Martha's Rule: Medicine Interview Case Study (2026)

Martha's Rule and patient safety

Martha Mills died of sepsis at 13 after her parents' worries were not acted on. Every acute hospital in England now has to offer the rule named after her, and it has been used more than 19,000 times.

Aug 2021Martha Mills dies of sepsis at 13

Feb 2022Coroner says earlier intensive care would probably have saved her

May 2024The rule starts at 143 hospital sites

Sep 2025All 210 acute sites in England covered

Mar 2027Deadline for every hospital to have all three parts

Summary

Martha Mills injured her pancreas falling off her bike in the summer of 2021 and was treated at King's College Hospital in London.
She developed sepsis there and died on 31 August 2021, aged 13.
Her parents had raised concerns as she got worse. She was not moved to intensive care in time.
The coroner found in February 2022 that she would most likely have survived with a prompt referral to the intensive care team.
Martha's Rule has three parts:
- Staff ask patients at least once a day how they are feeling, and act on the answer.
- Any member of staff can ask a different team to review a patient.
- Patients, families and carers can ask for that review themselves.

Dig deeper

The rule started in May 2024 at 143 hospital sites. On 4 September 2025 NHS England extended it to all 210 acute inpatient sites in England.
Hospitals must have every part in place by 31 March 2027 under their NHS contract.
The NHS recorded 19,177 calls between September 2024 and July 2026, 72% of them from families and carers:
- 5,660 were about a patient getting acutely worse.
- 3,432 led to a change in treatment.
- 749 ended with a move to high dependency, intensive or specialist care.
NHS England is now extending the rule to A&E, maternity and neonatal units.

Ethical issues

Principle	How it applies here
Beneficence	Acting in a patient's interest includes listening to the people who know them best. A parent often notices that something is wrong before the observations chart does.
Non maleficence	The harm to Martha came from a delay in referring her. The rule gives families and junior staff a route to a second team that does not depend on the first team agreeing.
Justice	About seven in ten calls turn out not to involve acute deterioration, and each one takes a critical care team away from other patients. Against that, 749 patients were moved to a higher level of care after a call.

Principle

How it applies here

Beneficence

Acting in a patient's interest includes listening to the people who know them best. A parent often notices that something is wrong before the observations chart does.

Non maleficence

The harm to Martha came from a delay in referring her. The rule gives families and junior staff a route to a second team that does not depend on the first team agreeing.

Justice

About seven in ten calls turn out not to involve acute deterioration, and each one takes a critical care team away from other patients. Against that, 749 patients were moved to a higher level of care after a call.

Interview questions

What is Martha's Rule and why was it introduced?
A mother tells you her child "is just not right", but all the observations are normal. What do you do?
You are the most junior doctor on the ward and think your consultant has missed something. How do you raise it?
How is Martha's Rule different from asking for a second opinion?
Most calls under the rule are not about a patient getting acutely worse. Is it still a good use of critical care teams?
Why might a doctor fail to listen to a patient's family?
Should the rule apply in GP surgeries and mental health units as well as hospitals?

Sources

NHS Englandengland.nhs.uk/…/marthas-rule
southwarknews.co.uksouthwarknews.co.uk/…/death-of-girl-13-inquest-says-it-is-likely-she-would-have-su
Courts and Tribunals Judiciaryjudiciary.uk/…/jonathan-stevens-prevention-of-future-deaths-report
NHS Englandengland.nhs.uk/…/marthas-rule-rolled-out-to-all-acute-hospitals

Photo: Paul Farmer, CC BY-SA 2.0, via Wikimedia Commons, colour altered.

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