Key takeaways
Martha’s Rule expanding across A+E departments and waiting rooms
Patients, families and healthcare professionals to be able to request urgent clinical reviews.
Follows successful pilot scheme
Early findings suggest improved identification and escalation of deteriorating patients.
Phased roll out to be completed by March 2028
Expansion introduced gradually across England, with full implementation by March 2028.
Martha's Rule is set to be implemented across all hospital A+E departments and waiting areas in England, marking the next phase in the nationwide rollout of the patient safety initiative.
Often the first point of contact before admission to a ward, A+E departments can be particularly challenging environments for patients whose condition may be deteriorating while awaiting treatment. The expansion will allow patients, their families, carers and healthcare staff to request an urgent clinical review if they are concerned that a patient's condition is worsening.
The announcement follows what has been described as the busiest summer on record for the NHS, with A+E departments seeing up to 240,000 more attendees than during the same period in 2025. Against this backdrop, empowering patients and those around them to escalate concerns is intended to provide an additional safeguard for those at risk of deterioration.
The expansion follows a successful pilot scheme at seven NHS Trusts which ran between September 2025 and March 2026, indicating that escalation could complement existing clinical pathways and identify early signs of deterioration, without requiring additional staffing. Implementation will be in the way of a phased rollout and is expected to be completed by March 2028.
The background to Martha's Rule
Martha's Rule was introduced following the death of 13-year-old Martha Mills in 2021 after she developed sepsis after being admitted with a pancreatic injury following a cycling accident. Concerns raised by Martha's family that her condition was worsening were not acted upon, prompting a campaign for patients and families to have access to a rapid review when they feel concerns are not being heard.
The principles underpinning Martha's Rule were echoed in recommendations made by reviews led by Dr Bill Kirkup, which highlighted failures to listen to patients and families and the need for better escalation of concerns.
Built around three key principles, Martha’s Rule prioritises daily patient check-ins, staff escalation rights and giving patients, families and carers the right to request an urgent review themselves. The latest expansion builds on the implementation of Martha's Rule across acute trust inpatient services.
Our view
The expansion of Martha's Rule into A+E departments represents a significant step in the NHS's ongoing efforts to strengthen patient safety and ensure concerns about deteriorating patients are acted upon promptly. By extending the ability for patients, families and healthcare professionals to request an urgent clinical review, the NHS is reinforcing a culture that encourages speaking up and escalating concerns when they arise.
As implementation continues across the healthcare system, providers should review their escalation processes, governance arrangements and staff training to ensure they are well placed to meet the requirements of Martha's Rule and support safer patient outcomes.
Our Health and Social Care team advises NHS organisations, independent healthcare providers and insurers on patient safety, clinical governance, regulatory compliance and healthcare litigation. We can support providers in understanding the implications of Martha's Rule, reviewing escalation procedures and managing the legal and regulatory risks associated with patient deterioration and adverse incidents.
For more information on Martha's Rule and what its expansion may mean for your organisation, please get in touch with our Healthcare and Public Law team.
