Raising concerns about your NHS care

Martha's Rule: A Lifeline for Patients in England

Martha’s Rule is a patient safety initiative that allows patients, families, and carers to request an urgent clinical review from a different team if they feel someone’s condition is worsening and their concerns are not being heard.

It was introduced across NHS hospitals in response to the tragic death of 13-year-old Martha Mills in 2021. Martha developed sepsis while in hospital, and despite her parents repeatedly raising concerns about her deteriorating condition, those concerns were not acted upon. Her parents, Merope Mills and Paul Laity, campaigned for change so that no other family would be left powerless in a similar situation. 

Key Goals of Martha’s Rule:

• Empower families and patients to escalate concerns without needing medical knowledge.
• Ensure timely intervention when a patient’s condition deteriorates.
• Promote open communication between care teams and families.
• Prevent avoidable harm by formalising access to second opinions.

Since its rollout, thousands of calls have been made under Martha’s Rule, leading to hundreds of potentially life-saving changes in care. Martha’s Rule empowers patients, families, and carers to request a rapid clinical review if they feel someone’s condition is deteriorating and their concerns aren’t being addressed.

Why it matters for Addison's and other types of adrenal insufficiency

• Addison's disease and adrenal insufficiency are rare conditions that are not always easy to diagnose, and that health care professionals, particularly those outside of the endocrinology specialisms, might not be aware of, or might have little experience of dealing with.
• People with all types of adrenal insufficiency require a time-critical steroid replacement medication regimen, including the adjustment of their glucocorticoid dosage when they are under physical or severe emotional stress (Sick Day Rules). If they experience low cortisol, they are at risk of adrenal crisis, a life-threatening emergency that requires time-critical administration of hydrocortisone. Adrenal crisis can present with vague symptoms like fatigue, nausea or confusion, which may be missed or misinterpreted, particularly in busy hospital settings. 

Martha’s Rule gives you the right to escalate concerns—even if staff seem unconcerned.

How to Make a Complaint

Try and resolve it informally

• Speak directly to the staff involved or the service provider (e.g. GP practice, hospital department, or ambulance trust).
• Ask to speak with the Practice Manager or Ward Manager, or in the case of an ambulance trust, Google your trust followed by "complaint" (e.g. London Ambulance Service Complaints) to bring up their individual process.
• You can also contact the Patient Advice and Liaison Service (PALS) at the hospital - they offer confidential support and may help resolve issues quickly.
• Formal complaint procedures can be long and take a lot of time and energy, so it is worth investing in the 'informal' stage to see if a resolution can be reached.

Making a formal complaint

If the issue isn’t resolved informally, you can make a formal complaint:

• Who to complain to: The NHS organisation where you received care (e.g., GP surgery, hospital trust or ambulance trust).
• How: In writing (email or letter), by phone, or using an online form on the provider’s website.
• When: Ideally, within 12 months of the incident.

Escalate if needed

If you're unhappy with the response, you can escalate your complaint to the Parliamentary and Health Service Ombudsman (PHSO). They will review whether the NHS handled your complaint fairly and thoroughly.

For NHS complaints, you can go directly to the PHSO, but you may also choose to involve your MP if you feel it would strengthen your case or if you're facing delays.

How MPs Can Help with NHS Complaints

Supporting Your Complaint

• MPs can write to the NHS organisation on your behalf to raise concerns or request a review.
• They may help escalate the issue if you’ve exhausted the formal complaints process and still feel unheard.
• Their involvement can sometimes prompt a more thorough or timely response.

How to Involve Your MP

Find your MP: Use www.parliament.uk to search by postcode.

• Write a clear summary of your complaint:
• What happened
• When and where
• What steps you have already taken
• Why you’re dissatisfied with the response
• What you’d like the MP to do (e.g., write to the NHS Trust, refer to the Ombudsman)
• Include supporting documents: Letters, emails, complaint responses, or medical notes (if relevant).
• Be respectful and concise: MPs receive many requests, so clarity helps.

When It’s Most Helpful

• If your complaint involves systemic issues, such as repeated failures in care for people with adrenal insufficiency.
• If you believe your rights under the Equality Act 2010 have been breached.
• If you’ve experienced delays, lack of transparency, or poor communication in the complaints process.

Tips for Writing Your Complaint

• Be factual: Stick to what happened, when, and who was involved.
• Stay objective: Avoid emotional language, even if the experience was upsetting.
• Be polite: A respectful tone helps your concerns be taken seriously.
• Be clear: State what outcome you’re seeking (e.g., an apology, service improvement, or explanation).

PALS

The Patient Advice and Liaison Service (PALS) is a free, confidential NHS service in England and Wales that supports patients, families, and carers. It acts as a friendly first point of contact if you have questions, concerns, or need help navigating NHS services.

What PALS Can Do for You

• Listen to your concerns and help resolve issues informally and quickly.
• Explain NHS procedures, including how to make a formal complaint.
• Provide information about NHS services, patient rights, and support groups.
• Help you communicate with NHS staff or departments if you feel unheard or misunderstood.
• Signpost you to advocacy services if you need help making a formal complaint.

When to Contact PALS

• If you feel something went wrong with your care, but want to try resolving it without making a formal complaint.
• If you’re unsure how to raise a concern or who to speak to.
• If you need help understanding NHS processes or accessing support.

How to Contact PALS

• In person: Most hospitals have a PALS office — ask at reception or check the hospital’s website.
• Online: Use the NHS PALS search tool to find your local service.
• By phone: Call your hospital switchboard or NHS 111 and ask to be connected to PALS.

What about in Scotland, Wales & Northern Ireland?

Scotland: Rather than PALS, Scotland has the Patient Advice and Support Service, which is delivered by the Citizens Advice network. It offers a similar service to PALS.

Wales: As well as having PALS in several of the Welsh Health Boards, there is also Llais (previously known as the Community Health Councils) that offer independent complaints advocacy.

Northern Ireland: PALS in Northern Ireland is not related to patient support.  However, both the Citizens Advice and the Health & Social Care (HSC) complaints procedure are available for patients in Northern Ireland. There is also a recently updated (July 2025) Model Complaints Handling Procedure (MCHP) from the Northern Ireland Public Services Ombudsman. It is a chunky document, but Section 3 is Key Information for Service Users, and includes a quick guide to the Complaints Procedure. 

Useful links:

• NHS England Complaints Guidance
• NHS Resolution Complaints Policy (2025)
• HSC Model Complaints Handling Procedure (2025): Quick guide to the Complaints Procedure - Northern Ireland

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