Martha Rule Expands Across All A And E Departments

Martha's Rule is being expanded to emergency departments across England from September 22, giving patients, relatives and hospital staff a formal way to request an urgent review of medical care. The system was created after the death of 13-year-old Martha Mills, who developed sepsis while being treated at a London hospital in 2021. Her family had raised concerns about her condition before her death.

The new expansion means the system will now cover Accident and Emergency departments, where patients can become seriously ill while waiting for treatment. Under Martha's Rule, patients, family members and staff can request a rapid clinical review when they believe a patient's condition is getting worse and their concerns are not being addressed. The system provides a dedicated route for concerns to reach another medical team, allowing doctors and nurses to reassess the patient quickly.

The policy was first introduced in inpatient hospital wards and has since been extended to other areas, including maternity and neonatal services. The expansion to A&E departments is important because emergency units can be busy and crowded, with staff required to make quick decisions while dealing with large numbers of patients. Patients and relatives may sometimes notice changes in a person's condition before those changes are fully recognized by medical staff, giving Martha's Rule a role in helping them raise concerns formally.

The scheme was tested in seven NHS trusts before the wider rollout. During the pilot, calls resulted in some patients receiving urgent surgery or being moved to intensive care. The government and NHS officials say the system can improve patient safety by creating an additional safeguard.

The nationwide expansion will not happen at every hospital at exactly the same speed. The wider rollout is expected to continue through a phased process, with completion planned by March 2028. The rule also includes emergency departments and their waiting areas, which is important because patients can deteriorate before they are seen by a doctor.

The policy is named after Martha Mills because her family's experience became part of the wider campaign for better communication between patients and medical staff. Her parents argued that families need a clear way to raise concerns when they believe a patient's condition is worsening. The introduction of Martha's Rule has created a stronger focus on listening to patients and families, while it does not replace normal medical decision-making and instead creates another route for urgent review.

The NHS has received thousands of calls under the wider scheme since it began. July 2026 recorded a high number of calls, showing continued use of the system. Health officials say the measure can help identify serious problems earlier, while faster recognition can be important when a patient's condition changes quickly.

The policy also places responsibility on staff to take concerns seriously and respond through the established process. England's emergency departments are under significant pressure because of high demand, so the new system is being introduced in an environment where staff must manage many patients at once.

Martha's Rule is also being considered or used in other parts of the United Kingdom. Scotland has begun using the approach, while Northern Ireland is considering it, and Wales has a similar system. For patients in England, the September 22 expansion means emergency departments will now have another formal safety mechanism.

The policy does not guarantee a particular medical outcome. Instead, it gives patients, families and staff a way to request another urgent assessment when they believe a serious change in condition may not be receiving enough attention. The wider rollout marks another stage in the NHS's effort to improve patient safety and communication in emergency care.