Martha’s rule to be expanded to every A&E in England
System gives patients, loved ones and health workers the right to ask for a second opinion on care
Martha’s rule, which lets NHS patients, staff and relatives request a review of their care, is being expanded to every A&E in England, health officials have announced.
The system gives patients, their loved ones and health workers the right to ask for a different medical team to examine the care being provided on inpatient wards and to recommend changes. It has already potentially saved hundreds of lives, official figures show.
Now it will be rolled out to every emergency department in England, including waiting rooms, offering “a critical new lifeline” to improve care and save more lives, NHS England said.
The system is named after Martha Mills, 13, who died in 2021 from sepsis after a bicycle accident. A coroner found she would probably have survived if she had been moved to the intensive care unit at King’s College hospital in London when she began deteriorating.
The initiative is the direct result of pressure put on politicians, NHS bosses and doctors after Martha’s parents, Merope Mills and Paul Laity, told the story of what happened to their daughter, who would have turned 19 this month if she had lived.
Mills, a senior editor at the Guardian, and Laity spent years campaigning for the introduction of Martha’s rule, under which people can call a hospital-run helpline with their concerns and seek a “rapid review”.
In the first 16 months of the scheme after its introduction in England in 2024, helplines received more than 10,000 calls, potentially saving 446 lives, figures show. Thousands of patients were either moved to intensive care, received drugs they needed or benefited from other changes as a direct result of the calls.
In June this year, the initiative was expanded to every maternity and neonatal unit in England, giving women and parents the right to a second opinion about the care of a mother or baby.
From this month, it will be expanded to A&E units. It means patients, loved ones and staff in busy emergency 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.
A phased rollout will be completed by March 2028, NHS England said. It follows a pilot in seven trusts which tested whether Martha’s rule could work safely in A&E.
During the eight-month pilot, 69 calls were made, with some patients going on to have urgent surgery or being transferred to intensive care, NHS England said.
Prof Aidan Fowler, 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.”
Matthew Hopkins, acute and ambulance director at the NHS Alliance, which represents and supports the health and care system in England, Wales and Northern Ireland, said health bosses supported the move.
“NHS leaders welcome the rollout of Martha’s rule to all hospital A&E departments and waiting rooms, following the initial pilot in seven trusts.
“They support the initiative’s aim to give the most vulnerable patients, families and staff the chance to be heard and raise concerns.
“This will 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.”
Gillian Merron, a health minister, 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.”
The latest data for Martha’s rule calls, for July 2026, show the highest ever monthly total (1,678) since the system was introduced.
