Martha’s Rule to be extended to A&E departments across England
Martha’s Rule is to be extended to A&E departments across England, giving patients, families and staff another route to request an urgent review when they are concerned that a patient’s condition is deteriorating.
The rule provides 24-hour access to a separate clinical review where concerns about deterioration have not been addressed. It was introduced following the death of 13-year-old Martha Mills, who developed sepsis while receiving hospital care in 2021.
The expansion follows an eight-month pilot across seven NHS trusts. During the pilot, 69 calls were made through Martha’s Rule in A&E departments, with some resulting in urgent surgery or transfer to intensive care.
The phased rollout across A&E departments is expected to be completed by March 2028. Hospitals are also extending the approach to maternity and neonatal services.
Martha’s Rule so far
NHS England data shows that 19,177 escalation calls were recorded between September 2024 and July 2026.
Around 30% of these calls related to acute deterioration. Of those, 749 resulted in transfer to intensive care, high dependency, enhanced care or other specialist services, while 2,683 led to other changes in treatment.
July 2026 recorded 1,678 calls, the highest monthly total since data collection began.
Elsewhere in the UK
Wales is introducing a similar approach called Call for Concern across adult, paediatric, maternity and neonatal hospital wards. It provides patients and families with a route to request further clinical review when they are concerned about deterioration.
Scotland is developing its own implementation of Martha’s Rule, with initial work focused on acute adult and paediatric hospital settings during 2026/27.
Martha’s Rule has not currently been formally adopted in Northern Ireland.