Patients, families and NHS staff will soon be able to escalate concerns about deteriorating conditions in emergency departments across England, as NHS England confirms a nationwide expansion of Martha’s Rule to all hospital A&E departments and waiting rooms.
The initiative, designed to strengthen patient safety and ensure concerns are acted upon quickly, will allow patients, loved ones and healthcare professionals to call a dedicated Martha’s Rule telephone number to request an urgent clinical review if they believe a patient’s condition is worsening and their concerns are not being heard.
The expansion marks a significant development for the programme, which until now has primarily been available to patients already admitted to hospital wards. Under the new plans, additional safeguards will be introduced in busy emergency departments, helping to identify patients whose condition may deteriorate while waiting for treatment.
The phased rollout will take place across England and is expected to be completed by March 2028.
The announcement follows what the NHS described as its busiest summer on record. Between June and August 2026, A&E departments experienced 241,061 more attendances than during the same period in 2025, increasing pressure on emergency services nationwide.
NHS England confirmed the decision follows a successful pilot programme at seven NHS trusts, which examined whether Martha’s Rule could operate safely and effectively within the demanding environment of accident and emergency departments.
The pilot, which ran between September 2025 and March 2026, demonstrated that the escalation process could complement existing clinical pathways while helping to identify early signs of acute deterioration, without requiring additional clinical staffing.
During the eight-month trial, 69 calls were made to dedicated Martha’s Rule lines. Several cases involved concerns relating to rapidly deteriorating patients, leading to urgent clinical reviews. Some interventions resulted in emergency surgery or transfers to intensive care.
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 was established following the death of 13-year-old Martha Mills in 2021 after she developed sepsis while receiving hospital treatment for injuries sustained in a bicycle accident.
Despite repeated concerns raised by Martha’s family regarding her deteriorating condition, those concerns were not escalated appropriately. A coroner later ruled in 2022 that Martha would probably have survived had she been transferred to intensive care sooner.
Named in her memory, the initiative aims to empower patients and families to speak up when they believe a patient is getting worse and ensure rapid access to a second clinical review.
Martha’s Rule has already been implemented at 221 acute adult and paediatric inpatient sites across England, with the inpatient rollout expected to be completed during 2026/27.
As part of the next phase, NHS organisations are expected to extend the programme into emergency departments, maternity services and neonatal units by March 2028.
Recent figures underline the growing adoption of the scheme. In July 2026, the NHS recorded its highest-ever monthly total of calls through Martha’s Rule, with 1,678 escalations logged. Between September 2024 and July 2026, a total of 19,177 calls were made by patients, relatives and NHS staff.
The programme requires healthcare teams to use a structured process to gather information from patients and families about a patient’s condition on a daily basis. It also provides a clear route for concerns to be escalated if individuals feel deterioration is not being recognised or addressed.
Importantly, healthcare professionals can also request reviews from other teams if they believe appropriate action is not being taken.
The continued expansion of Martha’s Rule is widely regarded as a significant step in strengthening patient-centred care and embedding a culture where concerns are listened to and acted upon quickly.
Its rollout has been driven by the dedication of Martha’s parents, Merope and Paul Mills, alongside NHS staff across England, with support from NHS England and the Health Innovation Network’s Patient Safety Collaboratives.
As implementation continues, NHS leaders hope the initiative will provide an additional layer of protection for patients at some of the most vulnerable moments in their care journey.
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