Key takeaways
Martha’s Rule now embedded in NHS contracts
All trusts must implement core components under the 2026/2027 NHS Standard Contract.
Escalation rights strengthened for patients and staff
Facilitates independent clinical review when concerns about deterioration are not addressed.
National rollout supported by clear implementation standards
Core standards aim to ensure consistent, safe adoption across acute and maternity settings.
This year marks the beginning of the nationwide implementation of Martha’s Rule across all acute trust inpatient services, with recent expansion into maternity and neonatal settings. The rule has now been incorporated into the NHS Standard Contract for 2026/2027, requiring all NHS trusts and foundation trusts to implement its three core components by 31 March 2027.
Background
Martha Mills died in 2021 after developing sepsis while in hospital. She had originally been admitted with a pancreatic injury following a cycling accident. Despite her family raising concerns about her worsening condition, these were not adequately addressed. In 2023, a coroner concluded that Martha, aged 13, would likely have survived if she had been transferred to intensive care sooner.
What is Martha’s Rule?
Martha’s Rule was introduced in response to Martha’s death and similar cases involving failures to respond to clinical deterioration. Developed by the then Secretary of State for Health and Social Care alongside NHS England, the rule emphasises the importance of recognising that patients, families and carers, those who know the patient best, may detect early signs of deterioration.
At its core, the rule promotes listening to and acting on concerns raised by patients and those close to them.
Maternity review
Following Donna Ockenden’s Independent Maternity Review into care at Nottingham University Hospitals NHS Trust, from 24 June 2026, the government committed to implementing Martha’s Rule in maternity settings. This ensures that parents can request a rapid review by an independent medical team if they are concerned about the condition of a mother or baby.
The initiative has already been piloted across 15 maternity and neonatal units, with further expansion expected.
The three core components
Martha’s Rule is built around three key principles:
Daily patient check-ins: patients are asked at least once a day how they feel and whether their condition is improving or worsening, with responses acted upon in a structured way.
Staff escalation rights: any staff member can request a review from an alternative team if they believe a patient’s deterioration is not being adequately addressed.
Patient and family escalation: patients, families and carers have a clearly advertised right to request an urgent review themselves.
Implementation progress
Martha’s Rule was first introduced in May 2024 across 143 pilot sites within NHS acute trusts in England. Following positive outcomes, a second phase in April 2025 extended implementation to all remaining sites.
With its inclusion in the NHS Standard Contract, NHS England has also published a set of core standards to support consistent and effective implementation across all providers.
Core standards
The six core standards outline expectations for NHS trusts:
Reliable implementation and equitable access to all elements of Martha’s Rule
Timely reviews conducted by appropriately skilled and independent clinicians
Meaningful involvement of patients, families, carers and staff
Awareness and understanding of the rule across all groups
Staff education and training to support effective use
Integration into governance and quality systems
Trusts are encouraged to undertake self-assessments to ensure these standards are met and to confirm that both patients and staff can confidently access and rely on the rule.
Impact and importance
The introduction of Martha’s Rule represents a significant cultural shift towards listening more closely to patients and those around them. It reinforces the importance of self-advocacy and empowers both families and healthcare professionals to escalate concerns when necessary.
Early NHS data suggests that the rule is already saving lives and improving patient outcomes. It works alongside existing clinical monitoring systems, strengthening the ability to detect and respond to patient deterioration more effectively.
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