top of page
Logo white + red.png


A red electrocardiogram
A red electrocardiogram
A red electrocardiogram

What is Martha's Rule? Understanding the NHS's Latest Advancement

What happened with Martha's Case?

Martha Mills, a 13-year-old, tragically lost her life to sepsis after the signs of her deteriorating condition were missed by healthcare professionals. Her ordeal began with a seemingly minor cycling accident during her summer holidays, which resulted in an injury to her pancreas. Despite being admitted to King's College Hospital in south London, her condition escalated into sepsis, a life-threatening response to infection that can lead to tissue damage, organ failure, and death. The inquest into Martha's death revealed that with prompt and appropriate medical intervention, her sepsis could have been treated, potentially saving her life. The hospital later issued an apology for the oversight in her care.

This case underscored the critical need for heightened awareness and rapid response to the signs of sepsis in healthcare settings. It also brought to light the essential role that patients' families play in monitoring and advocating for their loved ones, especially in situations where healthcare professionals may overlook critical symptoms. The campaign led by Martha's parents for better recognition and response to sepsis has catalysed the introduction of "Martha's Rule" in NHS hospitals. This initiative aims to empower patients and their families, ensuring that concerns about a patient's worsening condition are promptly acted upon, with the hope of preventing similar tragedies in the future.

What is Martha's Rule and how will it affect the NHS?

Martha's Rule is a new initiative set to be introduced in NHS hospitals in England from April, aimed at providing seriously ill patients with easy access to a second opinion if their condition worsens. The scheme is backed by the government and will allow about two-thirds of hospitals, at least 100 initially, to apply for funding to participate. This system seeks to empower patients and their families by enabling them to directly request a "rapid review" of the patient's treatment from a team of critical-care medics.

These reviews will be conducted by senior doctors or nurses who specialise in the care of patients who are deteriorating, ensuring an immediate reassessment of the patient's condition. Additionally, the scheme emphasises the formal recording of families' observations regarding the patient's condition or behaviour, acknowledging the vital role that patients and families can play in the monitoring process. The introduction of Martha's Rule reflects a significant shift towards enhancing patient safety and ensuring that concerns raised by patients or their families are promptly and effectively addressed.

What is Sepsis and how it can affect children?

Sepsis is a severe and potentially life-threatening condition triggered by the body's response to an infection. It arises when the body's defense system, in its attempt to fight off an infection, inadvertently turns on itself, causing widespread inflammation and clotting within the tissues and organs. This can lead to a cascade of changes that may damage multiple organ systems, leading them to fail. In the UK, sepsis is recognised as a medical emergency, with healthcare professionals trained to "think sepsis" when patients present symptoms indicative of severe infection. Early symptoms in children can include a high or low body temperature, chills and shivering, a fast heartbeat, and rapid breathing. In more severe cases, children may exhibit mottled, bluish, or pale skin, lethargy, a rash that does not fade when pressed, difficulty breathing, or convulsions/seizures.

Diagnosing sepsis promptly is crucial, especially in children, as their condition can deteriorate quickly. In the UK, the NHS employs several diagnostic tools and protocols to identify and treat sepsis at the earliest possible stage. These include blood tests, urine or stool samples, respiratory secretion testing, and imaging studies such as X-rays, CT scans, or ultrasounds to identify the source of infection. Treatment for sepsis typically involves administering intravenous antibiotics, providing oxygen if levels are low, and ensuring fluids are given to prevent dehydration and maintain blood pressure. In severe cases, children may require admission to an intensive care unit for more specialised support. The UK's healthcare system emphasises the importance of early recognition and rapid response in the treatment of sepsis, aiming to reduce the risk of long-term complications and fatalities associated with the condition.

NICE guidance / Sepsis Trust Guidance

The National Institute for Health and Care Excellence (NICE) and the Sepsis Trust UK are pivotal organisations in the UK, providing comprehensive guidelines, resources, and support for managing and raising awareness of sepsis, including its impact on children.

The National Institute for Health and Care Excellence (NICE) in the UK provides comprehensive guidance for the recognition, diagnosis, and early management of sepsis, including specific recommendations for children under 16 years old. This guidance, encapsulated in NICE guideline [NG51], emphasises the importance of early recognition of potential sepsis in anyone presenting with an infection, and it outlines steps for initial treatment, escalating care, and finding and controlling the source of infection. Key to this guidance is the notion of "thinking sepsis" early in the assessment process for individuals with suspected infection, especially given sepsis can present with non-specific symptoms and signs, sometimes even without fever. Healthcare professionals are advised to have a high index of suspicion for sepsis particularly in vulnerable groups such as those under 1 year or over 75 years of age, those who are pregnant, immunocompromised, have recently undergone surgery, or have a medical device or line in situ. High-risk individuals are recommended to receive broad-spectrum antibiotics and intravenous fluids in a hospital setting​​​​.

The Sepsis Trust UK focuses on raising public and professional awareness of sepsis, advocating for improved care, and providing support to those affected by sepsis. For children, the Trust provides educational resources aimed at parents, caregivers, and professionals to help them recognise the early signs of sepsis, empowering them to seek medical attention swiftly. The Trust also engages in policy advocacy to enhance the standard of care and support for sepsis patients, including children, within the NHS and wider. Through its initiatives, the Sepsis Trust UK aims to reduce the incidence and mortality associated with sepsis by ensuring both the public and healthcare providers are informed and vigilant.

For more detailed guidance and information, visiting the NICE website and the UK Sepsis Trust's official website would be beneficial.


In conclusion, the heart-wrenching case of Martha Mills has underscored the paramount importance of recognising and swiftly addressing sepsis, especially among children. The launch of Martha's Rule within the NHS marks a pivotal shift towards enhancing the responsiveness to sepsis in healthcare settings across the UK. This initiative, together with the crucial guidance provided by NICE and the advocacy efforts of the UK Sepsis Trust, signifies major progress in the fight against sepsis.

As an expert witness company, we've provided advice and specialist opinion in a significant number of sepsis related cases, reflecting both the commonality of this condition and the complexities involved in its diagnosis and treatment. These instances starkly highlight the necessity for early detection and the pivotal role healthcare professionals play in averting the severe consequences of sepsis.


A photo of Scott Harding-Lister, Head of Practice at Apex Health Associates


bottom of page