Martha’s Rule extended to all maternity services – what it means in practice

The Government has announced that Martha’s Rule will be extended to all maternity services across England, marking a significant development in patient safety and the way concerns are escalated within healthcare settings. 

The decision follows the publication of the Ockenden Review into maternity services at Nottingham University Hospitals NHS Trust, which highlighted serious and sustained failings, including missed opportunities to prevent harm and a culture in which the voices of women and families were not always heard. 

What is Martha’s Rule?

At its core, Martha’s Rule is about empowering patients and families to raise concerns and be heard.

It gives patients, families and carers the right to request a rapid, independent clinical review if they are worried that a patient’s condition is deteriorating and their concerns are not being acted upon. 

This escalation process is available alongside existing clinical pathways and is designed to ensure that concerns are recognised early and acted on promptly.

The initiative is named after Martha Mills, a 13‑year‑old who died in 2021 after developing sepsis in hospital, where her family’s concerns about her deteriorating condition were not responded to. 

Why the extension to maternity matters

The extension of Martha’s Rule to maternity services is particularly significant.

The Nottingham review, the largest maternity inquiry in NHS history, examined the experiences of over 2,500 families and identified recurring themes, including:

• failures to listen to women and families
• missed opportunities to identify clinical deterioration
• cultures where concerns were dismissed or not escalated appropriately

Extending Martha’s Rule into maternity care is a direct response to these findings. It recognises that and must have a clear, accessible route to escalate those concerns.

A cultural, not just procedural, shift

While Martha’s Rule introduces a defined escalation mechanism, its importance goes beyond process.

At its heart, it is intended to drive a cultural shift within healthcare towards:

• listening to patients and families
• valuing lived experience
• ensuring psychological safety for staff to raise concerns

Early data from the rollout in hospitals shows that the rule is already having an impact, with thousands of calls leading to changes in care and, in some cases, potentially life‑saving interventions. 

Practical implications for maternity services

For maternity services, the rollout will mean:

• Clear and visible routes for families to raise concerns about a mother or baby’s condition
• Access to a rapid second review by an independent clinical team
• Greater emphasis on documenting and acting on family concerns
• Increased accountability where escalation pathways are not followed

For practitioners, it reinforces the importance of:

• early recognition of deterioration
• open communication with families
• responding proactively to concerns rather than defensively

What this means for families

For families, Martha’s Rule offers something tangible that has too often been missing in past maternity inquiries: a clear right to be heard and a mechanism to act on that concern.

It gives families confidence that, if they feel something is not right, there is a formal route to escalate concerns quickly and independently—without having to “battle” the system.

Final reflections

The extension of Martha’s Rule is a welcome and important development. However, as with many recommendations arising from healthcare inquiries, its impact will depend on how effectively it is implemented and embedded into everyday practice.

For those working in or alongside maternity services, this is another reminder that patient safety is not just about clinical expertise, but about listening, escalation and culture.

If implemented well, Martha’s Rule has the potential to be a powerful tool in improving maternity safety—and, importantly, ensuring that the voices of families are not only heard, but acted upon.

Read more about Irwin Mitchell's expertise in birth injury cases.