Martha’s Rule

Martha’s Rule is an NHS safety initiative that gives patients, families, carers and staff a clear way to ask for an urgent review if they are worried that someone in hospital is getting worse.

It is named after Martha Mills, a young patient whose family raised concerns about her condition that were not acted on quickly enough.

The aim of Martha’s Rule is simple:
to recognise deterioration early and make sure concerns are listened to and acted on.

How Martha’s Rule works

Martha’s Rule has three key parts:

1. Daily check-ins with patients

Patients will be asked everyday how they are feeling — whether they are better, worse, or the same.
Any concerns should be taken seriously and acted upon in a structured way. Patients will also be asked if they understand their medical management plan – any queries will be clarified by the nursing and medical teams

2. Staff can escalate concerns

Any member of staff can request a review from another clinical team if they are worried a patient is deteriorating.

3. Patients, families and carers can escalate concerns

If you are worried about a patient and feel your concerns are not being addressed, you can request an urgent review yourself.

This review is carried out by a different clinical team (Critical Care Outreach Team), who will assess the situation and recommend next steps.

Has Martha’s Rule made a difference?

Yes — early results across the NHS show that:

  • Thousands of calls have been made to escalate concerns
  • Some of these have led to potentially life-saving interventions, such as admission to intensive care
  • Many others have resulted in changes to care, including new tests, treatments or specialist reviews

Martha’s Rule is helping hospitals respond more quickly when patients become unwell. It is now being adopted more widely and will be included in future NHS standards.

Martha’s Rule at Nottingham University Hospitals (NUH)

  • Nottingham University Hospitals NHS Trust is introducing Martha’s Rule as part of a pilot starting at the end of March 2026.

    What this means:

    • The pilot will cover:
      • All children’s hospital ward areas
      • Selected adult inpatient wards
    • More adult wards will begin using Martha’s Rule in a phased rollout over the next year
    • At this stage, Martha’s Rule does not apply to outpatient areas, including the Emergency Department

How to activate Martha’s Rule at NUH

If you are worried that you as a patient or an adult/child patient you know is getting worse and feel your concerns are not being taken seriously:

Step 1: Discuss your concerns with the doctor or nurse looking after the patient. Hopefully, they will see to your concern and help put your mind at ease, with no further action will be needed.

Step 2: If you are not satisfied with the response and are still concerned about a worsening condition, ask to speak with the nurse in charge of the ward or matron.

Step 3: If your concerns are not addressed, please request an independent review under Martha’s Rule by discussing with a staff member, You can say: “I’m very worried. I think their condition is getting worse and I want to use Martha’s Rule” or by calling our dedicated phone line;

0115 970 0700

This is a single point of access phone line with an automated triage process to get you through to the right team. This should be used for urgent concerns about clinical deterioration.

Be ready to share the following details:

  • Name of patient
  • Name of ward
  • A brief description of the concern and what action has been taken so far
  • Your contact details and relationship to the patient

Our Critical Outreach Teams will answer your call and review the situation before deciding what action is needed.

Important information

  • Please use the Martha’s Rule phone number above for urgent concerns about clinical deterioration.
  • Do not rely on calling the hospital switchboard for this type of acute escalation — they are not set up to manage urgent clinical deterioration concerns and may not be able to redirect calls appropriately.
  • When Martha’s Rule should not be used - For non-urgent feedback, complaints, or concerns (for example about communication, facilities, bed management) you should ask to speak to the ward manager for that area or contact the PALS team (Patient Advice and Liaison Service) on 0800 183 0204.
  • Difference between Martha’s Rule and requesting a second opinion. Martha’s Rule allows hospital inpatients and their families to seek a rapid review if their condition, or the condition of a loved one, is deteriorating. A second opinion is when you would like to see another consultant to discuss any diagnosis or treatment.

Why this matters

Patients, families and carers often notice small changes before they show up in tests or observations.

Martha’s Rule provides an extra layer of safety by:

  • Making it easier to raise concerns
  • Ensuring those concerns are taken seriously
  • Supporting quicker action when someone becomes unwell

It is part of building a more open and responsive approach to patient safety — where everyone’s voice matters.