What is Martha's Rule? Who are Martha Mills and mother Merope Mills - what does it mean for hospital stays?

Beginning in April, the NHS in England is set to implement 'Martha's Rule,' an escalation process that will operate 24/7 and be actively promoted within 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, with the NHS saying "initial provider sites will inform the development of wider national policy proposals... that can be expanded in a phased way across the NHS from 2025/26."

But what exactly is Martha's Rule, what does it mean for your next hospital stay, and who is the 'Martha' it is named after? Here is everything you need to know.

What is Martha's Rule?

Martha's Rule will give patients and families access to a rapid review if they are worried about a condition getting worse; the process formalises access to a critical care team for a second opinion.

Under the move, 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.

In September, then Health Secretary Steve Barclay told the House of Commons: “Martha’s Rule would be similar to the Queensland system called ‘Ryan’s Rule’ – a three-step process that allows patients or their families to review a clinical review of their case from a doctor or a nurse if their condition is deteriorating or not improving as expected."

In an accompanying report from think tank Demos, it said the rule is modelled on the Call 4 Concern system that has been adopted by a number of hospitals in the UK, giving patients a direct line to a second opinion.

It said Martha’s Rule should be advertised to families and staffed by an independent clinical review team, which many hospitals already have in place.

Who is 'Martha'?

The move follows the death of 13-year-old Martha Mills in 2021. She developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

Martha was being looked after at King’s after suffering a pancreatic injury following a fall from her bike while on a family holiday in Wales.

An inquest heard there were several opportunities to refer Martha to intensive care but this did not happen. The trust, which is a specialist national referral centre for children with pancreatic problems, has since apologised for mistakes in Martha’s care.

At one point, Martha began to bleed heavily through a tube inserted into her upper arm and through a drainage tube. She also developed a rash and her mother voiced concerns to staff that Martha would go into septic shock over a bank holiday weekend.

One of the trust’s own intensive care doctors told the inquest into Martha’s death he would “100%” have admitted her if he had seen her.

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: “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.

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

What does it mean for hospital stays?

Regarding the introduction of Martha’s Rule, NHS chief executive Amanda Pritchard said that "while the need for escalation will hopefully only be needed in a small number of cases", it had the potential to “save many lives in the future”.

She said: “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."

Martha's parents said in their statement: “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.

Will extra funding be provided?

Questions remain about what resources hospitals and other providers will be given to deliver the new scheme.

Rory Deighton, director of the NHS Confederation’s acute network, welcomed the move, but said: “Introducing a 24/7 clinical review process will have implementation costs and leaders will be concerned if they are just being expected to provide the additional service without any extra resources.

“But this rollout is part of an important shift where the NHS is looking to change the relationship between the NHS, clinicians, patients and their families.

"The future model of care is one where patients and their families are active partners in healthy communities, not just consumers of NHS services.”