Health and care
Martha's Rule explained: the three components and what they ask of nurses
What the rule requires, when every acute trust must have it in place, and how it sits beside NEWS2.
Checked against the published sources on 2 October 2026.
The short answer
Martha's Rule gives patients, families, carers and staff a route to a rapid review by a different team when they are worried that a patient is deteriorating. NHS England requires every acute trust to have its three core components in place for adult and paediatric inpatients by 31 March 2027.
- Deadline for acute trusts
- 31 March 2027
- Applies to
- Adult and paediatric inpatient settings
- Calls so far
- More than 10,000 by March 2026
- Works alongside
- The National Early Warning Score 2 (NEWS2)
The three components
Each closes a gap that a score on its own leaves open.
- Patients are asked at least daily how they feel, and whether they are getting better or worse
- Any member of staff can ask at any time for a review by a different team
- The same route is always available to patients, families and carers
Why it exists
Martha Mills died in 2021, aged 13, of sepsis in hospital. A coroner's inquest in 2023 found she would probably have survived had she been moved to intensive care sooner, and that her family had repeatedly raised concerns that were not acted on quickly enough.
Beside the score, not instead of it
Martha's Rule does not replace NEWS2. NHS England reports that most calls, 82 per cent in the data it cites, would not have triggered escalation through early warning scores alone. A normal score does not cancel a credible concern from someone who knows the patient well.
This page explains what the rule says. It is not legal, regulatory, clinical or financial advice on your own position. Rules change, so read the sources listed beside it, and tell us at hello@wajd.co.uk if something here is out of date.
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Questions people ask
What is Martha's Rule?
A route to a rapid review by a different team for patients, families, carers and staff who are worried that a patient is deteriorating.
When must hospitals have Martha's Rule in place?
All acute trusts must implement its three core components in adult and paediatric inpatient settings by 31 March 2027.
Does Martha's Rule replace NEWS2?
No. It works alongside physiological scoring, because a score does not capture everything.
A relative says the patient is not themselves but the observations are normal. What should I do?
Treat the worry as clinical information. Check the patient yourself, escalate by your local route using a structured format, and tell the family what you have done.