19,177 calls so far: Martha's rule is coming to every A&E in England
What happened
NHS England has announced that Martha's rule is coming to every accident and emergency department in England. Martha's rule gives patients, their families and NHS staff a way to ask for an urgent second look at someone's care. If you think a patient is getting worse and your worry is not being acted on, you can ring a dedicated phone number. That call brings in a different clinical team, one not already involved in that patient's care, to review them. Until now the rule has mainly covered people already admitted to a hospital ward. The change announced on 22 September 2026 extends it into emergency departments, including A&E waiting rooms. NHS England called reaching the waiting room a landmark step. The rollout is phased, and trusts are expected to have it running in their emergency departments by March 2028. The announcement follows a pilot at seven NHS trusts that ran from September 2025 to March 2026, testing whether the system could work in a busy A&E without getting in the way. During those months, 69 calls were made to the dedicated numbers. Some led to urgent action, including patients going straight to surgery or being moved to intensive care. The trial found it could sit alongside normal clinical procedures without needing extra clinical staff. The rule is named after Martha Mills. Martha was 13 when she died at King's College Hospital in London in 2021. She had injured her pancreas in a bicycle accident and then developed sepsis. Her family raised concerns as she got worse, but those concerns were not acted on. A coroner later concluded that Martha would probably have survived if she had been moved to intensive care sooner. Her parents, Merope Mills and Paul Laity, campaigned for years for the rule that now carries her name.
Why this matters
Most of us have sat in a waiting room at some point, worried about someone we love, and not been sure whether to say anything. You do not want to be a nuisance. You assume the staff have seen what you have seen. Sometimes they have. Sometimes they have not. A&E is where that gap is widest. Departments are busy, staff are stretched, and a person can change a great deal in the half hour between being checked and being checked again. What Martha's rule does is simple but powerful. It turns "I am worried" into a formal request that someone has to answer. You do not have to argue your case or find the right person. You ring a number, and a review happens. It also matters because families often spot things first. You know how your mum normally looks. You know your child's usual breathing. A nurse meeting them for the first time does not have that comparison. Martha's rule treats that knowledge as useful clinical information, not as interference. And it matters because it is now normal. Between September 2024 and July 2026, 19,177 calls were made through Martha's rule by patients, families and NHS staff. July 2026 alone saw 1,678 calls, the highest monthly total so far. Thousands of ordinary people have already used it.
What the evidence actually says
It is worth being careful here, because the numbers are often reported loosely. NHS England published figures in March 2026 covering the scheme's first 16 months, from September 2024 to December 2025. In that period there were 10,119 escalation calls. Of those, 3,457 - about one in three - identified a patient whose condition was genuinely getting worse quickly. Those calls led to 1,885 patients having their treatment changed. Within that group, 446 patients were moved to a higher level of care in what NHS England described as potentially life-saving interventions. More than 6,000 further calls raised concerns about communication, coordination or navigating the system rather than sudden deterioration. Many of those led to better care or clearer answers for families. Two things are worth taking from that. First, the system is not only for emergencies, and calls that turn out not to be urgent are still treated as worthwhile. Second, roughly two thirds of calls did not find rapid deterioration - and that is not a failure. It is what a safety net looks like when it is working. On the A&E pilot specifically, the evidence base is still small. Sixty-nine calls across seven trusts over seven months is a modest number. NHS England's conclusion was that the process is safe and workable in an emergency department, not that it has already been proven to save large numbers of lives there. The evidence from hospital wards is stronger, simply because far more calls have been made. Professor Aidan Fowler, NHS England's national director of patient safety, 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." Health minister Gillian Merron said: "Martha's rule is about making sure patients and their loved ones are heard when they raise concerns about their care."
Qurexa perspective
We deliver prescriptions and groceries across Lincolnshire, and our team speaks to a lot of people managing a health condition at home, often for a relative. The thing we hear most often is not a complaint about care. It is uncertainty about whether it is their place to speak up. People will tell our drivers that Dad has not been himself for two days long before they will tell a clinician. So we think this change is worth knowing about even if you are nowhere near a hospital today. Knowing that a formal route exists changes how you feel about raising a concern. It makes speaking up the ordinary thing to do rather than the awkward thing. Medication is a practical part of that picture. If someone ends up in A&E, one of the most useful things you can hand over is an accurate, current list of what they take. That is one reason our prescription delivery and adherence support keep a clear record of what has been dispensed and when. It is worth keeping an up-to-date copy in your phone or your bag.
Practical advice
If you are ever worried that a patient is getting worse and it is not being acted on, here is what to do. Say something early. Tell the nurse or doctor looking after the patient first. Be specific about what has changed: "she was talking to me an hour ago and now she is not answering properly" is more useful than "she seems worse". Ask for the Martha's rule number. Every hospital running it will have a dedicated phone number, and staff can tell you what it is. Look for it on posters, leaflets or information by the reception desk. Use it if your concern has not been answered. You do not need permission, you do not need to be a relative, and you do not need to be certain. It is designed to be used by anyone at the bedside, including staff. Be ready with the basics. When the reviewing team arrives, tell them what has changed, when it started, what the patient is normally like, and what medicines they take. Do not wait for it to get worse. The point of Martha's rule is to act during the window when acting still helps. Outside hospital, do not use this route. Ring 111 for urgent advice, or 999 in an emergency. Martha's rule is for people already in NHS care. Remember the A&E rollout is phased, so not every department will have it running yet. If yours does not, you can still ask directly for a senior clinical review.
What to know
Martha's rule lets patients, families and staff call a dedicated number to trigger an urgent review by a clinical team not already involved in that patient's care. NHS England announced on 22 September 2026 that it will be extended to every A&E department and waiting room in England, in a phased rollout completing by March 2028. The decision follows a pilot at seven NHS trusts from September 2025 to March 2026, in which 69 calls were made, some leading to urgent surgery or intensive care transfer. In the scheme's first 16 months, from September 2024 to December 2025, there were 10,119 calls. Around a third identified genuine rapid deterioration, 1,885 patients had treatment changed, and 446 were moved to a higher level of care. From September 2024 to July 2026 there have been 19,177 calls in total, with a record 1,678 in July 2026 alone. It is named after Martha Mills, who died aged 13 in 2021 after her family's concerns about her worsening condition were not acted on. Sources: NHS England, "Over 10,000 calls to Martha's Rule in first 16 months to trigger urgent review of care", 20 March 2026, https://www.england.nhs.uk/2026/03/over-10000-calls-to-marthas-rule-in-first-16-months-to-trigger-urgent-review-of-care/ | Nursing Times, "Martha's rule set to be expanded to all A&E departments", 22 September 2026, https://www.nursingtimes.net/emergency-and-critical-care/marthas-rule-set-to-be-expanded-to-all-ae-departments-22-09-2026/ | Open Access Government, "NHS to expand Martha's Rule to all A&E departments", 22 September 2026, https://www.openaccessgovernment.org/nhs-to-expand-marthas-rule-to-all-ae-departments/214570/ | PA Media via AOL, "Martha's rule to be expanded to every A&E in England", 22 September 2026, https://www.aol.co.uk/articles/martha-rule-expanded-every-e-230128000.html | NHS England, "Martha's Rule", https://www.england.nhs.uk/patient-safety/marthas-rule/ This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. If you are worried that someone's condition is getting worse, speak to the clinical team caring for them, or call 111 for urgent advice and 999 in an emergency.
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