Detecting Deterioration – what is Martha’s Rule?
Martha’s Rule is a national patient safety initiative from NHS England, which gives patients and families access to an urgent review if they are worried that an inpatient’s health condition is getting worse (deteriorating).
You may have also heard this referred to as Call For Concern.
Patients and their visitors have the right to request a rapid review if you’re worried that your or your loved one’s condition is getting worse. You will see posters and information around our hospital, including in patient bedrooms.
What does this mean?
We regularly check patients' vital signs and other important health measurements while they are in our hospital.
How often we do these checks will depend on the patient's health condition and needs.
In addition, from December 2025, our staff will also ask at least daily if patients are feeling better or worse.
This is to monitor any unexpected changes in their condition.
However, you know yourself or your loved one better than anyone. You may notice small changes before our hospital team does.
These changes could be early warning signs of deterioration.
What to do if you’re worried
If you are worried that a patient's health condition is getting worse, there are two main steps.
Step One
Speak to the ward team about your concerns.
Step Two
If you feel that your concerns have not been addressed or you are still worried about a patient, you can call our dedicated phone line at any time, day or night, 24 hours a day, seven days a week:
01223 639 444
Your call will go to a different team in our hospital, who specialise in the care of critically ill patients. They will work with your or your loved one’s care team to arrange any treatment needed or further review.
What things might make me call this number?
Some changes that you may notice:
- The patient seems different to usual (not themselves)
- Breathing differently
- Sweating or unusual skin colour
- Reduced urine output or not passing urine
- More sleepy than usual or confused
- Hands feel cold or very hot
- In pain and looks uncomfortable
When should I not make a call?
Martha's Rule is only for concerns about unwell inpatients who require an urgent clinical response. There is a difference between Martha’s Rule and second opinion.
Martha’s Rule allows hospital inpatients and their families to seek a rapid review if their condition, or the condition of a loved one, is deteriorating.
A second opinion is when you would like to see another consultant to discuss any diagnosis or treatment.
Additional contact information
Our patient advice and liaison service (PALS) supports patients, carers and relatives who wish to raise concerns or share compliments.
More about Martha Mills
Martha Mills died in 2021 after developing sepsis in a London hospital, where she had been admitted with a pancreatic injury after falling off her bike.
Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.
The initiative has three main components:
• 24/7 rapid review: All staff and patients, families, carers, and advocates can contact a critical care outreach team at any time.
• Daily health information: Clinicians will record daily information about a patient’s health directly from them or their families.
• Escalation process: Staff can use the 24/7 escalation process to raise concerns.