NHS England
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NHS to expand ‘life-saving’ Martha’s Rule to all A&Es
The NHS is expanding Martha’s Rule to all hospital A&E departments and waiting rooms to further boost patient safety for some of the most vulnerable patients.
The initiative will see patients, loved ones and staff in busy emergency departments able to call a dedicated Martha’s Rule phone number to trigger an urgent review if a patient’s condition is deteriorating and they are concerned this is not being listened to.
While Martha’s Rule has to date been used to flag concerns for those already admitted to hospital, the landmark expansion sees the NHS put in place additional safeguards in A&E waiting rooms should any patient begin experiencing acute deterioration while they are in the department
The phased roll-out – to be completed by March 2028 – comes as the NHS faced the busiest summer in its history this year, with nearly a quarter of a million (241,061) more attendances to A&E in June, July and August than in 2025.
NHS England today announced the start of the nationwide expansion following a pilot in seven trusts to test whether the escalation process could work safely and effectively in busy and fast-paced A&E environments.
England’s top doctor for patient safety said the move would give patients, their families and staff in A&Es a “critical new lifeline to improve care and save more lives.”
The pilot between September 2025 and March 2026 found that Martha’s Rule could work alongside existing clinical procedures to better spot the early signs of acute deterioration patients, without requiring additional clinical staff.
During the eight-month pilot, 69 calls were made to dedicated Martha’s Rule phone numbers, including some calls related to acute deterioration following an urgent clinical review. In some cases, this led to a patient having urgent surgery or being transferred to intensive care.
The initiative – which is helping transform the NHS’s culture – is named after Martha Mills, who died in 2021, aged 13, after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike.
Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2022 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.
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.
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.”
Health and Social Care Minister Baroness Merron said:
“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.”
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, more than 19,000 (19,177) calls have been made by patients, their families and NHS staff.
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 are concerned this is not being responded to.
Staff can themselves ask for a review from a different team if they are concerned the appropriate action is not being taken.
The roll-out of Martha’s Rule has been made possible by the dedication of Martha’s parents, Merope and Paul, and the hard work of NHS staff across the country, supported by NHS England and the Health Innovation Network’s Patient Safety Collaboratives.
Original article link: https://www.england.nhs.uk/2026/09/nhs-to-expand-life-saving-marthas-rule-to-all-aes/
