What is Martha’s Rule?
Martha’s rule is a recognised mechanism for obtaining an independent review of a patient’s care when their health is deteriorating. It allows patients, their families, carers, and all NHS (National Health Service) staff to call a dedicated number to request a rapid assessment from a different team.
This initiative was established following the tragic death of 13-year-old Martha Mills, who developed sepsis—a life-threatening reaction to infection—after a cycling accident. Despite her family repeatedly warning staff about her worsening condition, Martha was not transferred to intensive care in time. An inquest later concluded that an earlier transfer would have saved her life.
The first phase of Martha’s Rule was introduced across 143 acute hospitals in May 2024. By September 2025, it had expanded to all 210 acute hospitals, though not yet in every ward. Full implementation across all acute inpatient services is expected to be completed by 31 March 2027.
Impact on Claimants
Martha’s Rule provides strong and tangible evidence in a claim for negligence. The Bolam Test is the framework for establishing clinical negligence, determining whether a healthcare professional acted in accordance with a practice accepted as proper by a responsible body of medical opinion. Martha’s Rule assists in proving the breach of duty and causation under the Bolam Test by measuring the doctor's care against these recognised standards.
For example, if a practitioner failed to raise a concern, and an independent review under Martha’s Rule later finds that more should have been done, this clearly indicates that treatment fell below the expected standard of care—establishing a breach. The review can also show what intervention would likely have changed the outcome, helping to establish causation. Together, this evidence can assist claimants in proving that a practitioner's failure to act directly caused the patient's condition to worsen.
Impact on Defendants
The rationale behind Martha’s Rule is to save lives by identifying errors in medical care at a stage when they can still be corrected. This is expected to reduce the volume of clinical negligence claims, as it gives hospitals an opportunity to rectify their treatment of deteriorating patients before a claim arises. The Civil Bar anticipates that the scheme will have this effect. However, as the regime is relatively new, there is not yet enough evidence to confirm that it will prevent entire claims from being issued. Qualitative research is currently being undertaken across 16 NHS Trusts to evaluate the initiative’s full impact.
Even where litigation cannot be avoided entirely, earlier intervention mitigates the severity of harm, leading to lower-value claims and reduced legal costs. Between September 2024 and February 2026, 524 patients received a potentially lifesaving treatment. From a litigation perspective, striving to prevent avoidable harm minimises both human and financial implications of defending clinical negligence claims.