NHS hails 'Martha's Rule' as life-saving after 12,000 staff raise concerns about patients

Between September 2024 and February 2026, 1,781 calls were made by NHS staff to Martha’s Rule helplines across hospital trusts in England. Of those, 1,080 calls – around 61 per cent – were linked to identifying acute deterioration in a patient’s condition, including cases where patients were becoming critically unwell and required urgent escalation.

Across all users, including staff, patients and families, there were 12,301 calls made in the first 18 months of the scheme. According to NHS England, 4,047 of these were identified as acute deterioration, leading to 2,310 changes in treatment, including 524 cases where patients were transferred to higher levels of care.

Many calls related directly to fears that a patient’s condition was worsening – prompting urgent reassessment, escalation to senior clinicians or transfer to intensive care. Other calls did not involve acute deterioration but were still linked to improvements in care.

These included 2,951 cases where clinical concerns were addressed, such as delays to medication, tests or investigations, and 3,054 calls that helped resolve poor communication between staff and families or problems with discharge planning. Martha’s Rule was developed following the death of 13-year-old Martha Mills in 2021.

She died after developing sepsis in hospital, having been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2022 a coroner ruled she would probably have survived had she been moved to intensive care earlier.

Her parents, Merope Mills and Paul Laity, subsequently campaigned for a system that would make it easier for concerns about patient deterioration to be escalated. Martha’s Rule introduces a structured approach requiring regular checks on patients while also giving patients, families and staff a formal route to request an urgent review if they are concerned.

Professor Aidan Fowler, National Director of Patient Safety, said: "It's really encouraging that more than 1,000 staff have used Martha’s Rule to help flag rapid deterioration in patients as we continue to roll out this life-saving scheme. And today’s independent evaluation shows that even in the early days of Martha’s Rule, one in three people already knew about it, but there is more to do to ensure Martha’s Rule is helping every patient and family it could be.”

Health Secretary Wes Streeting said: "Martha's Rule is already having a lifesaving impact, and these figures show the real difference it is making to NHS staff, patients and families across the country. But this early research also shows there is more to do to ensure that this crucial initiative can be accessed by everyone who needs it."

Early research looked at three hospitals using the scheme and found staff and families felt it helped raise the alarm when patients were getting worse and improved teamwork on wards. However, it also flagged problems – including patchy use of patient checks and poor communication about what happens after concerns are raised.

Researchers warned some of the most vulnerable may struggle to use the system – including older people, those without family support, and patients with disabilities, language barriers or low literacy. The figures also show clear gaps in awareness and use. Patients from the most deprived backgrounds made up the highest share of serious cases flagged (26.1 per cent), compared to 14.5 per cent from the least deprived groups.

Just 32 per cent of the public had heard of Martha’s Rule in a survey of 2,047 people. Awareness was far higher among better-educated and wealthier groups.

Martha’s parents said: “It is hugely encouraging for us that a thousand clinically trained staff have already used Martha's Rule. This is also clear evidence that issues such as hierarchy, poor communication and some doctors' resistance to being challenged affect hospital care every day. Such factors were crucial to any explanation as to why Martha lost her life. We welcome a public conversation about healthcare that explores culture and goes beyond the real problem of stretched resources. And we are very grateful to all those NHS staff who have worked so hard to introduce Martha's Rule."

Martha’s Rule has been introduced at 143 pilot sites since May 2024 and is being expanded to all acute adult and paediatric inpatient services in England. The NHS says staff training, public information campaigns and local communications – including posters in hospitals – are being used to increase awareness and uptake.

The National Institute for Health and Care Research has said it will fund a further national evaluation. This will examine outcomes, staffing implications and how effectively the scheme operates in practice.

Professor Lucy Chappell, Chief Executive of the NIHR and Chief Scientific Adviser at the Department of Health and Social Care, said: “By identifying both where the scheme succeeds and where barriers to access remain, we can refine the system in real-time.”

Dr Lavanya Thana, Senior Policy Research Felllown, added: “Our interim findings show encouraging signs that it can strengthen communication and is valued by patients and families. These insights are vital for policymakers and to support ongoing learning and patient safety improvement in the NHS.”

The latest figures are likely to inform the next phase of the rollout as it moves towards full national implementation over the next two years.

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