Module 1 of 2 · 50 minutes
What Martha's Rule requires, and why it exists
By the end of this module you will be able to
- Describe why Martha's Rule was introduced
- State the three components and the 31 March 2027 deadline
- Explain how a patient, family member or member of staff triggers a review
- Explain what the NHS England data says about early warning scores
- Describe how to receive a worried call without defensiveness
Work through it
1 interactive for this module, built on the WAJD Teach engine. Nothing moves until you ask it to, and every one has a written version if you would rather read it.
Watch: Emma and George talk it through
4 minutes. Captions are on, and the same conversation is written out in full below. The voices are computer generated.
Emma George, Martha's Rule. I know it's a big deal but I've never been told what it actually says. Start from the start?
George I'll start with Martha. Martha Mills was thirteen. She died in 2021 of sepsis after an injury to her pancreas. The inquest in 2023 found she would probably have survived if she'd been moved to intensive care sooner. And her parents had said, repeatedly, that they were worried she was getting worse.
Emma And nobody acted.
George Not quickly enough. That's the finding. The principle that came out of it is simple. The people who know a patient best see them when we're not at the bedside, and they can notice deterioration before a chart does. There has to be a way for that to be heard.
Emma So what is the rule?
George Three parts, in NHS England's words. Patients are asked at least daily how they're feeling and whether they're getting better or worse. All staff can, at any time, ask for a review from a different team if they're concerned. And that route is always open to patients, families and carers.
Emma A different team. Why does that matter?
George Because the point is fresh eyes. Not the same team asked the same question twice. If you've been told it's fine and you still don't think it is, you need a way past that.
Emma How does somebody actually call?
George Each hospital has its own dedicated phone line. There's no single national number. It should be given to patients and visible on the ward. Do you know yours?
Emma ...No. Not off the top of my head.
George Then a frightened relative doesn't either. Learn it, and know where it's displayed. That's your first job.
Emma Is every hospital doing this?
George NHS England says all acute trusts must have the three core components in place in adult and paediatric inpatient settings by 31 March 2027. Many already run it in some or all areas, and they reported over 10,000 calls by March 2026.
Emma Doesn't NEWS2 do all this already? That's what the early warning score is for.
George It does a lot. But NHS England reports that most acute deterioration calls, 82 per cent in the data they cite, wouldn't have triggered escalation through early warning scores alone.
Emma Eighty two per cent? So most of the worry wasn't on the chart.
George Right. That doesn't make scores unreliable. They answer one question, what do the numbers say. Martha's Rule answers another, what do the people who know this patient think. You need both.
Emma What do I say when a relative rings the line, or says they're worried at the bedside?
George What you do with your face and your first sentence matters most. A defensive reply, the observations are fine, teaches them not to say anything again.
Emma So what instead?
George Thank them. Ask what they've noticed, in their words, and since when. Check the patient yourself. Tell them what you'll do and by when, then do it. If the line's the right route, help them use it.
Emma And if I think they're wrong?
George Check anyway. Treat a family's worry as clinical information, not as a complaint. A worried relative told they're wrong, on the day they're right, is how an inquest begins.
The written material
Why it exists
Martha Mills was 13 when she died in 2021 of sepsis, after an injury to her pancreas and a stay in hospital. At the inquest in 2023 the coroner found that she would probably have survived had she been moved to intensive care sooner. Her parents had repeatedly told staff they were worried that she was getting worse. The concerns were not acted on quickly enough.
The principle that came out of that is simple and uncomfortable. The people who know a patient best, and who see them when staff are not at the bedside, can notice deterioration before a chart does, and there has to be a way for what they notice to be heard and acted on.
The three components
NHS England describes Martha's Rule as three things. Patients are asked, at least daily, about how they are feeling and whether they are getting better or worse. All staff are able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating. And that escalation route is always available to patients themselves, their families and carers.
- A daily check-in with the patient: how are you, and are you getting better or worse?
- Any member of staff can ask for a review by a different team, at any time
- The same route is always open to patients, families and carers
How it is triggered, and the deadline
There is no single national number. Each hospital has its own dedicated telephone line for patients, families and staff to call when they are worried that a patient's condition is deteriorating, and the number should be given to patients and visible on the ward. Learn yours. If you cannot say what it is without looking, a worried family member certainly cannot.
All acute trusts must have the three core components in place in adult and paediatric inpatient settings by 31 March 2027. Many are already running it in some or all areas, and NHS England reported more than 10,000 calls by March 2026.
Why a score is not enough
Scores such as NEWS2 are valuable, and they are built from measurements. NHS England reports that most acute deterioration calls, 82 per cent in the data it cites, would not have triggered escalation through early warning scores alone. In other words, most of the worries that turned out to matter were not visible on the chart.
That does not make scores unreliable. It means they answer one question, what do the numbers say, and Martha's Rule answers another: what do the people who know this patient think? You need both.
Receiving a worried call
When a patient or a family member says they are worried, the first thing that matters is what you do with your face and your first sentence. A defensive reply, such as the observations are fine, teaches the family not to call again.
Thank them. Ask what they have noticed, in their words and since when. Check the patient yourself. Tell them what you are going to do and by when, and then do it. If the line is the right route, help them use it. A family member who is worried and is told they are wrong, on a day when they are right, is how an inquest begins.
Knowledge check
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