Martha’s Rule to be extended to every hospital A&E department in England
The rule, which was brought in after the death of 13-year-old Martha Mills, gives formalised, 24/7 access to an urgent review and is advertised throughout hospitals
Martha’s Rule will be extended to hospital A&E departments in England, making it easier for staff and families to ask for a second opinion.
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The rule, which was brought in after the death of 13-year-old Martha Mills, gives formalised, 24/7 access to an urgent review and is advertised throughout hospitals.
Martha developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London in 2021, with a coroner ruling she would have survived if medics had transferred her to intensive care earlier.
Her parents, Merope Mills and Paul Laity, have said their concerns about her deteriorating condition were repeatedly dismissed.
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Under the new plan, the NHS will extend Martha’s Rule, which is already being rolled out across all inpatient wards.
It means patients, loved ones and staff in busy A&E departments will be able to call a dedicated phone number to trigger an urgent review if a patient’s condition is deteriorating and they think their concerns are not being listened to.
The phased rollout will be completed by March 2028.
A pilot in seven trusts has already tested whether Martha’s Rule could work safely in A&E.
During an eight-month pilot, 69 calls were made to Martha’s Rule phone numbers, with some patients going on to have urgent surgery or being transferred to intensive care, NHS England said.
Professor Aidan Fowler, national director of patient safety at NHS England, 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.
“Martha’s Rule is already having a transformative effect in making our acute care even safer, and by expanding Martha’s Rule into A&Es, we are giving even more patients, their families and NHS staff a critical new lifeline to help improve care and save more lives.
“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 said: “Martha’s Rule is about making sure patients and their loved ones are heard when they raise concerns about their care.
“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.
“This is part of our wider efforts to put patient safety at the heart of the NHS.”
Overall, hospitals are also expected to extend Martha’s Rule to A&E, maternity and neonatal units by March 2028.
Latest figures for July 2026 show the highest-ever monthly total of calls made via Martha’s Rule (1,678).
In January, a report found the UK could be trailing countries such as Norway, Switzerland, Japan, Spain and Italy when it comes to patient safety.
A chart of the safest places to receive care from 38 countries in the Organisation for Economic Co-operation and Development (OECD) ranked the UK in 21st place, but this was based on 2021 data.
The global state of patient safety 2025 study, from Imperial College London, included key aspects of patient safety, one of which was deaths from treatable causes, such as from sepsis and blood clots like venous thromboembolism.