Martha’s Rule to Be Rolled Out to Every A&E Department in England
The Martha’s Rule A&E expansion represents an important development in patient safety across NHS emergency care in England. Under the new plans, Martha’s Rule is being extended to every hospital Accident and Emergency department, including waiting areas, giving patients, relatives and NHS staff an additional way to escalate concerns when they believe someone’s condition is deteriorating and those concerns are not being adequately addressed.
The nationwide A&E expansion follows the introduction of Martha’s Rule in acute inpatient care and testing of the approach within emergency departments. The rollout is being introduced in phases and is expected to be completed across A&E departments in England by March 2028.
For NHS organisations, clinical teams and healthcare professionals, the expansion reinforces an increasingly important principle within modern patient safety: patients and the people who know them best can provide valuable information about changes in their condition, and there should be clear routes for those concerns to be heard and reviewed.
What Is Martha’s Rule?
Martha’s Rule is a patient safety initiative developed following the death of 13-year-old Martha Mills in 2021. Martha developed sepsis while being treated at King’s College Hospital in London after suffering a pancreatic injury following a bicycle accident.
Her parents raised concerns about her deteriorating condition while she was in hospital. A coroner subsequently concluded that Martha would probably have survived had she been transferred to intensive care earlier.
Martha’s Rule was subsequently developed to strengthen the way concerns about deterioration can be escalated within hospitals.
At the heart of the initiative is a route through which patients, their families, carers and staff can request an urgent review when they are worried that a patient’s condition is worsening and believe their concerns are not being adequately addressed.
Further information about Martha’s Rule is available directly from NHS England:
What Does the Martha’s Rule A&E Expansion Mean?
The Martha’s Rule A&E expansion means the initiative is being extended beyond inpatient wards and into emergency departments across England.
Patients, relatives and staff in A&E will be able to use a dedicated telephone number to trigger an urgent review where they believe a patient is deteriorating and their concerns are not being acted upon appropriately.
Importantly, the plans include A&E waiting areas as well as patients who are already receiving treatment.
This is particularly significant because deterioration does not necessarily begin after a patient has been admitted or assessed. A person waiting for assessment may experience changes in symptoms or their overall condition, while relatives or carers may notice that something is significantly different.
Providing a defined escalation route within this environment adds another layer to existing clinical assessment and escalation processes.
The expansion is being introduced in phases, meaning patients should not assume Martha’s Rule is currently available in every A&E department. Local availability and instructions should be checked with the relevant NHS trust.
Why Is Martha’s Rule Important for Patient Safety?
Recognising deterioration quickly is a fundamental component of safe healthcare.
Clinical observations, early warning systems and professional judgement all play important roles in identifying deterioration. Martha’s Rule adds another source of information: the observations and concerns of patients themselves and the people around them.
A family member may recognise that a patient is unusually confused, less responsive, behaving differently or deteriorating in a way that is difficult to capture through an isolated observation.
Martha’s Rule does not replace clinical assessment or established escalation procedures. Instead, it provides an additional structured route for concerns to be raised and reviewed.
NHS England describes the programme as part of its work to improve the prevention, identification, escalation and response to physical deterioration.
More information on NHS patient safety improvement programmes can be found at:
NHS England » The National Patient Safety Improvement Programmes
Evidence From Martha’s Rule So Far
The scale of the programme has grown substantially since implementation began in 2024.
According to NHS England’s published statistics, there were 19,177 Martha’s Rule escalation calls between September 2024 and July 2026. Of these, 5,660 related to acute deterioration.
Among calls relating to acute deterioration, 749 resulted in transfers of care to an intensive care unit, high dependency unit, enhanced level of care, tertiary centre, specialist service or specialist ward. A further 2,683 resulted in other changes to treatment.
These figures demonstrate why effective escalation systems can have practical consequences for patient care.
The expansion into emergency departments follows testing in seven NHS trusts. During an eight-month A&E pilot, 69 calls were made to dedicated Martha’s Rule numbers. According to reporting on the NHS announcement, some cases resulted in urgent surgery or transfer to intensive care.
Listening to Patients, Families and Carers
One of the most important principles behind Martha’s Rule is recognition of the role patients and families can play in identifying deterioration.
Healthcare professionals have clinical expertise, observations, diagnostic information and access to medical histories. Patients and relatives can bring another type of information: familiarity with what is normal for that individual.
A relative may know, for example, that a patient is normally highly alert but has suddenly become confused. A parent may recognise an unusual change in their child’s behaviour. A patient may know that their symptoms are worsening despite observations that initially appear reassuring.
Creating an established escalation route can help ensure these concerns become part of the wider clinical picture.
NHS England data also illustrates the importance of family involvement. Of the Martha’s Rule calls recorded between September 2024 and July 2026, the largest proportion – 72% – came through the family or carer escalation process.
Supporting Healthcare Staff to Raise Concerns
Martha’s Rule is not solely designed for patients and relatives.
Healthcare professionals can also use escalation routes where they are concerned about a patient and believe the appropriate response has not occurred.
This supports a broader safety culture in which speaking up about deterioration is encouraged regardless of professional hierarchy.
NHS England reported in May 2026 that more than 1,000 NHS staff had used Martha’s Rule helplines during the programme’s first 18 months. Between September 2024 and February 2026, 1,781 calls were made by hospital staff, and 1,080 of those calls helped identify acute deterioration.
A healthcare system that makes it easier for both professionals and families to escalate genuine concerns can provide additional safeguards around patients whose condition may be changing rapidly.
Why A&E Is an Important Next Step
Emergency departments operate in particularly demanding circumstances.
Patients arrive with an enormous range of conditions and levels of acuity, from relatively minor injuries to immediately life-threatening illness. Clinical teams must continually assess, prioritise, monitor and reassess patients while managing unpredictable demand.
During June, July and August 2026, NHS England recorded more than 7.2 million A&E attendances, making it the busiest summer on record.
Against this background, systems for recognising deterioration and escalating concerns remain essential.
Extending Martha’s Rule to waiting areas is especially notable because it recognises that a patient’s condition can change while they are waiting. A person who was initially assessed at one level of urgency may deteriorate afterwards.
Martha’s Rule therefore provides an additional escalation mechanism alongside established triage, observations, clinical judgement and emergency response procedures.
Communication and Visibility Will Be Essential
For the Martha’s Rule A&E rollout to work effectively, patients need to know that the service exists and understand when and how it should be used.
Clear communication within hospitals will therefore be important.
NHS organisations implementing Martha’s Rule have already used communication materials such as posters to increase awareness among patients, relatives and staff. Information must be visible, understandable and accessible to people with different communication needs.
This is particularly relevant in A&E departments, where patients may be distressed, unwell or unfamiliar with the hospital.
Healthcare organisations will need to ensure local information clearly explains the escalation process without creating confusion with existing emergency procedures, complaints processes or routine requests for information.
Patient Safety Requires the Right Clinical Environment
Policies and escalation procedures form one part of patient safety. Hospitals also depend on appropriate clinical equipment, effective infection prevention measures, organised storage and reliable access to essential consumables.
Niche Healthcare supports NHS trusts, hospitals and healthcare organisations with healthcare supplies and equipment for a wide range of clinical environments.
Healthcare teams can explore the wider Niche Healthcare range here:
Healthcare Supplies UK | NHS Medical Supplier | Niche Healthcare
For departments requiring mobile storage and transportation of clinical supplies, the Stainless Steel Clinical Trolley is designed for use within hospitals, wards and other healthcare environments:
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The expansion of initiatives such as Martha’s Rule highlights the wider importance of ensuring healthcare professionals have appropriate systems, environments and resources to support safe and responsive patient care.
Martha’s Rule Beyond A&E
The development of Martha’s Rule is continuing.
The programme began being introduced at 143 pilot sites in May 2024 before expanding across acute adult and paediatric inpatient services.
NHS England has also been testing and expanding the approach into other areas, including maternity, neonatal and emergency care.
This broader development is important because concerns about deterioration are relevant across many different patient pathways.
The principles underpinning Martha’s Rule – listening, recognising deterioration, escalating concerns and obtaining timely clinical review – have relevance across healthcare.
What Does This Mean for NHS Trusts?
For NHS trusts, implementation involves more than providing a telephone number.
Organisations need appropriate clinical pathways behind that number so calls can be received, concerns assessed and urgent reviews undertaken where necessary.
Staff need to understand how the escalation pathway works and how it interacts with existing patient safety processes. Patients and visitors need accessible information explaining when the service should be used.
Implementation should also recognise the needs of people who may face barriers to raising concerns, including patients with communication difficulties, disabilities or limited English.
NHS England has specifically highlighted accessibility as part of implementation, alongside staff training and communication.
Ultimately, the value of the initiative depends on creating a culture in which reasonable concerns about deterioration are welcomed, assessed and acted upon appropriately.
Frequently Asked Questions About Martha’s Rule
What is Martha’s Rule?
Martha’s Rule is an NHS patient safety initiative that provides a route for patients, families, carers and staff to request an urgent review when they are concerned that a patient’s condition is deteriorating and believe their concerns are not being appropriately addressed.
Is Martha’s Rule currently available in every A&E department in England?
Not yet. The NHS has announced that Martha’s Rule is being expanded to every hospital A&E department in England, but the rollout is phased and is expected to be completed by March 2028. Patients should check with their individual NHS trust to determine whether the service is currently available in their local emergency department.
Can relatives use Martha’s Rule?
Yes. Family members and carers are an important part of the initiative. NHS England’s published data shows that family and carer escalation has accounted for the majority of Martha’s Rule calls recorded so far.
Does Martha’s Rule replace normal emergency care?
No. Martha’s Rule is an additional escalation mechanism for concerns about deterioration. It does not replace normal clinical assessment, emergency procedures, routine communication with healthcare professionals or existing patient safety processes.
Can NHS staff use Martha’s Rule?
Yes. Staff can also escalate concerns where they believe a patient is deteriorating and the appropriate response has not occurred. This is intended to strengthen existing professional escalation routes and support a culture where staff feel able to raise patient safety concerns.
Conclusion: Martha’s Rule A&E Expansion and the Future of Patient Safety
The nationwide Martha’s Rule A&E expansion represents another significant stage in the development of the initiative across NHS services in England.
Its central principle is straightforward but important: when a patient, relative, carer or member of staff believes someone is deteriorating and their concerns are not being adequately addressed, there should be a clear route for those concerns to receive further clinical attention.
With more than 19,000 escalation calls recorded between September 2024 and July 2026, Martha’s Rule is already being used extensively within NHS care. Extending the initiative into A&E departments and waiting areas has the potential to strengthen escalation pathways within some of the busiest and most unpredictable areas of the health service.
As the phased rollout progresses towards March 2028, effective communication, staff awareness, accessibility and reliable clinical escalation processes will all be essential.
For Niche Healthcare, developments such as Martha’s Rule reinforce the wider importance of supporting healthcare professionals with appropriate clinical environments, reliable healthcare equipment and practical solutions that contribute to safe, efficient patient care.
To explore Niche Healthcare’s healthcare supplies and equipment, visit:
Healthcare Supplies UK | NHS Medical Supplier | Niche Healthcare
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