The National Health Service is rolling out Martha’s Rule across all emergency departments in England to give patients and their families more power to raise concerns and request an urgent review when they believe a patient’s condition is worsening. The rule is named after Martha Mills, a 13-year-old who died in 2021 from sepsis following a bicycle accident at King’s College Hospital in London. Martha’s parents, Merope Mills and Paul Laity, became advocates for change after her death, as they felt their concerns were not taken seriously by hospital staff. A coroner later ruled that Martha probably would have survived if she had been moved to intensive care earlier.
The expansion of the rule is part of a broader effort to improve patient safety and ensure that concerns about care are addressed quickly.
The nationwide rollout began immediately and is expected to be completed by March 2028, following a successful trial in seven NHS trusts, according to the BBC. During the eight-month pilot program, there were 69 calls to dedicated Martha’s Rule phone lines. Some cases resulted in urgent surgery or transfers to intensive care.
In the first 16 months since its introduction in England, the system received more than 10,000 calls, according to a report from The Guardian. NHS England said 446 of those cases resulted in potentially life-saving transfers to enhanced levels of care.
The latest monthly data from July 2026 shows that Martha’s Rule received a record 1,678 calls in one month. NHS England recorded 19,177 calls between September 2024 and July 2026. Of those, 5,660 involved concerns about an acute deterioration in a patient’s condition.
The system allows patients, their loved ones, and healthcare workers to ask for a different medical team to review the care being provided when they believe concerns about deterioration are not being addressed. It also enables healthcare workers to seek another review when they believe appropriate action is not being taken.
Wales already has a similar program called Call4Concern. Scotland has also begun introducing Martha’s Rule while Northern Ireland is considering a similar approach.
The expansion to emergency departments is meant to ensure that concerns about worsening conditions are acted on swiftly. Healthcare staff can also use the system to raise concerns and seek support when they feel a patient’s care is not up to standard. This new phase of the rule aims to make it easier for anyone involved in a patient’s care to speak up when something seems wrong.
The NHS said the phased rollout will ensure that all emergency departments are ready to implement the system by the target date. Patients and families will be able to use a dedicated phone number to request an urgent clinical review when they believe concerns about deterioration are not being heard. The system will apply both to patients receiving treatment in A&E and people waiting to be seen.
The goal is to create a culture where concerns can be raised without fear of retribution, and where patients are better protected. The system is part of a larger push to improve transparency and accountability in hospitals across England.
Early evidence suggests Martha’s Rule has helped identify worsening conditions and prompted changes in treatment. NHS England reported that through July 2026, 749 calls involving acute deterioration led to transfers to intensive care, high-dependency care, specialist wards or other enhanced levels of care. Another 2,683 resulted in other changes to treatment.
By giving more people the right to question care and request changes, the NHS hopes to reduce preventable incidents in hospitals.
The rule is now being expanded across all emergency departments in England as part of a long-term strategy to improve patient safety. The phased expansion is scheduled to be completed by March 2028.
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