Martha’s Rule began being introduced in May 2024 and guarantees a right for patients, families, and carers to request a rapid review if they are concerned a patient’s condition is getting worse. Here, Rebecca Beaumont, Director of Investigation Services at TMLEP, reviews the positive outcomes seen in the latest data from NHS England and considers the need for continued developments to continue to improve patient safety.
Positive outcomes in latest data from NHS England
Data published in the Martha’s Rule Programme recently provides analysis of submissions for data collection between September 2024 and March 2026. This data shows that escalation calls made under Martha’s Rule have made a difference.
Of 13,481 escalation calls made, 4,336 related to an acute deterioration (32%). 15% of those acute deterioration calls required transfer of care (574 calls). 45% of the acute deterioration calls required other changes in treatment (1,930 calls). 72% of these calls came from the family/carer escalation process.
From June 2025 to March 2026, data was also reported for when the Early Warning Score (EWS) of the patient recorded at the time of the Martha’s Rule review would or would not have triggered a review through standard escalation processes against the outcome of the Martha’s Rule call. During this period, for those patients requiring transfer of care, for 222 calls the patients’ EWS would not have triggered escalation. For those requiring other changes in treatment, for 939 calls the patients’ EWS would not have triggered escalation.
This latest data shows the importance of listening to the concerns of patients’ families/carers as they can often see signs of worsening before this becomes apparent in regular observations and other monitoring methods such as the EWS.
Continued developments
As of May 2026, the introduction of Martha’s Rule has been expanded to all adult and paediatric acute inpatient services in England. The implementation is expected to be complete in these services during 2026/2027.
At TMLEP, we provide expert evidence and independent investigations for matters across the full breadth of the healthcare system in the UK. Failure to escalate and recognise deterioration in a patient’s condition is a key feature in claims and investigations in all healthcare disciplines – from general practice through to specialist tertiary care, in all care settings. With the positive developments seen in the most recent data from NHS England, it is important that the rights under the rule are expanded to other areas and jurisdictions where appropriate to improve patient safety by giving patients, their families, and their carers an enshrined right to have their voice heard.
Such expansion continues to be widely discussed by healthcare providers, governments, and the media, but two areas of interest TMLEP have seen in our work and conversations with clinicians.
Expansion to other areas of the care system
Steps are already being taken under the Martha’s Rule Programme to expand to other services in England. NHS England has identified that “the ambition” is to roll out Martha’s Rule to maternity, neonatal, and emergency departments and are testing the Rule in these services as part of phase 2 of the programme, as well as in community hospitals and mental health settings.
Maternity and neonatal services are an especially pertinent area to expand the rule into given the continued scrutiny of and need for improvement in these services, as TMLEP discussed in our feature regarding the judgment in CCC (by her mother and litigation friend MMM) v Sheffield Teaching Hospitals NHS Foundation Trust [2026] UKSC 5 in February 2026.
Implementation in the devolved nations
Martha’s Rule is only strictly applicable in England, with healthcare being a devolved issue for Northern Ireland, Scotland, and Wales. There have been calls for these nations to implement a similar escalation process to that outlined in Martha’s Rule.
A Wales-specific ‘Call4Concern’ system is being implemented and the Welsh Government set out a strategy and timelines for this in January 2026. The Welsh scheme will be available in all inpatient services including maternity and neonatal services, and the timeline for implementation has been set for end of 2026.
In Scotland, Hairmyres Hospital, NHS Lanarkshire, are piloting a ‘Call 4 Concern’ scheme as part of a wider initiative to improve patient safety within the Health Board. A recent Freedom of Information request responded to by the Scottish Government shows that outcomes of the rollout in England and the NHS Lanarkshire pilot are being monitored “to learn and understand what the journey could look like for Scotland.”
In Northern Ireland, information published suggests that there are no current discussions on rolling out Martha’s Rule or a similar process in Northern Ireland.
Conclusion
The continued successful rollout in England of Martha’s Rule means there is likely to be sustained interest in such processes being expanded. Given the data from the English pilot demonstrates that patients and their families and carers having the right to escalate does make a difference to treatment pathways, it is only right that Martha’s Rule remains part of the wider conversation around patient safety and healthcare improvement in the UK.
