Tejal Somvanshi
Patients and families in English emergency departments with a worsening relative now have a formal, protected way to push for another medical opinion—even when ward staff have moved on. NHS England announced September 22 that Martha’s Rule will extend to every accident and emergency department in England, building on a rollout that already covers 143 hospital sites.
Martha’s Rule gives patients, relatives, and hospital staff a dedicated escalation route to request an urgent review when they believe a patient’s condition is deteriorating and their concerns are not being addressed. The rule was introduced following the death of 13-year-old Martha Mills in 2021, who died from sepsis at King’s College Hospital after sustaining a pancreatic injury in a bicycle accident. Her family’s campaign led directly to the policy.
Phase 1 of Martha’s Rule rolled out to 143 hospital sites across England. The new A&E expansion will be phased across every emergency department in England, completing by March 2028. NHS England confirmed the expansion on September 22, with Health and Social Care Minister Baroness Merron acknowledging the family’s advocacy in the official statement.
Patients, relatives and staff in English emergency departments now have the formal right to use a dedicated escalation route to request an urgent review when concerns about a patient’s deterioration are not being addressed. If a family member shows signs of sudden deterioration—confusion, breathing difficulty, or a rapid change in condition that staff are not actively addressing—anyone present can invoke Martha’s Rule and trigger an urgent review by another clinical team. The process applies in A&E settings under the new expansion.
How the Escalation System Works in Practice
The seven-trust A&E pilot that preceded the national announcement recorded 69 calls over eight months. Some resulted in urgent surgery or transfers to intensive care. NHS England also reported that July 2026 produced 1,678 Martha’s Rule activations across all participating sites—the highest monthly total since the scheme launched.
The escalation process runs through a dedicated contact point at each hospital, typically displayed on patient information boards. Patients or relatives state they are requesting a Martha’s Rule review. A separate clinical team then assesses the patient’s observations, charts, and current treatment plan. Each hospital publishes its own Martha’s Rule contact number; there is no single national number. For a full guide to patient rights in NHS settings, see .
NHS data shows that around 30% of Martha’s Rule calls related to acute deterioration. The July 2026 monthly total of 1,678 calls, the highest since introduction, reflects the scheme’s growing use across participating trusts.
How do you trigger Martha's Rule in an NHS hospital?
Find the Martha’s Rule contact number displayed on patient information boards at your hospital—each trust publishes its own. State that you are requesting a Martha’s Rule review for a patient whose condition is worsening. A separate clinical team will then assess the patient independently of the treating team.
The full A&E rollout across England is scheduled to complete by March 2028. NHS trusts face phased compliance deadlines as the expansion progresses. NHS England will publish rollout milestones and compliance data as the March 2028 deadline approaches. Check back for updates as those figures are released.
