Martha's rule, which enables NHS patients, their relatives and staff to request an urgent review of a patient's care, is set to be expanded to every accident and emergency (A&E) department in England, including waiting rooms. The announcement was made by NHS England on 22 September 2026.
What is Martha's rule?
The rule is named after Martha Mills, who died aged 13 at King's College Hospital in London in 2021 after developing blood poisoning, also known as sepsis. Her family's concerns were not listened to, which prompted her parents, Merope and Paul, to create the rule to change that culture.
Under the rule, patients, loved ones and staff in A&E units will be able to call a dedicated phone number to trigger an urgent review if a patient's condition is deteriorating and they are concerned this is not being listened to. The move should offer “a critical new lifeline” to improve care and save more lives, NHS England said.
Expansion to all emergency departments
The rollout will cover every emergency department in England, including waiting rooms. This follows an initial pilot in seven trusts, according to Matthew Hopkins, acute and ambulance director at the NHS Alliance.
Prof Aidan Fowler, 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.”
Support from NHS leaders and ministers
Matthew Hopkins added: “NHS leaders welcome the rollout of Martha’s rule to all hospital A&E departments and waiting rooms, following the initial pilot in seven trusts.
“They support the initiative’s aim to give the most vulnerable patients, families and staff the chance to be heard and raise concerns. This will enhance the safety of care and will provide reassurance for patients and their families if there are concerns that the patient’s condition is getting worse.”
Gillian Merron, a health minister, 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.”
The expansion to all A&E departments in England is expected to provide a consistent mechanism for raising concerns about deteriorating patients across the country, building on evidence from adult and children’s wards where thousands of calls have already been made.
