NHS England: Martha’s Rule Rolled Out to All Acute Hospitals

Martha's Rule is now available in every acute hospital in England, the NHS has announced, as new data shows hundreds of patients have benefitted from potentially life-saving changes to their care thanks to the scheme.  

Between September 2024 and June 2025, there were 4,906 calls made to Martha's Rule helplines to escalate concerns about care – leading to 241 potentially life-saving interventions being triggered.

The positive results from the first year have led the NHS to expand its use to an additional 67 sites – meaning all 210 acute inpatient sites in England now offer the service.

Martha Mills died in 2021 aged 13 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike.

Martha's family's concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

In May 2024, NHS England announced the rollout of Martha's Rule across 143 pilot sites following the campaigning of Martha Mills' parents, Merope and Paul.

The new data published by the NHS shows almost three quarters (71.9%) of calls have been from families seeking help, with 720 calls leading to changes in care. This could include patients receiving a new medication such as an antibiotic.

Almost 800 (794) calls led to clinical concerns such as medication or investigation delays being addressed. A further 1,030 calls helped to resolve communication and discharge planning issues.

Martha's Rule is a major patient safety initiative in hospitals encouraging patients, families and carers to speak to the care team if they notice changes in someone's condition.

It also provides them with a way to seek an urgent review if their or their loved one's condition deteriorates - and are concerned this is not being responded to.

Staff can themselves ask for a review from a different team if they are concerned the appropriate action is not being taken.

The NHS has rolled out consistent branding and materials, including posters around hospitals, to ensure the programme is easy to understand for patients and their families.

Full evaluation of the programme is ongoing and will help inform proposals to expand to other settings.

Merope Mills and Paul Laity, Martha's parents, said: "It would be Martha's 18th birthday today, another milestone she has missed as a result of the poor care and hospital errors that led to her unnecessary death.

“We feel her absence every day, but at least Martha's Rule is already preventing many families from experiencing something similar.

“The figures prove that lives are saved when patients and families are given power to act on their suspicions when they feel doctors might have got it wrong and their voice isn't being heard.

“We are pleased to know more hospitals are taking up Martha's Rule and look forward to a time when every patient in the UK knows about the initiative and has easy access to it."

Professor Meghana Pandit, NHS national medical director, said: “There is no shadow of a doubt that Martha's Rule is having a transformative impact on the way hospitals are able to work with patients and families to address deterioration or concerns about care.

“There have now been almost 5,000 calls made to the hotlines, with hundreds of potentially life-saving interventions triggered, which is why we are now expanding Martha's Rule to all acute hospitals in England.

“I want to take this opportunity to thank Merope and Paul who have campaigned tirelessly on this issue and continue to work with us to ensure Martha's Rule is at the centre of our efforts to boost patient safety and quality of care.

“I also want to thank clinical staff up and down the country who have swiftly implemented this potentially lifesaving intervention and ensured it's success.”

Health and Social Care Secretary, Wes Streeting, said: “No family should ever have to go through what Merope and Paul endured when they lost Martha, but her parents' tireless campaigning has created a lasting legacy that is already having a potentially lifesaving impact across England. 

“Martha's Rule puts patients and families at the heart of their care. By rolling this out to every acute hospital in England, we're delivering on our promise through our Plan for Change to rebuild trust in the NHS and put patient safety first.

“With hundreds of potentially life-saving interventions and changes in care triggered so far, Martha's Rule is about ensuring that patients and their families have their voices heard when it is needed most. 

“This is exactly the kind of reform our health service needs - listening to patients, learning from tragedy, and taking action to prevent it happening again. Martha's memory will live on through every life this rule helps to save."

The Patient Safety Commissioner, Prof Henrietta Hughes, said: “I am delighted to see that Martha's Rule has now been rolled out across all acute trusts so even more patients can benefit from potentially lifesaving treatment.  Martha's Rule is transforming healthcare culture and shows the benefits of working in partnership with patients.'

Dr Ronny Cheung, consultant general paediatrician at Evelina London Children's Hospital, said: “Martha's Rule brings the voice of patients and families right to the heart of care, and that's something I really value as a clinician.

“Families often know their loved ones better than anyone – they can spot when something isn't right in ways that even experienced doctors might miss.

“I've had Martha's Rule invoked under my care, and while it can feel challenging initially, it's ultimately about creating a culture where everyone – patients, families and staff – has a voice to raise concerns.

“This can only make the care we provide better and safer for everyone.”

Rachel Power, CEO, at the Patients Association said: “The rollout of Martha's Rule to every acute hospital in England gives patients and their families a voice at critical moments, can lead to life-saving action, and is a landmark moment for patient safety.

“Behind the nearly 5,000 calls made in the last year are patients and families who were deeply concerned, worried that something wasn't right and potentially unsure if they would be listened to. 

“When people feel confident to speak up, and know their concerns will be acted on, the NHS becomes safer, more compassionate, and more responsive.

“This is patient power in action.” 

Chief Executive of NHS Providers, Daniel Elkeles, said: “Martha's Rule has had a great galvanising effect on the NHS in adopting these changes so quickly, with more patients set to benefit as the scheme is rolled out to all hospitals.

“It is a testament to the dedication of Martha Mills' parents that the initiative has been adopted with such positive results for patient safety and the quality of care.

“Credit too to frontline staff who have adapted to make it work so well.”

Dr Ben Richardson, paediatric consultant and Yorkshire & Humber clinical lead for the regional Martha's Rule pilot, said: "Working as part of a local, regional and national team, it's been amazing to see that in such a short space of time, how so many healthcare professionals have moved from apprehension about how to widely implement Martha's Rule to being thoroughly invested in the culture change that underpins its success.

“We all realise it's not just about being able to tick a box for each component of Martha's Rule, but to really think deeply about how to advocate for the patients their family's and the voice that is seldom heard."