Martha’s Rule is a patient-safety initiative being rolled out across NHS hospitals. It gives patients, families and carers a clear way to ask for an urgent review if they are worried that a health condition is getting worse – ensuring their concerns are heard and acted upon.
The policy was introduced following the death of 13-year-old Martha Mills, who died from sepsis in hospital in 2021. Her parents had repeatedly raised concerns about her deteriorating condition, but these were not acted on. A coroner later concluded that Martha would probably have survived had she been transferred to intensive care sooner.
Her family’s determination to create change in the midst of unimaginable loss has already helped improve safety for others. That legacy deserves recognition.
Sixteen months into implementation, early data suggests the impact is both encouraging and thought-provoking. More than 10,000 patients, families and staff have used the NHS process to escalate concerns about care. Around one in three of those contacts identified serious patient deterioration, and hundreds of people received potentially life-saving interventions.
Behind every one of those numbers is a moment when someone chose to speak up – often worried, uncertain, and sometimes after already feeling unheard.
I have been following the rollout of Martha’s Rule with real interest. It is one of the most significant recent patient-safety reforms because it recognises a simple but vital truth: patients, families and carers often know when something is wrong.
At The Advocacy Project, we work every day with people navigating complex health and care systems. We know from their experiences that patients and families frequently notice changes, risks or concerns before anyone else does. What feels important about this moment is that we are now seeing clear evidence of how powerful listening can be.
…people have the right to be heard. We can change the future by speaking up.”
Service User and member of Our Choice
The cost of not listening
For many people, stories like Martha’s are sadly not unfamiliar. The Learning Disabilities Mortality Review (LeDeR) has repeatedly found that people with a learning disability die significantly earlier, on average, than the general population. Too many of those deaths are linked to missed diagnoses, delays in treatment, or conditions that could have been prevented or treated earlier.
What the data tells us
The new NHS England figures are striking. Thousands of contacts have raised concerns about deterioration, while many others have related to communication, coordination and standards of care.
That matters.
It shows that when people raise concerns, they are often identifying genuine issues that need attention. It also reminds us that safety is not only about clinical intervention. It is also about communication, respect, clarity and ensuring people’s rights are upheld.
Crucially, the number of contacts has increased significantly as awareness of the scheme has grown. That tells us something important: when people know they will be heard, they are far more likely to speak.
Culture change takes more than policy
The early impact of Martha’s Rule is encouraging (evidence suggests that more than 500 lives may have been saved since 2024), but policy on its own is never enough.
We know that failures to listen can happen across every part of the health and care system, not only in hospitals. We also know that some people remain far less likely to speak up, even when routes to do so exist. This includes people with learning disabilities, people experiencing poor mental health, those affected by trauma, and others whose voices have too often been overlooked.
If we want lasting change, we must challenge the assumptions and barriers that can devalue lived experience. People who use services should not only be heard when something goes wrong; they should help shape how services are designed and improved. Our User Involvement work aims to do just that – because true change depends on culture as much as process.
We speak up for learning disabilities, what is important to people, we go to meetings, like transport, housing, talk about leisure centres to make things accessible.
User Involvement group member
A call to go further
Merope Mills has spoken powerfully about the sense of agency Martha’s Rule can give to patients and families. That word matters.
For too long, healthcare systems have spoken about patient-centred care while still holding much of the power. Martha’s Rule is an important step towards changing that balance.
It should also prompt us to think more broadly about how patient voice is supported across health and care services. At a time when the evidence for listening is becoming clearer than ever, the mechanisms that help people be heard should be strengthened. It feels deeply ironic that the planned abolition of Healthwatch and other patient voice mechanisms is now on the horizon, at the very moment when evidence is emerging that listening to patients, families and carers has such a tangible impact on care and outcomes.
Independent advocacy can play an important role here, particularly for people who may struggle to navigate systems or speak up alone in high-pressure situations.
Martha’s Rule is an initiative to welcome and build upon. It shows that when people are genuinely listened to, harm can be prevented and lives can be saved. But to make that promise real for everyone, it must be matched by a wider commitment across the NHS to hearing every voice.
To find out more about Martha’s Rule, visit: https://www.england.nhs.uk/patient-safety/marthas-rule/