NHS expands Martha's Rule to all A&E departments to empower patient safety concerns

A thirteen-year-old girl died from an infection that should have been treatable. Her name was Martha Mills. She was at King's College Hospital in London in 2021, recovering from a bicycle accident that had damaged her pancreas. Weeks into her hospital stay, her body developed sepsis—a cascade of infection where the immune system turns inward and begins destroying its own tissues and organs. Her family saw it happening. They raised concerns. No one acted on what they were saying. A coroner later concluded that Martha would almost certainly have lived if she had been moved to intensive care sooner and given the right treatment.

Her parents, Merope and Paul Mills, took that finding and transformed it into policy. They created Martha's Rule—a mechanism that gives patients, families, and hospital staff themselves a way to demand that someone listen when they believe care is going wrong. Starting now, the rule is being rolled out to every accident and emergency department across England's NHS, with completion expected by March 2028.

The mechanism is straightforward. If a patient's condition is worsening and a family member or staff member believes the hospital is not responding appropriately, they can call a dedicated phone number. That call triggers an urgent clinical review by a different team—a second set of eyes, a chance to be heard. It is not a complaint process. It is not bureaucracy. It is a circuit breaker in the moment when something feels wrong.

The rule has already been operating in hospital wards across the country, and the evidence from those settings suggested it could work in the chaos of emergency departments too. A pilot program ran across seven trusts over eight months. During that time, sixty-nine calls came in through Martha's Rule phone lines in A&E units. Some of those calls led directly to surgery. Some led to immediate transfer to intensive care. In other cases, the review confirmed that the current plan was sound. The point was not to override clinical judgment. The point was to ensure that concern itself was treated as clinical information.

Prof Aidan Fowler, the national director of patient safety at NHS England, described the expansion as offering families and staff "a critical new lifeline." He noted that in adult and children's wards, where Martha's Rule has been operating longer, thousands of calls have been made, many resulting in changes to treatment and what he characterized as potentially life-saving interventions. The rule, in other words, has already saved people.

Patients and families who want to know whether Martha's Rule is available at their local hospital can check the trust's website or ask staff directly. The expansion is happening now, though full implementation across all emergency departments will take until early 2028. Scotland has begun using the rule. Northern Ireland is considering it. Wales operates a similar system called Call4Concern. What started as one family's response to a preventable death is becoming standard infrastructure in how the NHS listens to the people it treats.