Martha's Rule is live in 221 hospitals and coming to every A&E in England: what it means for NHS staff

What Martha's Rule is

There are 3 main points:

1. 1Ask the patient. At least daily, how they're feeling and whether they're getting better or worse, and the answer is acted on.
2. 2Any member of staff can escalate. At any time, to a different team, if they think a patient is deteriorating and they're not being responded to.
3. 3So can the family. The same route is always open to patients, their families and carers, and is advertised across the hospital.

Each hospital has a dedicated Martha's Rule phone number. A call brings an urgent review at any hour. It comes from the critical care outreach team, the nurses and doctors who look after deteriorating patients outside intensive care, not from the team already treating the patient.

Why it exists

Martha Mills was 13 when she was admitted to King's College Hospital in 2021 with a pancreatic injury after falling off her bike. She developed sepsis and died days before her 14th birthday. Her parents had raised concerns that she was getting worse. Those concerns weren't acted on. The coroner found she would probably have survived had she been moved to intensive care earlier.

Her parents campaigned for a rule that lets a family force that second look. The first phase went live across 143 hospital sites in 2024. The remaining adult and paediatric inpatient sites are due in 2026/27. A&E, maternity and neonatal units are the phase announced this week. Community hospitals and mental health settings are still to come.

What it means for you

On a ward. You can ask for that review at any time. You don't go up your own chain first, and you don't need to be senior. A family can make the same call. The review happens whether or not the team treating the patient agrees it's needed. Nobody has to win an argument to get a second opinion.

In A&E. The same route now runs through the department. That matters in departments that saw nearly a quarter of a million more attendances this summer than last.

What it is not. It covers the waiting room and the corridor as well as the cubicles. It isn't a way to be seen sooner. A long wait on its own isn't grounds for a call. It's for a patient who is getting worse, wherever they're sitting or lying, whose concern isn't being acted on. Someone comes to them. They don't move up the queue for their first assessment.

What it has done so far

Since the first phase, 19,177 calls have been made by patients, families and staff. July was the busiest month yet, with 1,678. Of those calls, 5,660 were about acute deterioration. 3,432 led to a change in treatment. 749 patients were moved to a high dependency or intensive care bed.

The case against it, and the nuance

• Most calls aren't about deterioration. 7 in 10 calls are not about what they should be about. They were delays, communication and discharge. That is the ordinary work of the ward, now arriving through a hotline to the critical care outreach team, which also covers the wards and got no extra staff for it.
• It goes around the problem, not through it. Martha's team heard her parents and didn't reconsider. A paper in the Journal of Medical Ethics argues that a phone number lets a family step around a team that won't listen, and leaves that team as it was.
• It reaches the wrong people. The same paper argues that those who know to call aren't always those most at risk. And most people don't know to call. At a hospital that had run it for over 2 years, 93% of patients and relatives surveyed hadn't heard of it. Some feared that calling would look like whistleblowing.

Of the calls that wouldn't have triggered escalation on the early warning score alone, 13% led to a transfer of care and 56% to another change in treatment. So the calls that don't look like deterioration on paper still change care. Whether a change was needed or made to settle the caller, the figures don't say, and nobody has checked. And the workload fear hasn't shown up. In one children's A&E, every senior staff member surveyed expected more work before it started, and 88% expected worse patient flow. 6 months in, 87% said neither had happened.