An NHS escalation process known as Martha’s Rule will be rolled out across the NHS in England from April this year.

It will give patients and families access to a rapid review if they are worried about a condition getting worse.

Martha’s Rule formalises access to a critical care team for a second opinion - it will be available 24/7 and will be advertised throughout hospitals.

At least 100 NHS trusts are expected to bring in the rule, with the programme evaluated throughout this year and next.

The plan is to then extend Martha’s Rule to all acute hospitals, subject to government funding.

NHS teams will also look at ways to roll out an adapted Martha’s Rule model in community and mental health hospitals.

What is Martha’s Rule and how will it be used on the NHS?

Under the move, it means an urgent clinical review would be carried out by a different team in the hospital if a patient’s condition is rapidly worsening and they or their family feels they are not getting the care needed.

Martha’s Rule comes after the death of 13-year-old Martha Mills in 2021 who developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in South London.

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A coroner ruled she would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier.

Martha’s parents, Merope Mills, an editor at the Guardian, and her husband Paul Laity, raised concerns about Martha’s health a number of times but these were brushed aside.

The pair have since campaigned for Martha’s Rule to be introduced to give families more say.

They said in a statement: “We are pleased that the implementation of Martha’s Rule will begin in April.

“We want it to be in place as quickly and as widely as possible, to prevent what happened to our daughter from happening to other patients in hospital.


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“We believe Martha’s Rule will save lives. In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t; their knowledge should be recognised as a resource.

“We also look to Martha’s Rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged.

“We call on all NHS clinicians to back the initiative: we know that the large majority do listen, are open with patients and never complacent – but Martha’s doctors worked in a different culture, so some situations need to change.

“Our daughter was quite something: fun and determined, with a vast appetite for life and so many plans and ambitions – we’ll never know what she would have achieved with all her talents.

Daily Echo: This is how Martha's Rule will work in the NHSThis is how Martha's Rule will work in the NHS (Image: Jeff Moore/PA Wire)

“Hers was a preventable death but Martha’s Rule will mean that she didn’t die completely in vain.”

Regarding the introduction of Martha’s Rule, NHS chief executive Amanda Pritchard said it had the potential to “save many lives in the future”.

She commented: “Hearing about the heartbreaking loss of Martha and the experiences of her family has had a major impact for people right across the country, with parents, patients and NHS staff welcoming her parents’ call for a simple process to escalate concerns when they can see a loved one’s condition worsening.

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“NHS teams have been piloting ways to better identify and respond in these cases over the last year, and the roll-out of a national programme to give patients and families 24/7 access to a rapid clinical review will now help ensure that those experiencing acute deterioration can be identified and treated much more quickly.

“I know I speak on behalf of all NHS staff when I thank Merope and Paul for their extraordinary campaigning and collaboration on this hugely important issue.

“While the need for escalation will hopefully only be needed in a small number of cases, I have no doubt that the introduction of Martha’s Rule has the potential to save many lives in the future.”