Martha's Rule

Martha’s Rule

Raising Concerns When a Patient May Be Getting Worse

This guide explains Martha’s Rule and the additional safety route being introduced across NHS acute inpatient care in England for patients, families, carers and staff who are worried that someone may be deteriorating.

It explains the three core components of Martha’s Rule and how the rapid-review process can provide an additional clinical safety net when concerns do not appear to be receiving an adequate response.

It includes:

• What Martha’s Rule is and why it was introduced
• The three core components
• Why patient and family observations matter
• When a rapid review may be requested
• What can happen after a request
• How to communicate concerns clearly
• Accessible information and reasonable adjustments
• What Martha’s Rule does and does not replace
• The current 2026/27 implementation position
• Practical questions for patients, families and carers

A practical guide to speaking up about deterioration and understanding the additional escalation route provided through Martha’s Rule.

Space to Breathe Therapy