Martha’s Rule comes to every A&E in England, and it is a big shift
Martha’s Rule is being expanded to every A&E in England, including waiting rooms, under plans announced by NHS England. In plain terms, it means patients, relatives and even staff get a clearer, more direct route to demand an urgent second opinion if someone deteriorates and they feel they are not being listened to. Not in a vague, “ask again later” way, but by calling a dedicated number that triggers a rapid clinical review by a separate team.
That matters because emergency departments are where risk concentrates. People arrive undifferentiated, often without a diagnosis, sometimes without a clear history, and frequently with long waits. And when the system is under strain, the danger is not just delay, it is missed deterioration. Martha’s Rule is designed to catch exactly that moment when a patient is getting worse and the usual signals are not cutting through.
The rollout is phased, with NHS England expecting completion by March 2028. It follows a pilot at seven NHS trusts, and it builds on the scheme already operating across inpatient wards. The policy is also tied to a wider patient safety argument: that the NHS needs stronger, more reliable mechanisms for listening to patients and families when something feels wrong (because sometimes it is).
What NHS England has announced, and how Martha’s Rule works in A&E
The announcement is specific: Martha’s Rule will be extended to every emergency department in England, and it will apply both to patients waiting to be seen and those already receiving care. That detail is crucial. A lot of deterioration happens in the limbo of the waiting room, when observations are intermittent, staffing is stretched, and the patient’s story is still being assembled.
Under the A&E model described by NHS England, patients and relatives can call a dedicated phone number if they believe someone’s condition is worsening and their concerns are being ignored. The call is meant to reach a separate clinical team that can perform an urgent review. The scheme is not framed as a replacement for existing escalation routes, but as an additional, clearly signposted option that is available round the clock.
NHS England says early testing shows the system can operate alongside existing procedures in busy emergency departments without requiring additional clinical staff. That is an eye-catching claim, because A&E is already a pressure cooker. But the logic is that the review function is organised differently, not necessarily bigger. It is a structured escalation pathway that aims to reduce the chance of a deteriorating patient being stuck in the wrong queue.
The timing is not accidental. The expansion comes after what is described as the busiest summer on record for A&E departments, with 241,061 more attendances in June, July and August than the same period the previous year. More people through the front door means more clinical risk to manage, and more opportunities for the system to miss the quiet patient who is slipping.
Why it is called Martha’s Rule, and the case that changed the conversation
Martha’s Rule is named after Martha Mills, who died aged 13 from sepsis at King’s College Hospital in south London in 2021. She had been admitted after a bicycle accident. Her parents, Merope Mills and Paul Laity, repeatedly raised concerns about her deterioration and later said those concerns were not acted upon. A coroner concluded Martha would probably have survived if she had been transferred to intensive care earlier.
The policy exists because that story did not fade away. Mills and Laity campaigned for a system that gives families a straightforward way to trigger a rapid review when they believe something is going wrong. The moral force of the case is hard to ignore: parents noticing change, asking for help, and not being heard in time. It is the kind of scenario clinicians dread, and families fear, because it sits right at the intersection of human judgement and system failure.
There is also a deeper point here about information. Families often hold critical context: what “normal” looks like for the patient, what has changed, what feels alarming. In emergency care, where staff may meet a patient for the first time, that information can be the difference between a watchful wait and urgent escalation. Martha’s Rule tries to formalise that input so it does not depend on who happens to be on shift, or how confident a relative feels about speaking up.
And yes, the name matters. It anchors the policy in a real case, not an abstract safety initiative. That can be uncomfortable for institutions, but it also keeps the focus where it belongs: on preventable harm, and on the practical steps that might reduce it.
Martha’s Rule so far, what the numbers say and what they do not
Martha’s Rule is not starting from scratch. It has already been introduced at 221 acute adult and children’s inpatient sites. Between September 2024 and July 2026, more than 19,000 calls are made under the scheme, according to the figures cited. July 2026 alone sees a record 1,678 calls in a single month. Those are not trivial volumes, and they suggest the public and staff will use a clearly advertised escalation route when it exists.
The Guardian reports that in the first 16 months after introduction in England in 2024, helplines receive more than 10,000 calls and official figures indicate the scheme potentially saves 446 lives. It also describes thousands of patients being moved to intensive care, receiving drugs they need, or benefiting from other changes as a direct result of calls. The language is careful, “potentially saved”, because causality in safety interventions is messy. But the direction of travel is clear: calls lead to action, and action sometimes prevents catastrophe.
The A&E pilot provides a smaller, more focused dataset. Across seven trusts, between September 2025 and March 2026, there are 69 calls to Martha’s Rule numbers. NHS England says some of those calls lead to urgent surgery or transfers to intensive care. Again, no claim that every call is a near miss, but the point is that escalation is happening in real time, in the most chaotic part of the hospital.
What the numbers do not tell us, yet, is the full operational cost. How many calls are “false alarms” that still consume clinical time? How often does the rapid review agree with the original plan? How does it affect flow, crowding, and staff workload in departments already running hot? Those are not reasons to stop. They are the questions that will decide whether the rollout becomes a sustainable safety net or another well-intentioned policy that struggles at the sharp end.
Martha’s Rule in A&E, what it means for patient safety and NHS culture
At its core, Martha’s Rule is a cultural intervention disguised as a phone number. It formalises the idea that patients and families can be right, and that the system should make it easy to challenge a plan when someone is deteriorating. In healthcare, hierarchy is sometimes necessary, but it can also be dangerous. A structured escalation route gives people permission to speak up without feeling they are “making a fuss”.
Prof Aidan Fowler, NHS England’s national director of patient safety, frames the expansion as essential because A&Es see “some of our most vulnerable patients”. His argument is that the ability to raise concerns quickly and trigger a rapid review is a “critical new lifeline”. That language is not accidental. Emergency departments are where sepsis can be missed, where blood clots can be overlooked, where a patient can look stable until they suddenly do not.
There is also a staff dimension that is easy to miss. Martha’s Rule is not only for families. Staff themselves can request a review by another team if they believe concerns about a patient are not being properly addressed. That matters in A&E, where junior clinicians may feel uneasy but overruled, or where competing priorities can drown out a nagging worry. A formal mechanism can protect staff as well as patients, because it turns “I have a bad feeling” into a documented escalation step.
And then there is the uncomfortable comparison with other countries. The Yahoo report cites research published in 2026 ranking the UK 21st out of 38 OECD countries on patient safety, trailing nations including Norway, Switzerland, Japan, Spain and Italy. The study examines measures including deaths from treatable causes such as sepsis and blood clots, using international comparison data from 2021. That does not prove the NHS is unsafe, but it does underline why patient safety reforms are politically and clinically urgent. The NHS is not competing on slogans. It is competing on outcomes.
How this compares with earlier safety drives, and why A&E is different
The NHS has a long history of patient safety initiatives, from early warning scores to sepsis pathways to incident reporting systems. Many of these focus on improving professional detection and response. Martha’s Rule adds something slightly different: it builds a parallel route for patients and families to trigger escalation when professional systems are not moving fast enough.
That is not exactly groundbreaking in concept, because other high risk industries have long relied on “stop the line” authority, where any worker can halt a process if they see danger. Healthcare has tried to emulate that with varying success. The difference here is that the “worker” can be a parent in a waiting room. That is a profound shift in who is empowered to interrupt the flow of care.
A&E also changes the practicalities. On inpatient wards, teams are more stable, patients are monitored over days, and escalation pathways are clearer. In emergency departments, the patient mix is broader, the time horizon is shorter, and the environment is noisier, literally and organisationally. A dedicated number and a separate review team may cut through that, but only if it is properly embedded, well advertised, and treated seriously by staff.
There is a risk, too, of misunderstanding. A second opinion is not a guarantee of a different answer. But it can be a guarantee of a fresh look, and in safety terms, that is often what matters. The value is in catching the outlier, the patient who is deteriorating in a way that is not yet obvious on a standard set of observations.
What’s Next
The next two years are about implementation, not headlines. NHS England says the rollout to every A&E will be phased and completed by March 2028. That implies a long period where some emergency departments have the system fully operational and others are still building it. Expect a patchwork experience for patients in the short term, and a lot of behind-the-scenes work on staffing models, call handling, clinical governance and training.
One of the biggest tests will be how Martha’s Rule behaves under extreme pressure. The summer attendance figures, 241,061 more A&E attendances in June, July and August than the previous year, hint at the direction of travel. If crowding worsens, the temptation in any system is to treat escalation as an inconvenience. The policy will only deliver if hospitals protect the rapid review function as non-negotiable, even when the department is overflowing.
There is also a broader strategic question: does Martha’s Rule become a lever for improving the fundamentals of emergency care, or does it become a workaround for them? If calls repeatedly highlight the same failure points, such as delayed observations in waiting rooms or slow recognition of sepsis, leaders will face pressure to fix root causes, not just respond to crises. In that sense, the helpline data could become a powerful safety intelligence tool, showing where deterioration is being missed and why. But that requires transparency and a willingness to learn, not defensiveness.
Closing thoughts, a lifeline, and a measure of whether the NHS listens
Baroness Merron, the health minister, describes Martha’s Rule as making sure patients and loved ones are heard when they raise concerns about care. That sounds simple, almost obvious. But anyone who has spent time in a hospital knows it is not always how it feels. When people are scared, tired and out of their depth, being heard is half the battle.
Matthew Hopkins, acute and ambulance director at the NHS Alliance, says NHS leaders welcome the rollout and believe it will enhance safety and provide reassurance for patients and families. Reassurance matters, but safety matters more. The promise of Martha’s Rule is not comfort, it is action: a rapid review when deterioration is suspected, and a system that treats that suspicion as legitimate.
Ultimately, the expansion to every A&E in England is a statement about what the NHS wants to be. A service that does not just deliver care, but invites challenge when care might be going wrong. It is not a magic wand, and it will not solve the structural pressures driving A&E crowding. But it could save lives at the margins, the exact place where safety is won or lost. And for families who have watched someone worsen while waiting, that is not a marginal improvement at all.
