominently display how and when to escalate concerns, including bedside posters and leaflets
Staff training to encourage listening to families, recognizing that they often detect subtle signs of deterioration early
Strengthening the early warning score systems and escalation pathways already in place, making them more transparent and family-accessible
Rollout of Martha’s Rule
The implementation of Martha’s Rule began as a phased rollout following strong public pressure and policy discussions initiated in late 2023. NHS England, working with patient safety experts and Martha Mills’s family, selected 143 NHS trusts to pilot the scheme in early 2024.
These pilot sites tested how effectively patients and families could escalate a rapid clinical review when they were concerned about a patient’s condition. Following positive evaluations, the NHS committed to nationwide implementation. By April 2025, Martha’s Rule was made mandatory across all acute hospitals in England, with dedicated resources, signage, and staff training provided to ensure uniform compliance.
Impact & Data from Pilot Evaluation
During the initial rollout across 143 NHS hospitals in England (September–October 2024), 573 calls were made by patients, families, carers, and staff concerning suspected deterioration. Of these:
286 calls (50%) led to an urgent clinical review by critical care outreach teams
Around 57 reviews (20%) resulted in a change in treatment; such as administration of antibiotics, oxygen, or other life-saving interventions. However the patient remained on their ward.
14 patients were urgently transferred to intensive care units (ICU) after the escalation, potentially prevention serious complications or death.
By March 2025
A total of over 2,000 escalations had been made under the Rule
More than 300 escalations were followed by documented improvements in care
Over 100 patients were transferred to ICU or its equivalent directly due to their concerns being flagged through Martha’s Rule
Additionally, about 75% of calls originated from family members, highlighting the vital role that caregivers play in recognising deterioration that might otherwise be missed
These figures clearly exemplify both the scale and effectiveness of Martha’s Rule: it is being used with meaningful results, not abused, and is saving lives. NHS England’s national medical director, Prof Sir Stephen Powis, described it as “one of the most significant changes in patient safety in recent years,” and England’s Patient Safety Commissioner, Dr Henrietta Hughes, confirmed it “improving safety and reducing harm”
Conclusion and Pharmacally’s Take
At Pharmacally, we believe that patient safety begins with patient empowerment and Martha’s Rule marks a powerful shift in that direction. Martha’s Rule is arises from the heartbreaking loss of 13-year-old Martha Mills, This reform is more than just a policy, It is a major step toward making sure that patients and families are listened, their concerns are taken seriously, and their role in care decisions is truly respected.
For a long time, when patients or families raised concerns, those warnings often got delayed or overlooked due to complicated hospital systems and strict hierarchies. Martha’s Rule changes that it gives patients and families the power to speak up and be taken seriously, not just with empathy, but with real action.
At Pharmacally, where our core mission is to translate cutting-edge medical insight into safer outcomes, we see Martha’s Rule as a milestone for all who believe that safety is a shared responsibility. It formalizes a patient’s right to speak up and be taken seriously, especially when every minute matters.
We urge our readers, patients, caregivers, clinicians, and health systems to view Martha’s Rule not just as a protocol, but as a cultural reset. A chance to build a health system that listens, learns, and acts faster. Patient Safety doesn’t start in the ICU it starts at the bedside, with a voice saying, “I think something is wrong.”
Martha’s Rule isn’t just Martha’s legacy. It’s a blueprint for a safer, smarter, more responsive healthcare system. And at Pharmacally, that’s exactly the kind of future we stand for
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