Michaela Guthrie

There has been much publicity about the positive impact of Martha’s Rule in the NHS in England. In the space of just over a year, more than 10,000 calls were made to the Martha’s Rule helpline, from clinicians, patients and families. Around a third resulted in a change in care, including 446 potentially life-saving interventions.

Martha Mills died aged 13 in 2021. She suffered a pancreatic injury and developed sepsis, which went undetected. Her parents repeatedly raised concerns about her deteriorating condition, but they were dismissed. By the time the severity of her condition was recognised, it was too late.

Martha’s parents shared their experiences in heartbreaking interviews and articles. This led to the creation and implementation of Martha’s Rule, which has three components: patients will be asked at least once a day how they are feeling and if they feel they are getting better or worse; all staff can ask for a review from a different team if they are concerned a patient is deteriorating and their concerns are not being responded to; patients, families and carers will be able to seek such a review. This escalation route is available 24/7 and is often named ‘Call 4 Concern’ in hospital literature.

Martha’s Rule had an immediate impact following its full launch across NHS England in 2024. Within the first two months, research found 1 in 5 clinical reviews triggered by the rule led to life-saving changes in care.

Martha’s Rule doesn’t apply to the NHS in Scotland, but is being trialled in NHS Lanarkshire’s Hairmyres Hospital, with a round-the-clock helpline to connect concerned people with senior nursing staff, who then co-ordinate a review. The outcome of this trial will be of great interest.

So what protections are currently available in Scotland to patients and their families?

NHS Scotland’s Charter of Patient Rights and Responsibilities sets out what patients are entitled to expect and what they can do if they feel their rights have not been respected. It emphasises that patients have a right to be treated with fairness, equality, consideration and respect, and confirms patients can ask for a second opinion. However, there is no right to a second opinion in Scotland.

There are signs that things are moving on in the patient rights sphere. In May 2025, the chief medical officer for Scotland published the Realistic Medicine and Value Based Health and Care Casebook, which emphasises the need for a more accessible, personalised NHS, which prioritises “shared decision-making, reducing harm and waste, and delivering care that truly matters to people”. The Casebook promotes empowerment of patients and their families to actively participate in decisions around care and treatment. Crucially, it emphasises that patient participation is essential in ensuring informed consent.

This reflects the law in this area. The groundbreaking case Montgomery v Lanarkshire Health Board enshrined in UK law that patients have a right to be fully informed about their condition and be actively involved in decision making, including being informed of all possible treatment options and the associated risks.

It is clear the conversation around decision making in Scotland is changing for the better, but we still have some way to go before we have our own version of Martha’s Rule in place. Hopefully it will not require a Scottish tragedy like the loss of Martha Mills to spur our health service into action, and to encourage openness, transparency and collaboration with patients and their families.

Michaela Guthrie is a partner at Balfour and Manson. This article first appeared in The Scotsman.