Martha’s Rule.

Martha’s Rule is a major patient safety initiative that has been rolled out in a pilot scheme across 143 hospitals between March 2024 and May 2025.

The implementation of this initiative follows years of campaigning by Martha’s mother, Merope Mills. Following Martha’s death, Merope has fought for improvements to patient safety, for patient’s families concerns to be taken seriously and for an urgent second opinion to be sought on request when it is felt that a patient’s deterioration is not being effectively managed.

Martha Mills died in 2021, aged 13, having developed sepsis* in hospital where she had been admitted with a pancreatic injury. Martha had fallen off her bike and landed on her handle bars causing injury to her pancreas. Martha was in hospital for weeks and contracted a number of infections which is typical of this type of injury. However, in August she developed a further infection and her condition began to deteriorate. Martha’s parents repeatedly raised their concerns to staff and asked for Martha’s condition to be reviewed in light of this but were consistently dismissed as anxious parents. By the end of the August bank holiday weekend, a consultant review resulted in Martha being transferred to Paediatric Intensive Care Unit however it was too late for them to help Martha and she tragically passed away. An inquest found that her death was preventable.

Martha’s Rule provides patients and their families with a way to seek an urgent review if their or their loved one’s condition deteriorates and they are concerned this is not being responded to.

The initiative means that all patients, their families, carers and staff will be able to ask for a review from a different team at any time if they are not being responded to. The aim is to help improve both the quality and safety of care for patients whose condition is worsening. It is a key priority to improve the identification and management of the deterioration of patients.

In May 2024, the initiative was rolled out across 143 pilot hospitals and there are plans for it to be implemented in all care settings including community and mental health, as appropriate and subject to government funding.

As of December 2024, Martha’s Rule had been used 573 times with about half of these prompting an urgent care review by critical care staff and in about one fifth of these cases led to the person’s care being escalated, for example by administering potentially lifesaving antibiotics.

The initiative should empower patients, families, carers and staff to ensure their concerns are listened to and acted upon. If you have a concern about a loved one’s condition, don’t be afraid to speak up and get a second opinion. www.mariecurie.org.uk for more information. Also listen to our podcast here if you would like to hear more about this.

*Sepsis is a life-threatening emergency that happens when your body's response to an infection damages vital organs and, often, causes death.