The NHS is rolling out Martha's Rule to every hospital emergency department in England, enabling patients, families and staff to request urgent reviews of care when they believe a patient's condition is deteriorating and their concerns are not being addressed.
The initiative is named after Martha Mills, who died aged 13 at King's College Hospital in London in 2021 after developing sepsis following a cycling accident. A coroner later determined that she would probably have survived had she been transferred to intensive care earlier and received appropriate treatment. Her parents, Merope and Paul Mills, created the rule to transform how the NHS responds to safety concerns raised by patients and their loved ones.
Under Martha's Rule, patients, relatives and healthcare workers in A&E units can telephone a dedicated number to trigger an urgent clinical review if they are worried that deteriorating symptoms are not receiving proper attention. The nationwide expansion of the scheme to emergency departments begins immediately and is scheduled to be fully implemented by March 2028, building on a successful trial conducted across seven NHS trusts.
The scheme has already been rolled out to all inpatient wards across England. According to NHS England, more than 10,000 calls to Martha's Rule have been made in the first 16 months, demonstrating that usage has more than doubled since June 2025. During the eight-month pilot at the seven trusts, 69 calls were made to dedicated Martha's Rule phone numbers, with some relating to acute deterioration following urgent clinical review. Several of these calls resulted in patients receiving immediate surgery or being transferred to intensive care.
How did Martha Mills die?
Martha was hospitalised after a cycling accident during a family holiday left her with serious injuries to her pancreas. She had skidded on sand while riding and fell heavily onto the handlebars. After several weeks, she developed an infection that progressed to sepsis—a life-threatening condition in which the body's response to infection causes damage to its own tissues and organs. This deterioration was not managed appropriately, and her family's escalating concerns about her care were not properly heeded.
In 2022, a coroner's investigation concluded that Martha would probably have survived if she had been transferred to intensive care sooner and given suitable treatment.
What is the wider rollout plan?
The expansion of Martha's Rule to emergency departments is part of a broader programme extending the scheme across multiple hospital settings. NHS England reports that all acute trusts in England are working to implement the scheme, with completion of acute inpatient services expected during 2026/27. The NHS Standard Contract 2026/27 requires all trusts to implement the three core components of Martha's Rule by 31 March 2027.
Beyond emergency and inpatient departments, pilots are also under way for maternity and neonatal units, mental health services and community settings. In June 2026, the government announced that Martha's Rule was being extended to all maternity services in England following a review that revealed serious and sustained failures at Nottingham University Hospitals NHS Trust.
The original phase 1 rollout began in May 2024 at 143 pilot sites across NHS acute trusts, and phase 2 commenced in August 2025, extending the scheme to all acute inpatient hospital sites in England. The expansion to emergency departments now represents a significant step in making the safety mechanism available across more hospital settings where rapid deterioration can occur.
What do NHS leaders say about the expansion?
Prof Aidan Fowler, national director of patient safety at NHS England, described the expansion as providing families and NHS staff
a critical new lifeline to help improve care and save more lives.He added that
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.
Health minister Baroness Merron characterised the initiative as part of
wider efforts to put patient safety at the heart of the NHS.
Staff themselves can request a review from a different clinical team if they believe appropriate action is not being taken, embedding the safety mechanism within the workforce as well as empowering patients and families.
How can patients access Martha's Rule?
Patients and their families can find out whether Martha's Rule is available at their local hospital by visiting their NHS trust's website or asking hospital staff directly. The scheme is already operational in Scotland, which has begun implementing it, and Northern Ireland is considering adoption. Wales operates a comparable initiative called Call4Concern.
What happens next?
The rollout to all A&E departments across England is expected to be completed by March 2028. Full implementation of Martha's Rule across acute trust inpatient services should be finished during 2026/27, with the contractual deadline for trusts to implement the three core components set at 31 March 2027. Continued expansion into maternity, mental health and community settings is also planned as part of the wider patient safety strategy.
