Patient Safety Rule Expansion
NHS Expands Martha’s Rule to All English A&E Departments by 2028
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Key Points
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Martha’s Rule was piloted across 143 acute hospitals between September 2024 and March 2025 and has since been introduced at 221 acute adult and paediatric inpatient sites; full implementation in those settings is expected during 2026–27.
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The A&E expansion is part of a wider plan prompted partly by the Ockenden review into NHS maternity and neonatal services; the government instructed in June that Martha’s Rule should also be extended to maternity and neonatal wards.
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A national three-year research programme, introduced in July, is evaluating how Martha’s Rule is implemented across NHS hospitals and how best to ensure patients, families and staff are heard when they raise concerns about deterioration.
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Gillian Merron, parliamentary under-secretary of state at the Department of Health and Social Care, said extending the rule to A&E would provide “another way to speak up” and help ensure concerns are acted on quickly.
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Matthew Hopkins of the NHS Alliance’s acute and ambulance network said the expansion would “enhance the safety of care” and reassure patients and families who fear that a patient’s condition is worsening.
The NHS is rolling out Martha's Rule to every hospital accident and emergency department in England by March 2028, giving patients, families, and staff a dedicated 24/7 phone line to request urgent clinical reviews when they fear a patient's condition is worsening. The Independent reported that the expansion follows a pilot at seven trusts that generated 69 calls, some leading to urgent surgery or intensive care transfers. The initiative stems from the 2021 death of 13-year-old Martha Mills from sepsis, after doctors dismissed her parents' warnings that she needed higher-level care.
Martha's Rule is already live at 221 inpatient hospital sites across England, with full rollout to all wards expected by 2026–27. NHS England is also extending the rule to maternity and neonatal units following recommendations from a government review into childbirth safety. A three-year research programme launched in July is studying how the system works and how to ensure concerns are heard and acted on quickly.
How Martha's Rule Works in A&E
When a patient or relative believes a condition is deteriorating, they can call a 24/7 critical care hotline to request an independent clinical review. National Health Executive explained that a senior doctor from outside the emergency team will assess the patient within a set timeframe. The rule removes the need to argue with the attending A&E staff and gives families a formal, documented pathway to escalate concerns. Staff can also trigger reviews if they spot warning signs of decline.
Baroness Gillian Merron, a senior health official, said the expansion provides "another way to speak up" and ensures concerns are "acted on quickly." Matthew Hopkins of the NHS Alliance's acute network said Martha's Rule would "enhance the safety of care" and reassure families who fear rapid deterioration. The system uses existing critical care staff, so trusts do not need to hire additional teams.
The Story Behind Martha Mills
In August 2021, Martha Mills, a 13-year-old girl, fell off her bike and developed sepsis—a life-threatening infection. Her parents repeatedly told doctors they were worried her condition was worsening and asked for her to be moved to intensive care. The medical team dismissed their concerns. Martha died of septic shock. A coroner later ruled that an earlier transfer to intensive care would have saved her life.
Martha's parents launched a five-year campaign demanding that hospitals listen to families and staff when they raise safety alarms. Wired-Gov called the resulting Martha's Rule a "life-saving" initiative. The rule has since become a symbol of patient empowerment and a rejection of medical hierarchies that silence relatives. Her parents' advocacy reshaped NHS safety culture and created a new standard for how hospitals must respond to escalation requests.
Pilot Results Show Real Lives Saved
The seven-trust A&E pilot between September 2024 and March 2025 received 69 calls. Many led to urgent interventions: some patients were rushed to surgery, others transferred to intensive care units within hours. Across all active inpatient sites nationwide, 19,177 calls were logged between September 2024 and July 2026, with July hitting a record 1,678 calls in a single month. Early data suggests over 10,000 calls across all settings triggered approximately 446 potentially life-saving interventions.
The evidence shows Martha's Rule works fastest in high-pressure environments like A&E, where speed is critical. Pharmacy.biz reported that patients, families, and staff can now raise concerns about deteriorating conditions without fearing dismissal. The consistent call volume and intervention rates demonstrate that the system fills a genuine safety gap. Hospitals are preparing dedicated phone lines and signage in waiting rooms to make the rule visible and accessible.
Wider Rollout and Timeline Ahead
Martha's Rule is already embedded in 221 acute inpatient sites. The government ordered in June 2026 that the rule be extended to all maternity and neonatal wards—a direct response to the Ockenden Review, which found systemic failures in NHS childbirth care. Full rollout to inpatient wards nationwide is targeted for 2026–27, while every A&E department and waiting room must have the system live by March 2028.
Professor Aidan Fowler, NHS England's national patient safety director, said "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." A national three-year research programme is now evaluating how Martha's Rule performs across different settings and how to ensure it reaches patients and families who need it most. The expansion reflects a cultural shift toward listening to patient voices and acting on them without delay.
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