Martha’s Rule, the patient-safety scheme giving families the right to demand an urgent review of a patient’s care, is to be expanded to every accident and emergency department in England.
NHS England announced the phased rollout to all hospital A&E departments and waiting rooms on Tuesday, with completion expected by March 2028.
Patients, loved ones and staff in busy emergency departments will be able to call a dedicated Martha’s Rule phone number to trigger an urgent review if they believe a patient’s condition is deteriorating and their concerns are not being listened to, the health service said.
The initiative is named after Martha Mills, the 13-year-old who died in 2021 while in the care of King’s College Hospital in south London, after developing sepsis. She had been admitted with a pancreatic injury after falling off her bike, but her family’s repeated concerns about her deteriorating condition went unanswered. In 2022, a coroner ruled that Martha would probably have survived had she been moved to intensive care sooner.
The announcement follows a pilot in seven NHS trusts between September 2025 and March 2026, which tested whether the escalation process could work safely in busy and fast-paced A&E environments. During the eight-month pilot, 69 calls were made to dedicated Martha’s Rule numbers — in some cases leading to urgent surgery or a transfer to intensive care — and NHS England said the scheme worked alongside existing clinical procedures without the need for extra clinical staff.
Professor Aidan Fowler, NHS England’s national director of patient safety, 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.”
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.”
The expansion comes as the NHS faced the busiest summer in its history, with nearly a quarter of a million more A&E attendances in June, July and August than in the same period last year — and follows a survey in which London nurses reported patients dying in “suffocating” hospital wards during the summer heatwave.
Martha’s Rule has already been rolled out to 221 acute adult and children’s hospital sites, with more than 19,000 calls made by patients, families and staff between September 2024 and July this year, including a record 1,678 in July alone. NHS England credited Martha’s parents, Merope and Paul, whose dedication made the rollout possible.
Under the scheme, hospital staff must use a structured approach to gather information about a patient’s condition from patients and their families at least daily, and families can request an urgent review if they feel deterioration is not being responded to. Staff themselves can also ask for a review from a different team if they believe appropriate action is not being taken.
Hospitals are additionally expected to extend the scheme to maternity and neonatal units by March 2028. Patients and families can check whether Martha’s Rule is already available at their local hospital or NHS trust by visiting the trust’s website or asking hospital staff.
The expansion follows other life-saving initiatives across the capital, including a volunteer campaign rolling out bleed-control kits in Waltham Forest — but for Martha’s family and patient-safety campaigners, the story began at a south London hospital and could soon change how every A&E in England listens to the people who know a patient best.
