Martha's Rule

'Martha's Rule' is an important patient safety initiative that gives patients, families, carers and our staff an additional escalation pathway if they are concerned that a patient is rapidly deteriorating.

Martha's Rule involves staff asking, listening, recording and acting on any changes in condition reported by patients or their loved ones. It ensures that patients, relatives, carers and staff have access to a round-the-clock urgent review from an independent care team.

It will help improve both the quality and safety of care for patients whose condition is worsening, ensuring that concerns are listened to and acted upon if they have not been already addressed in the usual ways.

Martha’s Rule is in addition to our current escalation processes and is separate to the existing ability to request a second opinion, which is different to Martha's Rule.

Martha's Rule at Oxford University Hospitals

We ran a pilot of Martha's Rule for some adult patients at the John Radcliffe Hospital in Oxford and Horton General Hospital in Banbury.

We are continuing to run the service in these areas to gather further learning before the full rollout of Martha's Rule across the Trust in 2026.

When to use Martha's Rule

Inpatients or their relatives and carers (and staff looking after the patient) can call the relevant number for Martha's Rule for help and advice if:

the ward has been part of the pilot in which case the service in that area is ongoing. Please speak to ward staff to clarify if needed (posters have been put up on each of the wards that participated in the pilot)
you are worried that the patient is acutely deteriorating
you continue to be concerned despite raising your concerns with the doctors and nurses looking after the patient.

If, after speaking to the doctors and nurses looking after you or your relative, you remain worried and feel your concerns are not being addressed, you can call for a rapid critical care review.

Call 0300 304 7777 and quote 'Martha's Rule call'. This is available 24 hours a day, seven days a week.

We will always ask for your consent when your number is taken, so that clinical staff can contact you and we can ask for feedback about the service you receive. Your response will be recorded securely.

You know yourself or your loved one better than anyone. You may notice small changes before they show up in our routine measurements. Telling us about these changes can help us detect deterioration early, so we can take action to prevent more serious health problems.

We see you as a partner in the care we are providing. You are not bothering us - we want to hear from you.

Martha's Rule is a patient safety service for acutely deteriorating patients. To report other problems, for example with food, parking or any other general issues, please speak to ward staff or the Patient Advice and Liaison Service (PALS).

If your ward has not been part of the pilot, please continue to speak to the nurses and doctors on the ward if you are concerned about your or your relatives condition. If you feel as though your concerns are not being addressed, please ask to speak to the nurse in charge, consultant or ward manager.

Responding to your call

When you call, you will be asked about your concerns and where the patient is currently an inpatient.

Where appropriate, a critical care doctor will review the patient and provide an independent assessment.

This may involve changing the treatment or moving the patient to a more intensive ward.

Difference between Martha's Rule and second opinions

Martha’s Rule is a patient safety initiative – it is not a second opinion.

A second opinion involves getting the views of an independent specialist clinical team or healthcare professional about ongoing diagnosis or treatment.

Please ask your doctor or nurse in charge if you wish to request a second opinion and we will facilitate this.

Martha's Rule gives our inpatients, families, carers and staff access to an urgent review if their concerns about the acutely worsening condition of a patient is not being heard.

Background to Martha's Rule

Martha Mills died in 2021 after developing sepsis whilst being treated at King’s College Hospital, where she had been admitted with a pancreatic injury after falling off her bike.

During her stay, Martha's family's concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

In response to this, campaigning from Martha's parents, and other cases related to the management of deterioration, the Department of Health and Social Care and NHS England agreed to implement Martha's Rule, which is designed to ensure the vitally important concerns of patients, and those who know the patient best, are listened to and acted upon.