Marthas Rule Explained: The Ultimate 2026 Guide for Patients and Families

Marthas Rule is an NHS patient safety initiative that gives patients, families, and staff a clear way to request an urgent second opinion if they believe a patient’s condition is deteriorating and their concerns are not being heard. Introduced after the death of 13-year-old Martha Mills in 2021, Martha’s Rule is now available across inpatient wards and, from September 2026, is being extended to every A&E department in England.ashfordstpeters.nhs+1

This guide explains what Martha’s Rule is, how to use it step by step, what happens after you call, and what it means for patients and families in 2026.

What Is Martha’s Rule?

Marthas Rule is a national NHS policy designed to help spot early signs of clinical deterioration and ensure concerns from patients, families, and staff are acted on quickly. It creates a formal, 24/7 escalation pathway so that anyone worried about a patient’s condition can request an urgent review by a different clinical team.yahoo+2

The rule applies to:

• Patients in hospital (inpatients)

• Their families and carers

• NHS staff who are concerned about a patient’s deterioration

From late September 2026, it also covers people in A&E departments, whether they are waiting for care or already being treated.

The Story Behind Martha’s Rule

Martha’s Rule is named after Martha Mills, a 13-year-old girl who died of sepsis in 2021 while under the care of King’s College Hospital NHS Foundation Trust in south London. Martha had been admitted with a pancreatic injury after falling off her bike, but her parents’ repeated concerns about her worsening condition were not acted on in time.

In 2023, a coroner ruled that Martha would probably have survived if she had been transferred to intensive care sooner. Her family campaigned for changes to ensure other families would be listened to, leading to the creation of Martha’s Rule as a national patient safety initiative.swbh.nhs

The Three Core Components of Marthas Rule

Marthas Rule has three main parts that work together to improve patient safety and communication.

1. Daily Check-Ins With Patients and Families

Hospitals implementing Martha’s Rule should ask patients at least once a day how they are feeling and whether they think their condition is getting better, worse, or staying the same. This information must be recorded and acted on in a structured way.medicalindependent

The goal is to catch early warning signs of deterioration that might be missed during routine observations.

2. Staff Can Request an Urgent Review at Any Time

Any member of NHS staff — including junior doctors, nurses, and allied health professionals — can request a rapid review from a different clinical team if they are concerned about a patient’s deterioration and feel their concerns are not being addressed.

This gives staff a formal escalation route independent of the immediate care team.

3. Patients and Families Can Call for a Rapid Review

Patients, families, and carers can contact a dedicated phone number (available 24/7) to request an urgent review by an independent clinical team if they remain worried after speaking to the bedside care team.ashfordstpeters.nhs

This is the part of the rule most people think of when they hear “Martha’s Rule.”

How to Use Marthas Rule: Step-by-Step

If you are worried about a patient’s condition in hospital, follow these steps in order.healthwatchdarlington.co

Step 1: Speak to the Bedside Care Team

Tell the nurse, doctor, or ward manager caring for the patient that you are worried and feel something is wrong. Be specific about what you have noticed — for example, changes in breathing, alertness, pain, or colour.

Step 2: Escalate Within the Ward If Needed

If your concerns are not addressed, ask to speak to the nurse in charge or the duty doctor. Make it clear that you remain worried and would like your concerns documented and acted on.healthwatchdarlington.co

Step 3: Call the Marthas Rule Line

If you still feel the patient is deteriorating and your concerns are not being listened to, call the hospital’s dedicated Martha’s Rule phone number. This number is usually displayed on wards, in patient information leaflets, and on hospital websites.ashfordstpeters.nhs

You can call 24 hours a day, seven days a week. Some hospitals also accept WhatsApp messages.medicalindependent

What to Say When You Call

When you call the Martha’s Rule line, be ready to provide:

• The patient’s name and date of birth

• The ward or department they are in

• Your specific concerns about their condition

• What you have already done (e.g., spoke to the nurse, spoke to the doctor)

The team will arrange an urgent review by a different clinical team.yahoo+1

What Happens After You Call?

Once a Marthas Rule call is made, an independent clinical team will review the patient’s condition as a priority. This team is separate from the original care team to ensure an objective assessment.

Possible outcomes include:

• Changes to medication or treatment

• Additional tests or monitoring

• Transfer to a higher level of care (e.g., HDU or ICU)

• Reassurance that the current plan is appropriate, with a clear explanationquomi

Between September 2024 and April 2026, more than 14,000 Martha’s Rule calls were recorded across the NHS. Around 72% were made by patients, families, or carers. Of the cases involving acute deterioration, over 2,700 led to changes in treatment, including more than 600 transfers to higher or specialist levels of care.quomi

Who Can Use Marthas Rule?

Martha’s Rule can be used by:

• Adult and child patients in hospital

• Family members and carers

• NHS staff working in the hospitalswbh.nhs

It applies to inpatient wards and, from September 2026, to all A&E departments in England. Some trusts are still rolling it out ward by ward, so availability may vary by site.

Martha’s Rule in A&E: What’s New in 2026?

From 22 September 2026, Martha’s Rule is being extended to every A&E department in England. This means patients, loved ones, and staff in emergency departments can now call a dedicated number to trigger an urgent review if they believe a patient’s condition is deteriorating and their concerns are not being listened to.

The phased rollout will continue through to March 2028 to ensure all sites are fully equipped.

Common Mistakes and Misunderstandings

Mistake 1: Calling Marthas Rule Before Speaking to the Care Team

Martha’s Rule is designed to be used after you have raised concerns with the bedside team and still feel they are not being addressed. Calling the Marthas Rule line first may delay the review, as you will likely be asked to follow the proper escalation steps.healthwatchdarlington.co

Mistake 2: Using It for Non-Urgent Concerns

Martha’s Rule is for situations where a patient’s condition is actively deteriorating and there is a genuine concern that this is being overlooked. It is not a general complaints line or a way to request routine second opinions for stable conditions.medicalindependent

Mistake 3: Assuming It Applies Everywhere Immediately

While the rule is national, some hospitals are still implementing it ward by ward. Check with your local trust or look for signage on the ward to confirm availability.

Limitations and Important Considerations

Marthas Rule is a powerful tool, but it is not a substitute for emergency care. If a patient is in immediate danger, call 999 or alert hospital staff immediately.

The system is also designed to be used appropriately to avoid wasting NHS resources needed for other patients. Calls should be made when there is a genuine concern about deterioration that is not being addressed.

Why Martha’s Rule Matters for Patient Safety

Martha’s Rule strengthens communication between patients, families, and clinical teams. It ensures that concerns about deterioration are taken seriously and reviewed by an independent team when needed.swbh.nhs

By giving patients and families a formal escalation route, the rule helps:

• Catch deterioration earlier

• Reduce delays in treatment

• Improve trust between families and clinical teams

• Create a safer environment for everyone in hospitalswbh.nhs+1

How to Find Your Local Martha’s Rule Number

Martha’s Rule phone numbers vary by hospital trust. To find the correct number:

• Check information leaflets given on admission

• Look for posters or signage on the ward

• Ask the nurse in charge or ward manager

• Visit your hospital trust’s website and search for “Martha’s Rule”ashfordstpeters.nhs

Some trusts also provide WhatsApp numbers for faster contact.

FAQ

Is Marthas Rule available in every hospital?

Marthas Rule is a national NHS initiative, and every acute trust in England is implementing it. However, some trusts are rolling it out ward by ward, so it may not be available in every department immediately. From September 2026, it is being extended to all A&E departments.

Can I use Marthas Rule if I’m not a family member?

Yes. Patients, families, carers, and NHS staff can all use Martha’s Rule if they have concerns about a patient’s deterioration.swbh.nhs

What if I call Marthas Rule and nothing changes?

The independent review team will assess the patient and make recommendations. If you remain concerned after the review, you can raise your concerns again with the care team or use the hospital’s formal complaints process.

Does Marthas Rule apply to children?

Yes. Marthas Rule applies to both adult and child patients in hospital. It was created following the death of 13-year-old Martha Mills.ashfordstpeters.nhs

Can I use Marthas Rule in A&E?

From 22 September 2026, Martha’s Rule is being extended to all A&E departments in England. Patients, families, and staff in A&E can call a dedicated number to request an urgent review.

Is there a time limit for using Marthas Rule?

No. Marthas Rule is available 24 hours a day, seven days a week. You can call at any time if you have concerns about a patient’s deterioration.ashfordstpeters.nhs

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