Following a successful pilot, the NHS will roll out Martha’s Rule to all hospital accident and emergency departments and waiting rooms by March 2028. 

The NHS is expanding Martha’s Rule to all hospital A&E departments and waiting rooms. The initiative will see patients, families and staff in emergency departments able to call a dedicated Martha’s Rule telephone number to trigger an urgent review if a patient’s condition is deteriorating and they are concerned this is not being listened to.

The rule was introduced following the tragic death of 13-year-old Martha Mills from sepsis in 2021. It allows patients, carers, families, or NHS staff to request an independent review when there are concerns that a patient’s condition is deteriorating or that care has not met expected safety standards. Its aim is to ensure that concerns are escalated promptly and acted upon before serious harm occurs.

Although government figures have already shown the rule’s positive effects on patient safety, a national three-year research programme was introduced in July to evaluate how Martha’s Rule is being implemented across NHS hospitals in England, aiming to identify the best ways to ensure patients, families and healthcare staff are heard when they have concerns about a patient’s deterioration.

“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,” said Gillian Merron, Baroness Merron, Parliamentary under-secretary of state at the Department of Health and Social Care. 

In response to the announcement, Matthew Hopkins, director of the NHS Alliance’s acute and ambulance network, said that the move would “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”. 

No additional clinical staff

The phased roll-out – to be completed by March 2028 – follows a pilot in seven trusts to test whether the escalation process could work safely and effectively in A&E environments.

The pilot between September last year and March found that Martha’s Rule could work alongside existing clinical procedures to spot the early signs of acute deterioration in patients, without requiring additional clinical staff. In that time, 69 calls were made to dedicated Martha’s Rule telephone numbers, including some calls related to acute deterioration following an urgent clinical review. 

In some cases, this led to a patient having urgent surgery or being transferred to intensive care.

“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,” said Aidan Fowler, national director of patient safety at NHS England. 

Martha’s Rule will now be rolled out to 221 acute adult and paediatric inpatient sites by the end of the year. Hospitals are also expected to extend it to A&E, maternity and neonatal units as part of a phased implementation.

As Rebecca Beaumont, director of investigation services at TMLEP, wrote in Healthcare Today in the summer: “It is only right that Martha’s Rule remains part of the wider conversation around patient safety and healthcare improvement in the UK”. 

Latest figures for July show the highest-ever monthly total of calls made via Martha’s Rule (1,678), and since September 2024 to July this year, more than 19,000 calls have been made by patients, their families and NHS staff.