England • Information checked 30 September 2026
Martha’s Rule is an NHS patient safety programme in England. It gives patients, families, carers and staff a way to request a rapid review when someone in hospital is getting worse and their concerns are not being addressed. It brings in a different clinical team to assess the situation. NHS England
If you remain worried after speaking to the team looking after you or your loved one, you can use the hospital’s Martha’s Rule contact route.
How did Martha’s Rule come about?
Martha Mills died on 31 August 2021, aged 13, after developing sepsis following a pancreatic injury sustained in a cycling accident. She had been treated at King’s College Hospital in London. At the inquest in February 2022, the coroner found that prompt referral to paediatric intensive-care specialists and appropriate treatment would probably have saved her life. Coroner’s report, 28 February 2022
Her parents, Merope Mills and Paul Laity, campaigned for families to have a clear way to raise urgent concerns and obtain a fresh clinical review. Supported by the think tank Demos, their campaign helped bring about the national programme, announced by NHS England in February 2024. Original NHS announcement
Martha’s mother, Merope Mills, recounts the family’s experience in her 2022 Guardian article.
What does it mean practically, and how does it differ from a second opinion?
A routine second opinion involves asking another healthcare professional to consider a diagnosis or treatment plan. Martha’s Rule is specifically for concerns that a patient’s condition is deteriorating and the response is inadequate. It provides an urgent escalation route; it does not guarantee a particular treatment. Great Ormond Street Hospital: second opinions · NHS core standards
How do you request a review?
- Tell the nurse or doctor what has changed, when it started and why you are worried. You do not need to identify the medical cause.
- If your concerns remain unaddressed, use the hospital’s Martha’s Rule route. There is no single national number. Ask staff, check ward posters or search the hospital’s official website. Some hospitals call the service “Call for Concern”.
- Give the patient’s name, ward or department, and a brief account of your concern. Explain what you have already raised with the care team.
These steps draw on NHS England’s guidance and University Hospitals Birmingham’s patient information; follow the arrangements at your hospital.
What happens after you call?
An appropriately skilled clinician who is not directly responsible for the patient’s ongoing care should carry out or arrange a rapid review. The team should explain its findings and any action to you. Response arrangements vary between hospitals. NHS core standards
If someone is worsening while you wait, alert ward staff immediately. If the service is unavailable on your ward, ask the nurse in charge how to obtain an urgent clinical review.
What if you need help to use the service?
Ask staff for help making the call or for an interpreter or communication aid. NHS standards require access to take account of disability, language and communication needs. They also recognise the role of families and carers in supporting someone with dementia or a learning disability. NHS core standards
What are the three parts of Martha’s Rule?
- Patients should be asked at least daily whether they feel better or worse, with their answers recorded and acted on.
- Staff should be able to seek a review from another team at any time when concerns about deterioration are not being addressed.
- Patients, families and carers should have the same round-the-clock route, with clear information explaining how to use it.
These are the programme’s three core components, described by NHS England.
How much has Martha’s Rule been used?
NHS England’s latest published figures, checked on 30 September 2026, cover September 2024 to July 2026. The July report was published on 10 September 2026.
| Measure | Reported result |
|---|---|
| Total escalation calls | 19,177 |
| Calls from families or carers | 72% of all calls |
| Calls about acute deterioration | 5,660 – 30% of all calls |
| Transfers or referrals to higher-level or specialist care | 749 – 13% of acute-deterioration calls |
| Other treatment changes | 2,683 – 47% of acute-deterioration calls |
Together, 3,432 calls about acute deterioration led to treatment changes, including transfers. The 749 figure covers intensive or high-dependency care, other enhanced care and specialist referrals or transfers.
These are reported calls and outcomes, not a count of unique patients or proven lives saved. NHS England publishes them as management information; not every site reports each month, and some submissions are excluded for data-quality reasons. NHS England: July 2026 report
Is it available everywhere?
This article covers England. NHS England reported 221 acute adult and children’s inpatient sites in its 22 September 2026 announcement. Full implementation of the three inpatient components is required by 31 March 2027. Availability can still differ between hospitals and wards. NHS rollout update · Core standards
The expansion into A&E departments and waiting rooms, maternity and neonatal units is phased, with completion expected by March 2028. An announcement of expansion does not mean every department already offers the service. NHS England, 22 September 2026
The expansion currently excludes homebirths, birth centres, same-day emergency care, urgent treatment centres and minor injury units. Testing continues in community hospitals and mental health settings. Check the hospital’s website or ask staff about your particular ward or department. Current NHS guidance
What about other concerns?
For concerns such as food, cleanliness or general service issues, speak to the ward team or nurse in charge. The hospital’s Patient Advice and Liaison Service (PALS) can help if these remain unresolved. Urgent concerns about someone becoming more unwell need to be raised with clinical staff. University Hospital Southampton patient guidance
Before a hospital stay, save the local contact details and ask how to raise an urgent concern. Knowing the route in advance can make it easier to speak up.
Sources and further reading
- Martha Mills: original coroner’s report — inquest findings and dates.
- Merope Mills: personal account.
- NHS England: original rollout announcement — the campaign and introduction of the programme.
- NHS England: Martha’s Rule overview — purpose, components and current scope.
- NHS England: July 2026 data — usage and reported outcomes.
- NHS England: September 2026 expansion announcement — rollout into further settings.
- NHS England: core standards — review process, access and implementation requirements.
- University Hospitals Birmingham: Call for Concern — practical contact guidance.
- Great Ormond Street Hospital: seeking a second opinion — the separate second-opinion process.
- University Hospital Southampton: patient factsheet — review arrangements and other concerns.
Leave a Reply