NHS England has confirmed that Martha’s Rule will be extended to all hospital A&E departments across England, giving patients, loved ones and staff 24/7 access to a dedicated phone number to trigger an urgent review if a patient’s condition is deteriorating and they feel their concerns are not being heard.
Background of Martha’s Rule
The rule was introduced following the death of 13-year-old Martha Mills, who developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London in 2021, where she had been admitted with a pancreatic injury after falling off her bike. In 2022, a coroner ruled that Martha would probably have survived if medics had transferred her to intensive care earlier. Her parents, Merope Mills and Paul Laity, have said their concerns about their daughter’s deteriorating condition were repeatedly dismissed.
Expansion and pilot results
Under the new plan, the NHS will extend Martha’s Rule – which is already being rolled out across all inpatient wards – to hospital A&E departments, making it easier for families and staff to ask for a second opinion. NHS England this week announced the start of the nationwide expansion, with the phased roll-out due to be completed by March 2028.
The expansion comes after a pilot in seven trusts tested whether Martha’s Rule could work safely and effectively in busy A&E environments. During an eight-month pilot between September 2025 and March 2026, 69 calls were made to Martha’s Rule phone numbers, with some patients going on to have urgent surgery or being transferred to intensive care, NHS England said.
Official response and rollout progress
Professor Aidan Fowler, national director of patient safety at NHS England, said: “A&Es see some of our most vulnerable patients, so the ability to raise concerns about deterioration quickly and trigger a rapid review of care is essential.
“Martha’s Rule is already having a transformative effect in making our acute care even safer, and by expanding Martha’s Rule into A&Es, we are giving even more patients, their families and NHS staff a critical new lifeline to help improve care and save more lives.
“Early testing has shown that Martha’s Rule can work well in busy A&Es and builds on the evidence from our adult and children’s wards, where thousands of calls have been made by patients, families and staff to date – with many leading to changes in treatment and potentially life-saving interventions.”
Martha’s Rule has now been rolled out to 221 acute adult and paediatric inpatient sites, with rollout expected to be completed in 2026/27. Hospitals are also expected to extend it to A&E, maternity and neonatal units by March 2028 as part of a phased implementation. Latest figures for July 2026 show the highest ever monthly total of calls made via Martha’s Rule (1,678), and since September 2024 to July this year, 19,177 calls have been made by patients, their families and NHS staff.
How Martha’s Rule works
Martha’s Rule requires staff to use a structured approach to obtaining information about a patient’s condition from patients and their families at least daily and encourages patients, families and carers to speak to the care team if they notice changes in someone’s condition. It also provides them with a way to seek an urgent review if their or their loved one’s condition deteriorates and they are concerned this is not being responded to. Staff can also ask for a review from a different team if they are concerned the appropriate action is not being taken.
Patients and their families can check with their local hospital or NHS trust where Martha’s Rule is available by visiting the trust’s website or asking hospital staff.
Health and Social Care Minister Baroness Merron added: “Martha’s Rule is about making sure patients and their loved ones are heard when they raise concerns about their care.
“Expanding it to A&E will give patients, families and staff another way to speak up when they are worried that someone’s condition is getting worse, ensuring concerns are acted on quickly. This is part of our wider efforts to put patient safety at the heart of the NHS.”
