Martha’s Rule

MARTHA’S RULE – Your right to a second medical opinion

In the summer of 2021, 13-year-old Martha Mills fell off her bike. No big story there, but the events that followed triggered significant changes to the rights of patients who are not getting the treatment they feel they need, with the rolling out of Martha’s Rule across 143 Hospital sites in the UK so far.

WHAT IS MARTHA’S RULE?

Martha Mills was a 13-year-old girl who died from sepsis while she was an inpatient at King’s College Hospital in London after suffering injury to her pancreas following a bike accident.

Martha’s family were concerned about her condition, but despite asking for a second opinion, they were not listened to. Martha died in hospital a few days before her 14^th birthday. A 2022 inquest into Martha’s death ruled that Martha would most likely have survived if her family’s concerns had been listened to and she had been transferred to intensive care earlier[1]. The Medical Practitioners Tribunal Service is currently considering this case[2].

Martha’s parents, determined that no one should ever experience the loss of a loved one in these circumstances again, successfully campaigned for the right for patients, families and carers to request a second medical opinion if they are worried that a condition is getting worse.

WHAT DOES IT MEAN FOR ME?

According to the NHS England website[3] Martha’s Rule means:

• Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way
• All 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

MARTHA’S LAW IN ACTION: HAS IT MADE A DIFFERENCE?

Figures published by NHS England in April 2025[4] show that Martha’s Rule is already making a difference to patient safety. Between September 2024 and February 2025:

• 2,389 calls were made to escalate concerns; 73% from families seeking help and 47% relating to acute deterioration
• 129 potentially life-saving interventions were triggered, including:
  • 57 urgent admissions to high dependency or intensive care units
  • 60 transfers to specialist services (coronary care, respiratory care, return to theatre)
  • Changes in care for a further 336 cases, for example the introduction of a new medication such as an antibiotic
    

• Calls unrelated to acute deterioration are also improving patient care, including:
  • 340 calls led to clinical concerns such as medication delays being addressed
  • 448 calls resolved communication issues

HOW DO I INVOKE MARTHA’S RULE IN PLYMOUTH?

At Derriford Hospital, Martha’s Rule is also described as a ‘Call for Concern’[5] and described as ‘a patient safety service for patients staying in hospital and their families’.

University Hospitals NHS Trust explain that ‘You, a relative or carer can call for urgent help and advice if you have concerns about their condition that have not been answered by the ward team.’ The service is provided by the Acute Care Team and can be accessed as follows:

• By calling 01752 433021 – if no-one answers, please leave a message and you will be called back as soon as possible.
• If you are unable to reach the Acute Care Team on the above number call 01752 202082 and ask to ‘bleep ACT on a call for concern’.

Contact switchboard via a hospital phone (dial 50 or the ward staff will help you) and ask to ‘bleep ACT on a call for concern’.

[1]https://www.judiciary.uk/wp-content/uploads/2022/03/Martha-Mills-Prevention-of-future-deaths-report-2022-0063_Published.pdf

[2] https://www.msn.com/en-gb/public-safety-and-emergencies/health-and-safety-alerts/consultant-should-have-referred-teenager-to-intensive-care-tribunal-rules/ar-AA1G9c7U?ocid=BingNewsSerp

[3] https://www.england.nhs.uk/patient-safety/marthas-rule

[4] https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/nhs-patient-safety-strategy-progress-so-far/

[5] https://www.plymouthhospitals.nhs.uk/call-for-concern#:~:text=Call%20for%20concern%20is%20a%20patient%20safety%20service,This%20service%20is%20also%20known%20as%20%E2%80%98Martha%E2%80%99s%20Rule%E2%80%99.