Martha’s Rule: A Patient-Safety Mechanism Saving Hundreds in England

Martha’s rule gives any hospital patient, relative or staff member the right to request a rapid, independent review of the patient’s care. A dedicated helpline, run by each NHS trust, can be called when a concern arises; a second clinical team then assesses the case and can recommend escalation to intensive care, a high-dependency unit or a specialist ward. The mechanism has been in use across England since September 2024.

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The policy is named after 13-year-old Martha Mills, who died of sepsis in 2021 after her family’s concerns were ignored at King’s College Hospital. An inquest concluded she would probably have survived if her deterioration had been recognised earlier. Her parents, Merope Mills and Paul Laity, campaigned for a statutory right to a second opinion, leading the Department of Health and Social Care to embed the rule in NHS England’s patient-safety framework.

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NHS England reports 12 301 calls to the helpline in the first 18 months (Sept 2024 – Feb 2026). Of these, 4 047 (? 33 %) identified a patient whose condition was worsening; 2 967 calls came from patients or their carers, the remainder from staff. In total, 524 adults and children were transferred to intensive-care, high-dependency or specialist units after a review, a figure the health secretary cites as “already having a life-saving impact”. More than 1 000 clinically trained staff have themselves sought a review, indicating uptake beyond patient-initiated requests.

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• Martha Mills – the eponymous case whose death prompted the rule.

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• Merope Mills & Paul Laity – campaigners and parents of Martha.

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• Wes Streeting – Health Secretary, champion of the policy.

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• Paul Whiteing – chief executive, Action against Medical Accidents, a patient-safety charity.

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• Oxford University Hospitals NHS Foundation Trust – the trust where a high-profile case was resolved.

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• Prof Andrew Brent – chief medical officer of the trust.

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• Karen & David Osenton – a family whose experience illustrates the rule in practice.

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David Osenton, a retired engineer in his early 70s, was admitted to the cardiac ward of John Radcliffe Hospital in Oxford with severe heart-failure. After a week of rapid decline, his daughter Karen read the Martha’s-rule poster and invoked the mechanism: “I am invoking Martha’s rule. I want somebody to see my dad right now.” Within minutes a team of doctors arrived; David was transferred to intensive care, where he received “exceptional” treatment. He survived, though he remains frail, and the trust issued an apology for communication lapses that delayed his escalation.

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Health Secretary Streeting said the data demonstrate that the rule is already saving lives and praised the Mills family for turning personal tragedy into systemic change. Whiteing highlighted the rule’s potential to challenge a “culture of defend and deny” that discourages patients from raising concerns. Prof Brent expressed regret that aspects of David’s care fell short of the trust’s standards and affirmed the organisation’s commitment to listening to patients, relatives and carers.

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Stakeholders note persistent cultural barriers: hierarchy and reluctance among clinicians to be challenged can still impede timely escalation. An interim review found only 32 % of the public were aware of the rule, with awareness four times higher among those with higher education, suggesting outreach gaps. Patient-safety advocates argue the mechanism should be expanded and better promoted to ensure equitable access.

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The impact figures rely on NHS England’s internal data; no independent audit has been published to verify outcomes. Awareness metrics are limited to self-reported surveys, leaving uncertainty about how many eligible patients remain unaware of the right to a second opinion.

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• “Wes Streeting, the health secretary, said the figures proved that Martha’s rule is “already having a life-saving impact”.” — Wes Streeting, Health Secretary

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• “Too often the people we support still tell us about the culture of defend and deny that they face when they ask questions or raise concerns about their treatment. If this rule is challenging that culture, then its use must be expanded as soon as is possible.” — Paul Whiteing, chief executive, Action against Medical Accidents

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• “ In a statement, Prof Andrew Brent, the chief medical officer at OUH, said: “On behalf of the trust, I am sorry that some aspects of the care David Osenton received did not meet the high standards that we set ourselves.” — Prof Andrew Brent, chief medical officer, Oxford University Hospitals NHS Foundation Trust

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• “He was on the edge of the bed, rocking, and he could barely speak. He was so yellow, so gaunt. I just walked to the desk and I said: ‘You will get a consultant here now. I am invoking Martha’s rule. I want somebody to see my dad right now.’” — Karen Osenton, daughter of patient David Osenton

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