Martha's Rule: The Most Powerful Safeguarding Tool Is Being Listened To

25 Jun

This week, the Government announced that Martha's Rule will be extended to every maternity and neonatal service across England following the publication of Donna Ockenden's review into maternity care at Nottingham University Hospitals NHS Trust. The review, the largest in NHS maternity history, examined the experiences of around 2,500 families and found serious and sustained failures in care, including repeated instances where women and families raised concerns that were not acted upon.

For many, this announcement will be seen as another patient safety initiative. From a safeguarding perspective, it represents something much more profound. It represents a shift in power.

What is Martha's Rule?

Martha's Rule was developed following the death of 13-year-old Martha Mills, who died from sepsis in 2021 after her family repeatedly expressed concerns that her condition was deteriorating. A coroner concluded that Martha would probably have survived had she been transferred to intensive care sooner.

The initiative gives patients, families and carers the right to request a rapid clinical review if they believe a patient's condition is worsening and they feel their concerns are not being responded to.

Importantly, Martha's Rule also empowers healthcare staff to escalate concerns if they believe deterioration is not being recognised.

It is not simply a second opinion.

It is a structured escalation pathway designed to ensure that concerns are heard before harm occurs.

Why Has It Been Extended?

The decision follows Donna Ockenden's review into maternity services at Nottingham University Hospitals NHS Trust.

The review identified repeated failures to recognise deteriorating mothers and babies, missed opportunities to intervene, poor communication, and a culture in which families and even staff often felt their concerns were ignored or dismissed.

In response, the Government has committed to rolling Martha's Rule out across every maternity setting in England, ensuring parents can request an urgent independent clinical review if they believe their baby or the mother is deteriorating.

Early evidence already demonstrates the impact.

Across NHS sites where Martha's Rule has been implemented, thousands of escalation calls have been made, with hundreds resulting in potentially life-saving transfers to higher levels of care or significant changes to treatment.

Listening Is a Safeguarding Intervention

At RLB, we often talk about safeguarding as though it begins when abuse, neglect or harm is identified.

But safeguarding often starts much earlier.

It starts when somebody says: "Something doesn't feel right."

The tragedy behind Martha's Rule is not simply that clinical deterioration occurred. It is that people noticed. Parents noticed. Professionals noticed. Concerns were raised but those concerns were not always heard.

That should resonate far beyond healthcare.

This Isn't Just About Hospitals

The principles behind Martha's Rule apply across every safeguarding setting.

In education...

Do we listen when a child tells us something has changed?

In social care...

Do families feel confident enough to challenge professional decisions?

In workplaces...

Do employees feel psychologically safe enough to escalate concerns?

In charities...

Can volunteers question decisions without fear?

In safeguarding, we often talk about professional curiosity. Perhaps we should spend just as much time talking about professional humility. Being willing to stop, listen, reflect, and accept that the people closest to a situation may sometimes notice what professionals have missed.

Our Perspective

One sentence from the NHS guidance stands out:

"Those who know the patient best may be the first to notice changes."

That principle applies to safeguarding everywhere. Parents know their children. Families know their loved ones. Colleagues notice when someone's behaviour changes. Communities recognise when something feels different.

Good safeguarding cultures do not see challenge as criticism. They see challenge as another layer of protection. Too often, safeguarding reviews identify the same themes:

People spoke up.
People raised concerns.
People weren't listened to.

Martha's Rule reminds us that safeguarding is not simply about having reporting systems.

It is about creating cultures where every concern is taken seriously, regardless of who raises it.

Looking Ahead

Martha's Rule is undoubtedly an important patient safety initiative but perhaps its greatest legacy will be cultural rather than clinical. It reminds us that safeguarding is built on listening, not hierarchy, not assumptions, not professional status. Listening.

Because the difference between someone being heard and someone being dismissed can quite literally be the difference between life and death.

At RLB, we believe safeguarding is everyone's responsibility and that responsibility begins with creating environments where every voice matters, every concern is explored, and nobody is ever made to feel that speaking up was the wrong thing to do.