Karen Osenton was barely through the doors of the John Radcliffe Hospital in Oxford when she saw her father, David, perched on the edge of his bed, rocking, barely able to speak, his skin a sickly yellow. She walked straight to the nurses’ station and said: “You will get a consultant here now. I am invoking Martha’s Rule. I want somebody to see my dad right now.”
Within minutes the room was full of doctors. David, a retired engineer in his early 70s who had been fit and active before his illness, was, his daughter was told, “the sickest person in the hospital”. His lungs were filled with fluid and he had multi-organ failure. Inside an hour he was moved to intensive care, fighting for his life.
The invocation of Martha’s Rule came on the sixth day of David’s admission to the cardiac ward last July. For six days his family had watched him grow progressively worse. His wife, Kathleen, had repeatedly pleaded with staff: “My husband is not right, this is not David. He is so unbelievably poorly.” Even the other patients in the bay asked nurses: “Can you not see this man is extremely unwell?” But the deterioration went unchecked.
David had first visited his GP more than a month before, complaining of extreme breathlessness. Over the following weeks he became increasingly thin and weak, with suspected heart failure. He made repeated trips to accident and emergency and was sent home each time before finally being given a bed in the specialist cardiac unit last July. Even then, Karen says, every day she saw him he got worse. He could not walk, sleep or eat. By the time she arrived on that sixth day, he was jaundiced and gaunt.
Oxford University Hospitals NHS Foundation Trust (OUH), which runs the hospital, has apologised to the family and admitted mistakes were made in treating David’s cardiac failure. A review found that some delays in assessing him were “unfortunately due to service pressures and staffing limitations”, but added that clinicians also failed to spot that he was getting worse. By the time they did, he was too unwell to have the recommended surgical valve repair. A “lapse in communication” meant that two different teams were confused over which was responsible for his care.
Once in intensive care, Karen says David’s treatment was “exceptional”. “But it didn’t need to get to that point, ever,” she added. “Every day I had read those posters, every day I thought about Martha’s mum and thought: what a strong woman to do something like this. Not realising that I’d actually have to use it myself.”
What is Martha’s Rule?
Martha’s Rule is a patient safety initiative named after Martha Mills, a 13-year-old who died in 2021 from sepsis after her family’s concerns about her deteriorating condition were not adequately addressed. A coroner ruled that she would probably have survived if moved to intensive care earlier. The rule provides a formal mechanism for patients, families, carers and staff to request a rapid review by an independent clinical team when they believe concerns about a patient’s worsening condition are not being listened to.
The rule has three core components. First, patients and their families are asked daily about their condition and whether they are getting better or worse, with that information acted upon. Second, any member of staff can request a rapid review from a different team if they are worried about a patient and feel their concerns are being ignored. Third, patients, families and carers have a clear escalation route to request a rapid review, advertised prominently across the hospital.
Martha’s Rule began its phased implementation across England in April 2024, starting with 143 pilot sites. Phase 2 began in April 2025, expanding to all remaining NHS acute trusts, and the rollout is expected to be complete in all acute inpatient settings during 2026/27. Oxford University Hospitals NHS Foundation Trust, which includes the John Radcliffe, is participating, making the rule available on all inpatient wards, including adult, children’s, neonatal, maternity and emergency departments.
Early data from the first 16 months of implementation, from September 2024 to December 2025, shows that more than 10,000 calls were made to Martha’s Rule helplines. These led to 446 potentially life-saving interventions, with 1,885 patients receiving changes to their treatment. One in three calls identified acute deterioration, leading to crucial interventions. The data also suggests Martha’s Rule is picking up patients needing intervention who might not have been flagged by standard early warning scores. The proportion of cases resulting in a change or escalation of care increased over time, from one in eight in the first month to one in five after six months. Notably, 72% of calls came through the family or carer escalation process.
Martha’s Rule is also described as a “cultural intervention” aimed at flattening medical hierarchies, improving clinician listening and openness, and empowering patients and families. It formalises a right that previously had no clear pathway. While there is no legal right to a second opinion on the NHS, the General Medical Council says doctors must respect a patient’s right to seek one. Martha’s Rule provides a structured way to exercise that right within the hospital setting.
The John Radcliffe Hospital has faced scrutiny in the past. In 2005, concerns were raised about the mortality rate of patients undergoing heart surgery, with rates estimated to be double the national average between 2001 and 2004. More recently, in April 2025, the hospital’s maternity unit came under fire, with calls for an independent inquiry after more than 350 concerns about poor standards of care, including baby deaths, harm to babies and mothers, and a failure to listen to women’s concerns. A Care Quality Commission inspection in April 2023 found that while many services were good, overall the John Radcliffe “required improvement”, with specific issues in planning and delivering care in A&E, surgical and outpatient services, patient record completion, and staff shortages in maternity, surgical wards and operating theatres.
OUH has a formal complaints procedure, including a Patient Advice and Liaison Service, and says it takes complaints seriously, aiming to investigate and reply within 25 working days. In a statement, Professor Andrew Brent, the trust’s chief medical officer, said: “On behalf of the trust, I am sorry that some aspects of the care David Osenton received did not meet the high standards that we set ourselves. As an organisation, we are committed to actively listening to the concerns voiced by patients, relatives and carers and continuously improving the care we provide to all our patients. Martha’s rule and second opinions provide patients, families, carers and our staff the opportunity to raise and discuss concerns, providing additional safeguards for our patients’ care. We are glad the family were able to do this in this instance, resulting in a good outcome for David.”
David slowly recovered, but the once active motorcyclist and hands-on grandfather is now far from the man he was. “If we’ve gone for a family day out, he gets very shaky and light-headed and needs to sit down for a while,” Karen said. “People of my parents’ age group are very much: ‘Doctors know best, don’t question them.’ Whereas you really have to advocate for yourself and say: ‘No, there’s something not right.’ To stand up for your loved ones, because you only really get one chance to do that.” She added that the family remains “all still very angry” about the way Kathleen’s concerns were dismissed.
