Martha’s Rule: Accessing rapid reviews for hospital inpatients
Martha’s Rule is a patient safety initiative to support the early detection of deterioration in hospital by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.
Following a successful pilot in 2024 and 2025, all acute trusts in England are now working to put Martha’s Rule in place. Full implementation is expected to be complete across all acute trust impatient services during 2026/27.
In this article:
- What is Martha’s Rule
- Martha’s Story
- How to access Martha’s Rule at our local NHS Hospital Trusts
What is Martha’s Rule?
Martha’s Rule allows patients, and their loved ones to request a rapid review if they feel a health condition is quickly getting worse, and their concerns are not being listened to. They may notice small changes that could be early warning signs of deterioration before they show up in routine measurements.
If, after speaking to the care team, they remain worried and feel their concerns are not being addressed, Martha’s Rule means that they can call a dedicated number to request a rapid review from a different team.
Martha’s Rule also empowers staff to call for a rapid review if they feel their concerns about a patient are not being responded to.
The three core components of Martha’s Rule
- 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.
This is a service for patients staying in hospital only. If you have serious concerns about someone who is not in hospital, please call 111 or 999, or attend your closest A&E.
Martha’s Story
Martha’s Rule is named after Martha Mills, a teenager who died in 2021 after developing sepsis in hospital. She had been admitted with a pancreatic injury after falling off her bike, but her treatment team did not address her family’s concerns about her deteriorating condition. In 2023, a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.
In response to this, the government agreed to introduce a nationwide scheme based on initiatives already in place at some hospitals.
You can find out more about Martha's Rule on the NHS England website.
Martha’s Rule at our local hospitals
You can check if Martha’s Rule is available in a particular hospital by looking at the trust’s website or by speaking to staff. Read below to find out how Martha’s Rule is being implemented at our local hospitals.
Guy’s and St Thomas’ NHS Foundation Trust
Guy’s and St Thomas’ NHS Foundation Trust have introduced Martha’s Rule as a service for patients staying in any of their hospitals: Guy’s, St Thomas’, Royal Brompton, Harefield and Evelina Children’s Hospitals.
What this means for patients and their loved ones
If you were visiting a loved one staying on one of the wards and noticed they were becoming more unwell, the Trust asks that you first raise these concerns with the ward team. If you are still concerned, there is now a dedicated phone number you can call to request a rapid review for yourself or a loved one.
When you make a Martha’s Rule call, you will be asked to leave a voicemail message which should include the patient’s name, name of the ward, a description of your concern, what has already been done and your details.
This voicemail will be picked up by a member of the team who specialise in the care of seriously ill patients. They will then come and review the patient and make a decision about next steps in their care.
If you have any questions, would like further information or would be happy to provide some feedback on Martha's Rule and speaking up about concerns, please contact Rebecca Harper at: rebecca.harper30@nhs.net
King’s College Hospital NHS Foundation Trust
Martha’s Rule is available 24 hours a day, seven days a week at King’s College Hospital and the Princess Royal University Hospital.
It applies to adult and paediatric inpatients at King’s College Hospital, and adult inpatients only at the Princess Royal University Hospital, with the exception of the Maternity wards at both hospitals.
What this means for patients and their loved ones
Inpatients and/or their relatives can call 020 3299 8400 for immediate help and advice if they are worried the inpatient’s condition is getting worse.
You will need to mention the inpatient’s name, the name of the ward, a brief description of your concern and your relationship to the inpatient and contact details.
All telephone calls to this number will be assessed and, where appropriate, a doctor or nurse from our Critical Care Outreach Team will visit the patient on the ward to ensure they are receiving the suitable treatment and support.
