Martha's Rule and the Medico-Legal Landscape

In September 2025, NHS England confirmed that Martha’s Rule is now active across all acute hospitals in England. This initiative gives patients, their families, and staff the right to request a rapid review by a different clinical team if they are concerned that deterioration is being overlooked.

The rule is named after Martha Mills, a 13-year-old who tragically died in 2021 from sepsis after her parents’ concerns were not acted upon. Her case highlighted systemic failures in escalation, communication, and recognition of deterioration - failures now directly addressed by Martha’s Rule.

While its primary purpose is patient safety, Martha’s Rule also has far-reaching implications for medico-legal practice and the way clinical negligence claims will be investigated, defended, and litigated.

The Structure of Martha’s Rule

Martha’s Rule has three key elements:

1. Daily check-ins: Patients are asked if they feel better or worse, ensuring their perception of deterioration is heard and documented.

   
   

2. Staff escalation: Any member of staff can request a review by a different clinical team if they believe concerns are not being addressed.

   
   

3. Family escalation: Families can trigger an urgent review via a prominently advertised system (such as a hotline or bleep), independent of the patient’s primary team.

These structured routes for escalation provide both a safety net for patients and a formal audit trail for accountability.

What This Means for Medico-Legal Claims

1. A Clearer Audit Trail

Every time Martha’s Rule is triggered, it generates a record: who raised the concern, when, how it was handled, and what the outcome was. For solicitors and expert witnesses, this provides a much stronger evidential basis than previously available. Disputed accounts of “we raised concerns but were ignored” will now be supported—or challenged—by documented escalation logs.

2. Shaping Breach of Duty Analysis

The presence of Martha’s Rule creates an additional benchmark of reasonable practice. If families or staff attempted escalation and the hospital failed to respond appropriately, this may more easily be framed as a breach of duty. Likewise, failure to inform patients and families of their right to use Martha’s Rule could itself become a source of liability.

3. Strengthening Causation Arguments

The national roll-out has already produced data showing that calls made under Martha’s Rule lead to meaningful interventions, including ICU transfers and urgent treatments. This strengthens causation arguments: if escalation was ignored or delayed, claimants may demonstrate that earlier action would likely have changed the outcome.

4. Greater Disclosure in Litigation

Expect to see disclosure requests expanding to include:

• Martha’s Rule activation logs, timestamps, and outcomes

• Local hospital policies and staff training records

• Communication materials provided to patients and families

• Any internal reviews linked to failed or delayed escalation

This will give courts and experts far greater clarity about how a trust responded to concerns.

5. Expansion Across Care Settings

The rule is currently embedded in acute hospitals, but NHS England is testing it in maternity, neonatal, emergency, community, and mental health services. This means claims in these fields will also begin to feature Martha’s Rule evidence, widening its medico-legal relevance.

Final Thoughts

Martha’s Rule represents both a cultural and legal shift. It empowers patients and families, flattens hierarchies, and formalises escalation. For clinical negligence lawyers and expert witnesses, it provides a structured evidential framework that can clarify breach of duty and strengthen or weaken causation arguments.

Handled correctly, Martha’s Rule will prevent avoidable harm. But when it is ignored, misapplied, or poorly communicated, it will almost certainly feature in litigation.

Understanding this framework is now essential for anyone working in the medico-legal field.