The short version
- The Martha's Rule protocol is being rolled out to all emergency departments in England by March 2028, following successful trials at seven hospital trusts.
- Patients, families, and medical staff can use a dedicated hotline to request immediate second opinions or urgent reviews if they believe deteriorating conditions are not being adequately addressed.
- Early data from pilot programs indicates that these interventions have led to critical changes in treatment, including transfers to intensive care and emergency surgeries.
The National Health Service in England has initiated the expansion of a patient safety protocol known as Martha's Rule across all hospital emergency departments. This measure allows patients, their families, and medical staff to trigger an urgent review of care if they believe a patient’s condition is deteriorating without appropriate attention. The nationwide rollout began recently and is scheduled for completion by March 2028, building upon a successful eight-month pilot program conducted at seven hospital trusts.
The initiative is named after Martha Mills, a thirteen-year-old girl who died in 2021 at King's College Hospital in London. Her death followed a cycling accident during a family holiday that resulted in serious pancreatic injuries. Weeks after the incident, she developed an infection that progressed to sepsis, a severe reaction to infection where the body’s response damages its own tissues and organs. A coroner later ruled that Martha likely would have survived if she had been transferred to intensive care sooner and received more appropriate treatment.
Martha’s parents, Merope and Paul Mills, established the rule in response to their experience, aiming to shift hospital culture so that concerns raised by families are taken seriously. Under the new system, anyone involved in a patient's care can call a dedicated phone number to request an immediate assessment from a different team. This mechanism is designed to provide a formal channel for challenging clinical decisions when there is uncertainty or disagreement about the adequacy of current care.
Data from the initial pilot phase suggests the protocol can facilitate timely interventions. During the eight-month trial, sixty-nine calls were made to the dedicated lines. Some of these calls related to acute deterioration following urgent clinical reviews. In several instances, the triggered reviews resulted in immediate changes to patient management, including emergency surgeries or transfers to intensive care units. These outcomes highlight the potential for the system to identify critical issues that might otherwise be overlooked in busy emergency settings.
Prof Aidan Fowler, national director of patient safety at NHS England, described the expansion as a critical new lifeline for both families and staff. He noted that early testing demonstrated the rule works effectively in high-pressure A&E environments. The protocol builds on evidence from adult and children's wards, where thousands of similar calls have already been made by patients, families, and healthcare professionals. Many of these previous interventions led to changes in treatment plans and potentially life-saving actions.
The initiative also aims to support medical professionals who may feel uncertain about their assessments or face pressure in fast-paced environments. Staff members are encouraged to use the system if they believe appropriate action is not being taken, providing a structured way to seek second opinions without fear of reprisal. This dual approach empowers both laypersons and experts to contribute to patient safety, fostering a collaborative environment where concerns can be raised formally and addressed promptly.
Public figures who have experienced similar tragedies have voiced support for the rollout. Actor Jason Watkins, whose daughter Maude died from sepsis in 2011, praised the rule for giving parents a voice when issues arise. He emphasized that the protocol encourages medical practitioners to pause and reflect on whether they are doing everything possible to assess patients accurately. Watkins urged parents to ask for second opinions if they feel worried about their child's care in emergency departments.
While England implements this specific framework, other parts of the United Kingdom are adopting similar measures. Scotland has begun using Martha's Rule, and Northern Ireland is considering its adoption. Wales operates a comparable scheme known as Call4Concern. Health minister Baroness Merron stated that the initiative is part of broader efforts to place patient safety at the center of NHS operations. Patients and families can verify availability by checking local hospital websites or asking staff directly.
The full implementation across all emergency departments represents a significant shift in how patient concerns are handled within the English healthcare system. By formalizing the process for requesting reviews, the NHS aims to reduce delays in critical care and improve outcomes for vulnerable patients. The success of the program will depend on consistent usage by both staff and families, as well as the responsiveness of medical teams to these triggered reviews.
As the rollout progresses through 2027 and into 2028, monitoring of the system's impact will be crucial. Officials will likely track metrics such as the frequency of calls, the nature of interventions triggered, and any changes in patient outcomes. The goal is to create a sustainable culture of safety where early detection of deterioration leads to timely action, preventing avoidable deaths and improving overall care quality in emergency settings.
Sources behind this briefing
Go to the original reporting
- BBC News↗Martha's Rule rolled out at every A&E department in England
