On what would have been Martha Mills’s eighteenth birthday, a sweeping change to patient safety in England’s hospitals quietly reached a new milestone. As of September 4, 2025, “Martha’s Rule” is now available in every acute hospital across England, marking a pivotal moment for the National Health Service (NHS) and the families it serves. The initiative, named after 13-year-old Martha Mills, who tragically died from sepsis in 2021 after her parents’ concerns were repeatedly dismissed, is designed to empower patients and their families to seek urgent second opinions when they fear something is amiss with care.
The story behind Martha’s Rule is as heartbreaking as it is galvanizing. According to Sky News, Martha was admitted to King's College Hospital NHS Foundation Trust in south London following a bike accident. While recovering, she developed sepsis—a life-threatening response to infection. Despite her parents, Merope Mills and Paul Laity, raising alarms about her deteriorating condition, their worries were brushed aside. The situation became dire when Martha began bleeding heavily through medical tubes. Her mother warned staff that Martha was at risk of septic shock, but her pleas went unheeded. A later inquest found that, had doctors recognized the warning signs and transferred Martha to intensive care sooner, she most likely would have survived. One intensive care doctor even testified, “I would 100% have admitted her if I had seen her.”
The Mills family’s pain has since become a catalyst for change. As The Independent reports, Merope Mills and Paul Laity launched a campaign to ensure that no other family would endure the same loss. “We feel her absence every day, but at least Martha’s rule is already preventing many families from experiencing something similar,” they said in a statement. “The figures prove that lives are saved when patients and families are given power to act on their suspicions when they feel doctors might have got it wrong and their voice isn’t being heard.”
What exactly does Martha’s Rule entail? In essence, it formalizes the right of patients, their families, carers, and even staff to request an urgent clinical review by a different medical team if there are concerns about a patient’s worsening condition. This escalation process is available around the clock and is advertised throughout hospitals, making it clear that everyone has the right to speak up. Notably, patients are now asked at least daily about their well-being, and staff are empowered to seek a review from another team if they feel their concerns are not being addressed.
The numbers, shared by NHS England and reported by Sky News and Glamour UK, are telling. Between September 2024 and June 2025, Martha’s Rule helplines fielded 4,906 calls—nearly three-quarters from families. Of those, 720 led to direct changes in care, such as new medications or antibiotics, and almost 800 addressed clinical concerns like delayed investigations or missed medications. Importantly, 241 cases involved improvements in care that may have saved lives. These results underscore the initiative’s life-saving potential and the critical importance of listening to those closest to the patient.
Martha’s Rule was first piloted in May 2023 at 143 sites, with the Sunak government outlining the measure in response to Martha’s death. Now, with 67 additional sites joining, all 210 acute inpatient facilities in England are covered. Acute care, as Glamour UK explains, refers to short-term medical treatment in settings like hospitals, accident and emergency departments, and inpatient surgeries. The rule’s reach is broad, and its message is simple: patients and families know the patient best, and their voices matter.
The rollout has not gone unnoticed at the highest levels of government. Health Secretary Wes Streeting told Sky News, “No family should ever have to go through what Merope and Paul Mills endured when they lost Martha, but her parents’ tireless campaigning has created a lasting legacy that is already having a potentially lifesaving impact across England. Martha’s rule puts patients and families at the heart of their care. By rolling this out to every acute hospital in England, we’re delivering on our promise through our plan for change to rebuild trust in the NHS and put patient safety first.”
Yet, the introduction of Martha’s Rule comes against a backdrop of broader challenges in the NHS. According to Glamour UK, England’s first Women’s Health Strategy in 2022 revealed that 51% of the population had faced obstacles in accessing necessary care. Reports of “medical gaslighting,” particularly for chronic conditions like endometriosis, and a 2025 survey showing that 51% of Black, Asian, and ethnic minority patients had encountered discrimination in NHS services, highlight persistent inequalities. Compared to white British patients, ethnic minority groups reported worse communication with their GPs and felt less taken seriously. These findings suggest that while Martha’s Rule is a crucial step, much work remains to ensure equitable, respectful care for all.
The campaign’s impact has spurred calls for further expansion. Merope Mills, speaking on BBC Radio 4’s Today programme and reported by The Independent, urged the government to extend Martha’s Rule into maternity care. “We spend more on settling medical negligence maternity cases—maternity lawsuits—than on maternity care in this country and there’s something very, very wrong with that. I believe it’s because there are a number of cases where women’s voices aren’t listened to,” she said. Mills emphasized that Martha’s Rule acts as a safety net not just for patients but also for doctors, allowing concerns to be raised and addressed without fear. “It’s a safety net for doctors and clinical staff as much as it is for a patient,” she added.
Dr. Aidan Fowler, national director of patient safety in England, confirmed that the government is already exploring how to pilot Martha’s Rule in maternity settings. “We will be piloting it in maternity. It’s a more complex area—not only can people giving birth deteriorate physically, but we have their babies that might deteriorate… so we’ve got to make sure the right people respond,” he explained to the BBC. The need for reform is urgent: a national investigation into “systemic” failures in NHS maternity care was launched in June 2025, following reports that families who lost babies were “gaslit” in their search for answers. As The Independent revealed, a 2020 exposé uncovered repeated poor care at Nottingham University Hospital, with dozens of babies left with brain damage or worse. A criminal investigation into corporate manslaughter is ongoing.
For patients and families navigating the healthcare system, Martha’s Rule offers a lifeline. Advocacy tips, such as asking questions, taking notes, and having a medical advocate, are now more than just good advice—they are supported by formal mechanisms that recognize the patient’s right to challenge and clarify their care. The NHS Constitution, as Glamour UK points out, enshrines these rights, but Martha’s Rule brings them to the fore in a practical, accessible way.
As the NHS continues to grapple with issues of trust, equality, and safety, Martha’s Rule stands as a testament to the power of persistence, the importance of listening, and the enduring impact of one family’s loss. The hope is that, in honoring Martha’s memory, countless other lives will be safeguarded—and that the culture of care within the NHS will shift toward one where every voice, no matter how small, is heard.
