Martha’s Rule: Second Opinions, Patient Safety, and Medicolegal Risk

On 9 March 2026, NHS England reported that Martha’s Rule helplines had received over 10,000 calls in their first sixteen months. More than 3,400 of those calls identified acute clinical deterioration, resulting in 1,885 changes in management, including 446 potentially life‑saving interventions. These figures are significant. They demonstrate that patients and families often recognise deterioration before it is acted upon by treating teams.

They also carry important medicolegal implications.

This article explains what Martha’s Rule is, why it matters for patient safety, and how it is likely to influence clinical negligence claims involving deteriorating inpatients.

Martha Mills and the Origins of Martha’s Rule

In August 2021, thirteen‑year‑old Martha Mills was admitted to King’s College Hospital following a cycling accident. The injury caused a pancreatic transection, and she was transferred for specialist paediatric care.

Over the following days, Martha developed sepsis. Her parents repeatedly raised concerns that her condition was worsening, pointing to persistent fever, hypotension, tachycardia, and a rash suggestive of sepsis. These concerns were not escalated appropriately. A subsequent investigation identified at least five occasions on which referral to paediatric intensive care would have been appropriate. A PICU bed was available throughout.

Martha died on 31 August 2021. At the 2022 inquest, the senior coroner concluded that, on the balance of probabilities, she would have survived had she been referred promptly to intensive care. The trust admitted breach of duty.

What Is Martha’s Rule?

Martha’s Rule was developed in response to this case and introduced across NHS hospitals in England from April 2024. It establishes a formal right to an urgent second opinion for hospital inpatients and has three core components:

• Patients are asked at least once daily about their condition and care
• Any member of staff can request an urgent independent clinical review if concerned
• Patients, families, and carers can directly trigger escalation if they believe deterioration is not being addressed

Following a national pilot, the scheme was rolled out to all acute NHS trusts in September 2025. By December 2025, it had generated over 10,000 calls. While 446 led to potentially life‑saving intervention, many others resulted in improvements to care, communication, or coordination.

Medicolegal Implications for Clinical Negligence Claims

Although Martha’s Rule is a patient‑safety initiative, it is likely to influence how courts assess the management of deteriorating inpatients.

Over time, failure to offer or facilitate access to a second opinion may itself be relied upon as evidence of breach of duty.

Documentation will be central. Calls made under Martha’s Rule are logged. Where escalation occurred but appropriate action did not follow, that record may be powerful evidence in subsequent litigation. Conversely, where no call was made because the patient or family was unaware of the scheme, inadequate implementation or publicity may itself attract criticism.

Why the Inpatient Setting Is Different

In the outpatient setting, seeking a second opinion is relatively straightforward. A patient can ask their GP for referral or pursue a private opinion.

The inpatient context is different. Patients are often acutely unwell, anxious, and dependent on the treating team. Requesting a second opinion may feel like challenging those responsible for their care. Many patients lack the confidence to do so. Families may also fear that raising concerns could damage relationships with staff, particularly if they have already felt dismissed.

Martha’s Rule addresses this imbalance. It provides a formal, non‑confrontational route to independent review. Escalation does not depend on persuading the treating team to seek a second opinion; it is a right that patients and families can exercise directly.

Early data supports this. Hundreds of potentially life‑saving interventions indicate that even conscientious teams can miss evolving deterioration. Independent review brings fresh perspective where familiarity may obscure risk.

Practice‑Focused Takeaways

Conclusion

Martha’s Rule is already improving patient safety. As it becomes embedded across the NHS, it will also reshape the medicolegal landscape surrounding deteriorating inpatients.

For clinicians, the message is clear: when patients or families say something is wrong, listen — and where doubt exists, involve an independent review. For those advising on clinical negligence claims, Martha’s Rule will increasingly form part of the standard against which care is judged.

At its core, the rule reflects a simple principle: patients and families are often the first to notice when something is going wrong, and healthcare systems must be designed to hear them.