You know yourself or your loved one better than anyone. If you are worried that a patient is getting more unwell while in hospital, please tell us.
Martha’s Rule gives patients, families, carers and staff a route to request an additional urgent review if they are worried that a patient’s condition is getting worse and they feel their concerns have not been listened to or acted on.
Martha’s Rule is part of our wider work to improve patient safety and support earlier recognition of deterioration.
What is Martha’s Rule?
Martha’s Rule is a patient safety initiative that helps patients, families, carers and staff raise concerns if a patient is getting more unwell.
It has three main parts: patients will be asked, at least daily, how they are feeling and whether they feel better or worse; staff can ask for a review from another team if they are worried that a patient is deteriorating and their concerns are not being responded to; and patients, families and carers can also ask for a review if they are worried that a patient is deteriorating and feel their concerns are not being addressed.
Who can use Martha’s Rule?
Martha’s Rule is for inpatients in hospital where there are concerns that the patient is getting more unwell. It is not currently for general outpatient appointments, A&E, routine queries or general complaints.
What to do if you’re worried
You may notice small changes before they show up in our routine measurements. These changes could be early warning signs of deterioration.
1You may notice small changes before they show up in our routine measurements. These changes could be early warning signs of deterioration.
1. Speak to the nurse, doctor or ward team caring for the patient.
2. If you are still worried and feel your concerns have not been listened to or acted on, ask for Martha’s Rule.
3. COMING SOON: You can use the QR code or WhatsApp chatbot if available, or ask a member of staff to help you use the non-digital route.
What happens when a concern is raised?
The team will review the information you provide and prioritise the concern based on clinical urgency.
A member of the team may give advice, speak to the ward team, or arrange for a clinical review. They will explain what is happening and what the next steps are.
Who was Martha?
Martha Mills died in 2021 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, aged 13, would probably have survived had she been moved to intensive care earlier.
In response to this, and other cases related to the management of deterioration, the then Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’ – a patient safety initiative as part of a wider NHS strategy to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.
What Martha’s Rule is not for
Martha’s Rule is not for general complaints, car parking, food, visiting times, appointment queries, routine requests, long-term condition queries or routine requests for a second opinion.
If your concern is not about a patient getting more unwell, staff can help you contact the right team, such as the ward manager, matron or our Patient Advice and Liaison Service.
If you cannot use WhatsApp
Please speak to a member of staff if you cannot use WhatsApp, do not have a mobile phone, need information in another language, or need help to raise a concern.