Martha’s Rule NHS: 19,177 Calls That Could Save Lives
Last Updated: 24 September 2026
Martha’s Rule NHS is the patient-safety lifeline that gives you the right to demand an urgent second opinion when someone you love is getting worse in hospital — and this week it took its biggest step yet. On 22 September 2026, NHS England announced the rule will be extended to every accident and emergency department and waiting room in England.
The expansion follows a successful seven-trust pilot in emergency settings. Under Martha’s Rule NHS, patients, families and staff can call a dedicated 24/7 number to trigger a rapid review by a different clinical team when they feel deterioration is not being acted on.
What is Martha’s Rule NHS?
Martha’s Rule NHS is a patient-safety process that lets patients, relatives and NHS staff request an urgent review by a different clinical team when a patient’s condition is deteriorating and their concerns are not being addressed. It runs 24 hours a day and is being rolled out across hospital wards, maternity units and every A&E department in England.
What Is Martha’s Rule NHS? A Simple Definition
Martha’s Rule — noun: an NHS patient-safety right, named after 13-year-old Martha Mills, that guarantees patients and their families a formal route to escalate concerns about a deteriorating condition to a second, independent clinical team.
At its heart, the rule has three simple components. First, hospital staff must use a structured approach to gather information about a patient’s condition from patients and families at least once a day.
Second, patients, families and carers are actively encouraged to speak to the care team the moment they notice a change in someone’s condition. Third — and this is the part that changes everything — if those concerns are not being responded to, anyone can trigger a rapid review by a different team.
The review is carried out by a critical care outreach team, separate from the team already looking after the patient. They arrive with fresh eyes, listen to the family’s concerns, examine the patient, and recommend changes — which can range from extra monitoring to urgent surgery or a transfer to intensive care.
Official figures show the Martha’s Rule NHS escalation process has now been used more than 19,000 times since it launched in September 2024. NHS leaders credit the system with potentially hundreds of life-saving interventions.
The Story Behind the Rule: Remembering Martha Mills
Every patient-safety policy has a human story behind it, and this one begins with a teenager who loved life. In the summer of 2021, 13-year-old Martha Mills was admitted to King’s College Hospital NHS Foundation Trust in south London with a pancreatic injury she had suffered after falling from her bike.
While she was in hospital, Martha developed sepsis — a life-threatening reaction to infection that can cause the body’s organs to shut down. Her parents, Merope Mills and Paul Laity, could see she was deteriorating and repeatedly raised the alarm with the clinical teams looking after her.
Their concerns were not acted on quickly enough. Martha’s condition continued to worsen, and she was not transferred to intensive care in time.
She died in August 2021 — a tragedy her family has always believed could have been avoided.
In February 2022, an inquest coroner ruled that Martha would probably have survived if she had been referred to intensive care sooner and treated appropriately. The coroner found that clinicians had failed to escalate her care despite the family’s repeated warnings.
Rather than letting grief turn inward, Merope and Paul channelled it into campaigning for change. They called for a formal, guaranteed route for families to escalate concerns when they believe something is seriously wrong — a route that does not depend on a busy ward team’s availability or a junior doctor’s confidence to challenge a senior colleague.
Their campaign won support across politics and the media, and in May 2024 the NHS formally announced Martha’s Rule NHS. It remains a fitting legacy: a system designed so that no other family has to experience what theirs did.
How Martha’s Rule NHS Works in Hospital Wards Today
The Martha’s Rule NHS process began on adult and children’s hospital wards, and that is where it has had its greatest impact so far. After a pilot across 143 acute hospitals between September 2024 and March 2025, the scheme was rolled out to 221 acute adult and paediatric inpatient sites across England.
On these wards, the process works around the clock. Dedicated Martha’s Rule NHS phone numbers are displayed prominently, and patients and relatives are told about the service when they arrive.
If a family member spots that a patient is becoming confused, struggling to breathe, or simply “not themselves”, they can speak to the ward team.
If they feel unheard, they can escalate using the Martha’s Rule NHS number.
What happens next is deliberately simple:
- A call is made to the dedicated Martha’s Rule NHS number, day or night.
- A critical care outreach team — separate from the ward team — is alerted.
- The outreach team carries out an urgent, independent review of the patient.
- The review team decides on next steps: changed medication, extra monitoring, or escalation to intensive care.
Crucially, the system is not being overused. Early NHS data suggests it is meeting a genuine need: the calls are coming from people with real concerns.
A meaningful share of calls lead to changes in treatment — reassurance for clinicians who initially worried the helplines would be flooded with inappropriate calls.
In June 2026, the government went further, instructing that the rule should be extended to maternity and neonatal units in response to the findings of the Ockenden review into NHS maternity and neonatal services. Women and parents now have an explicit right to a second opinion about the care of a mother or baby.
You can read the official explanation of how the service operates on NHS England’s Martha’s Rule page, which sets out the national guidance for trusts.
Martha’s Rule NHS Is Coming to Every A&E Department
The announcement made on 22 September 2026 marks the most significant expansion of the scheme to date. NHS England confirmed that Martha’s Rule NHS will be extended to every hospital accident and emergency department and waiting room in England.
Until now, the rule has been used to flag concerns for patients already admitted to wards. The landmark change extends that same protection to people who become acutely unwell while waiting to be assessed or treated — often the most vulnerable moment in an emergency department journey.
The expansion follows an eight-month pilot across seven NHS trusts, which ran from September 2025 to March 2026. The trial tested whether the escalation process could work safely in busy, fast-paced A&E environments — and the results were encouraging.
During the pilot, 69 calls were made to dedicated Martha’s Rule NHS numbers in emergency departments. A number of those calls led directly to patients having urgent surgery or being transferred to intensive care. The trial also found the system could run alongside existing clinical procedures without requiring additional clinical staff — a critical finding for an NHS under severe workforce pressure.
“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,” said Professor Aidan Fowler, NHS England’s national director of patient safety. “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.”
The rollout will be phased, with full implementation targeted for March 2028. That means patients should not assume their local A&E already offers the service — hospitals are at different stages, and families should check their trust’s website or ask staff whether the rule is available.
Health and Social Care Minister Baroness Merron added: “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 Numbers: 19,177 Calls and Counting
The scale of Martha’s Rule NHS in practice is now clear from the official data. NHS figures show that 19,177 escalation calls were recorded between September 2024 and July 2026, with July 2026 producing a record monthly total of 1,678 calls.
Those headline numbers break down into a remarkable story of early impact:
- 19,177 escalation calls logged between September 2024 and July 2026.
- 1,678 calls in July 2026 alone — the highest monthly total on record.
- 241 potentially life-saving interventions in the scheme’s first nine months, revealed on what would have been Martha’s 18th birthday.
- 69 pilot calls in A&E settings, some leading to urgent surgery or intensive care transfers.
- 221 acute inpatient sites now running the rule, with a contractual deadline of 31 March 2027 for full ward coverage.
Earlier figures suggest that in the first 16 months of the Martha’s Rule NHS scheme, helplines received more than 10,000 calls that may have saved hundreds of lives. Thousands of patients were moved to intensive care, given drugs they needed, or benefited from other treatment changes as a direct result of the calls.
The context makes the expansion urgent. Emergency departments have just endured the busiest summer in NHS history, with 241,061 more A&E attendances in June, July and August 2026 than in the same period in 2025.
Long waits in crowded waiting rooms increase the risk that a deteriorating patient goes unnoticed.
That is precisely the gap the expanded rule is designed to close.
Detailed reporting of the latest figures, including the 19,177-call total, was covered alongside the A&E expansion announcement earlier this week.
How to Use Martha’s Rule: A Step-by-Step Guide for Families
If you are sitting beside a hospital bed — or in an A&E waiting room — and something feels wrong, here is exactly how to use Martha’s Rule NHS. The process is designed to be calm, respectful and fast.
- Trust your instincts and speak to the care team first. Tell the nurse or doctor looking after your loved one what you have noticed — new confusion, breathing changes, unusual drowsiness, or simply that they are “not themselves”. Families often spot deterioration before monitors do.
- Ask for the Martha’s Rule number if you feel unheard. If your concerns are dismissed, delayed or you are told “everything is fine” but your instincts disagree, ask staff for the hospital’s dedicated Martha’s Rule NHS phone number. It should be displayed on wards and in waiting rooms.
- Call the number — it is answered 24 hours a day. You do not need permission to call. Explain who the patient is, where they are, and what has changed. Be specific: “My mum was talking normally an hour ago and now she can’t keep her eyes open.”
- A different team carries out a rapid review. A critical care outreach team, independent of the team already treating the patient, will come and assess them. They will listen to your concerns as part of that review.
- Act on the review’s findings. The outreach team may change medication, order new tests, increase monitoring, or arrange a transfer to a higher-dependency area. You should be told what was decided and why.
- Follow up if things change again. If the patient’s condition worsens later, you can use the process again. The right to escalate does not expire after one call.
It is worth knowing what Martha’s Rule NHS is not for. It is not a general complaints line for food, parking or visiting hours — hospitals have separate PALS services for that.
And it is not a substitute for calling 999 in a genuine emergency outside hospital.
Staying alert to early warning signs matters in every setting. Spotting changes in your own health early is a habit worth building — our guide on how to improve gut health naturally explores how paying attention to everyday symptoms can help you act sooner.
What Changes for NHS Staff Under the New Rules
Martha’s Rule NHS is not only a right for families — it is also a protection for staff. Nurses, junior doctors and healthcare assistants can themselves request a review from a different team if they are concerned that the appropriate action is not being taken for a patient.
That matters enormously in hospital culture. A junior nurse who spots deterioration at 3am may previously have hesitated to challenge a senior colleague’s plan.
The rule gives every member of staff a formal, blame-free route to say:
“I am worried, and I want a second opinion.”
Staff must also use a structured approach to gathering information from patients and families at least daily. That means actively asking relatives what they have noticed, rather than waiting for them to speak up.
It is a quiet revolution in how ward rounds work — treating the family’s observations as clinical data.
The Martha’s Rule NHS approach is already changing how teams communicate. NHS England describes it as helping to transform the culture of the health service, encouraging open conversations between clinicians, patients and families about risk.
Why Patient Voices Matter: The Bigger Patient-Safety Picture
The expansion of Martha’s Rule NHS lands at a moment of intense pressure on the health service. Record A&E attendances, long waiting lists and stretched staffing mean the traditional safety nets — regular observations, senior reviews — are under strain.
Giving families a formal voice adds a layer of protection that does not depend on staffing levels.
The Martha’s Rule NHS rollout recognises that relatives are part of the safety net, not bystanders to it.
Patient-safety experts have long argued that families are an untapped early-warning system. Research repeatedly shows that relatives notice subtle changes — a shift in alertness, a new restlessness, a fading appetite — hours before vital-sign monitors register a problem.
The Martha’s Rule NHS process turns that observation into action.
There is also a deeper lesson about listening. The coroner’s findings in Martha’s case were not about a lack of medical knowledge — they were about a failure to hear the people who knew her best.
Every escalation call is, in a sense, a small correction to that failure.
The scheme is not without challenges. Availability is not yet uniform: NHS England warns the rule may be running on only certain wards within a single hospital, and the A&E rollout will take until March 2028 to complete.
Testing is still under way in those settings. Community hospitals, mental health settings and urgent treatment centres remain outside the current Martha’s Rule NHS expansion for now.
But the direction of travel is unmistakable. From 143 pilot hospitals to 221 inpatient sites, from maternity units to every A&E in England, the principle is spreading: when a patient is getting worse, no concern should go unheard.
Looking after your health also means using the NHS services already around you. Our article on Boots flu jabs explains how high-street pharmacies are helping to keep winter pressures — and the A&E queues that come with them — under control.
What is Martha’s Rule NHS?
Martha’s Rule NHS is a patient-safety process that lets patients, relatives and NHS staff request an urgent review by a different clinical team when a patient’s condition is deteriorating and their concerns are not being addressed. It runs 24 hours a day, seven days a week.
When will Martha’s Rule be available in every A&E?
NHS England announced the expansion on 22 September 2026. The rollout to every A&E department and waiting room in England is phased and is expected to be completed by March 2028, so families should check their local trust’s website or ask staff whether it is available.
Who was Martha Mills and why is the rule named after her?
Martha Mills was a 13-year-old who died of sepsis in 2021 at King’s College Hospital in London. Her parents, Merope Mills and Paul Laity, repeatedly raised concerns about her deteriorating condition that were not acted on. A 2022 inquest found she would probably have survived with earlier intensive care, and her parents’ campaign led to the creation of Martha’s Rule.
How do families use Martha’s Rule to request a review?
First, speak to the care team about what you have noticed. If you feel unheard, ask for the hospital’s dedicated Martha’s Rule phone number — it is displayed on wards and in waiting rooms and answered around the clock. A critical care outreach team, separate from the team already treating the patient, then carries out an urgent independent review.
How many times has Martha’s Rule been used?
NHS figures show 19,177 escalation calls were recorded between September 2024 and July 2026, with July 2026 producing a record 1,678 calls. Early data indicates hundreds of potentially life-saving interventions, including transfers to intensive care and urgent surgery.
Does Martha’s Rule apply to NHS staff as well as families?
Yes. As well as patients and relatives, NHS staff can use Martha’s Rule to request a review from a different team if they are concerned the right action is not being taken for a patient. It gives junior staff a formal, blame-free route to escalate concerns.
Conclusion: A Legacy That Keeps Saving Lives
Martha’s Rule NHS began with one family’s unbearable loss and their determination that it should never happen to anyone else. Five years after Martha Mills died, her name is attached to a system that has fielded more than 19,000 escalation calls — and, in hundreds of cases, changed the outcome.
The expansion to every A&E department and waiting room in England is the logical next step. Emergency departments are where the most vulnerable patients wait the longest, and where a worried relative’s voice can matter most.
Here is what to do now: find out whether your local hospital trust has introduced Martha’s Rule NHS — check the trust’s website or ask staff on your next visit. Share this article with anyone who has a relative in hospital.
And remember the words that could one day save a life: trust your instincts, and escalate.
