Martha’s Rule: Helping Carers Speak Up When Something Doesn’t Feel Right

If you care for someone, you may notice changes before anyone else does

As an unpaid Carer, you often know the person you care for better than anyone.

You may recognise the small changes in their behaviour, breathing, alertness, pain or general wellbeing that other people might not immediately notice. When the person you care for is in hospital, that knowledge can be particularly important.

Martha’s Rule is a national NHS patient safety initiative designed to make sure patients, families and Carers have a stronger voice when they are worried that someone’s condition is getting worse. It provides a clear route to ask for an urgent review when you feel that deterioration is not being recognised or your concerns are not being adequately addressed.

Why is it called Martha’s Rule?

Martha’s Rule was introduced following the death of 13-year-old Martha Mills. Martha died at King’s College Hospital in London in 2021 after developing sepsis. Her parents had raised concerns about her deteriorating condition. A coroner subsequently concluded that Martha would probably have survived if she had been transferred to intensive care earlier and received appropriate treatment. Her parents, went on to campaign, the result is Martha’s Rule – helping to create a culture in which patients, families and Carers are listened to and have a clear route to escalate concerns.

Why Martha’s Rule matters to Carers

For many Carers, speaking up for the person they care for is already an important part of their caring role. You might notice that your mum’s breathing is different from normal, that your dad is becoming much sleepier, or simply feel that the person you care for is becoming more unwell. These observations matter.
Being a Carer can give you valuable knowledge of what is ‘normal’ for the person you support. If something has changed, do not be afraid to say so.

What should I do if I am concerned?

If the person you care for is an inpatient with Sandwell and West Birmingham NHS Trust and you are worried that their condition is getting worse, raise your concerns with the ward nurse or doctor first. If you continue to be concerned after speaking to the clinical team, or there is a sudden noticeable change that you feel has not been recognised, the Trust’s Call for Concern service provides another route to ask for help.

Call for Concern: 07811 715041 (for urgent concerns about a patient’s condition)

The service is available 24 hours a day, seven days a week. If you do not have access to a mobile phone, you can ask the ward team to bleep the service for you. The service is run by the Critical Care Outreach team, who can assess the situation and work with the patient’s medical team and other healthcare professionals where necessary.

A simple way to explain your concerns

It can sometimes be difficult to know what to say, particularly when you are worried or overwhelmed.

Try explaining:

• What you have noticed: “Dad is much sleepier than he normally is.”
• What has changed: “Yesterday he was talking to me, but today he is struggling to stay awake.”
• Why you are worried: “I care for him at home and this isn’t normal for him.”
• What you need: “I am concerned that he is getting worse. Could someone please review him?”

You do not need to use medical language. Your knowledge of the person you care for is valuable in its own right.

Martha’s Rule is continuing to develop

On 22 September 2026, the NHS announced that Martha’s Rule will be expanded to every A&E department in England. The national rollout is beginning now and is expected to be completed by March 2028, following trials in seven NHS trusts. It builds on the implementation of Martha’s Rule across inpatient hospital wards.

Carers should be aware, however, that national expansion does not mean every A&E department has the service in place immediately. If you are attending A&E and have concerns, ask staff what escalation arrangements are currently available at that hospital.

Sandwell’s approach receives national recognition

There has also been national recognition for work taking place locally. In August 2026, Sandwell and West Birmingham NHS Trust announced that its work implementing Martha’s Rule had been shortlisted for the HSJ Patient Safety Awards 2026, in the Nursing Led Patient Safety Initiative of the Year category.

Part of the Trust’s approach includes a Patient Wellness Questionnaire, which asks patients about how they feel, including whether they feel better, worse or the same and whether they have concerns about changes in their condition. Responses can then be considered alongside clinical observations, helping healthcare professionals build a fuller picture of what is happening.

Your knowledge as a Carer matters

At Sandwell Carers Service, we recognise that Carers are often a vital source of information about the people they support.

You may know their routines, communication, medication, behaviour and health better than anyone else. You may notice a subtle change that would be difficult for somebody meeting them for the first time to recognise.

Martha’s Rule reinforces an important principle: patients, families and Carers should be listened to and involved as partners in care.

Speaking up is not about challenging healthcare professionals for the sake of it. It is about sharing what you know and working together to help keep the person you care for safe. So, if something does not feel right, say something.

You know the person you care for. Your observations matter. Your voice matters.

Take a look at our Support from Health Professionals page on our website to what other assistance is available.