Adopting Martha’s Rule in paediatrics – the story so far and insights for NHS trusts

Martha’s Rule is currently being rolled out across the NHS, with Health Innovation Networks leading on implementation guidance and support for regional NHS trusts. In this article, we share an update on our progress and invaluable insights from pilot programmes.

What we’ve learned so far

To support the rollout, Health Innovation Networks from across the country hold a monthly meeting with NHS trusts within each region to share learning and progress.

During these meetings, we identified that NHS trusts have experienced some challenges, including concerns in rolling out Martha’s Rule in paediatrics settings. These included concerns about a lack of appropriate teams for second review and electronic resources to record Patient Wellness Questions.

In August, we invited Dr Ben Richardson, a Consultant Paediatrician from Yorkshire and Humber, whose paediatric department participated in a pilot to see how they overcame this.

Here are a few insights:

• You don’t need a Paediatric Critical Care Outreach Team (CCOT). Martha’s Rule in adult settings is supported by CCOTs. However, most paediatric settings do not have their own CCOT. Dr Richardson shared that in most sites, a different team conducts the second review, working alongside the adult CCOT in triage.
• Paediatric Early Warning Scores (PEWS) do not include a patient wellness question; however, national research is ongoing to incorporate this to capture parents’ or children’s perceptions of their condition.
• Dr Richardson shared Standard Operating Procedures and Flowcharts to support teams to roll out Martha’s Rule in paediatrics.
• Culture is key. This isn’t just about flowcharts – it’s about making sure concerns are heard and acted on.

These were invaluable insights for the regional teams we are supporting.

What’s next

• NHS trusts in the Kent, Surrey and Sussex region are now completing their procedures for rolling out Martha’s Rule in paediatrics.
• Health Innovation Kent Surrey Sussex continues to support NHS trusts in the roll out of Martha’s Rule.
• Pilots are underway across England for introducing Martha’s Rule to maternity, community, A&E and mental health settings.
• NHS trusts continue to collect data on the roll out of Martha’s Rule.
• Monthly regional sharing networks and regular national updates continue.
• On 4 September 2025, which would have been Martha’s 18^th birthday, Martha’s Mum, Merope, announced that Martha’s Rule will be rolled out across all care settings across England.

Martha’s Rule – the background

Martha’s Rule was introduced after the tragic death of 13-year-old Martha Mills in 2021. Despite her parents’ concerns, she wasn’t referred to intensive care when she needed it. The coroner later said she would probably have survived if that escalation had happened.

Martha’s Rule aims to make sure families and staff always have a clear way to ask for an urgent review from a different clinical team, often a Critical Care Outreach Team, if they feel something isn’t right. Patients will also be asked at least daily about how they are feeling, and if they are getting better or worse, and this information will be acted on in a structured way. But more than that, it’s about culture, breaking down hierarchies, listening better, and working in partnership with families.

Why it matters for all of us

Even if you’re not directly involved, Martha’s Rule is a reminder of why patient safety and family voices matter. It’s about empowering everyone – patients, parents, and staff – to speak up when something doesn’t feel right and making sure those concerns are taken seriously.

More information on Martha’s Rule