What Is Martha’s Rule? Read This Before You Head To A&E

You might remember the heartbreaking story of Martha Mills, who died aged 13 after developing sepsis following an injury sustained during a bike ride.

Martha was admitted to hospital with pancreatic injury as a result of the end of her bike’s handlebar hitting into her stomach.

Per the BBC, her family’s concerns over her deterioration in hospital were not listened to, and – following her death – a coroner ruled that had she been referred promptly and appropriately treated, the “likelihood is that she would have survived her injuries”.

Her parents, Merope and Paul, later campaigned for a new rule whereby loved ones could flag concerns and trigger an urgent review if a patient’s condition deteriorated and they were concerned they weren’t being listened to by medical professionals.

This rule, dubbed Martha’s Rule, is now being rolled out across all NHS hospital A&E departments, with a view to complete this between now and March 2028.

Patients, loved ones and even staff in busy emergency departments will be able to call a dedicated Martha’s Rule phone number to trigger an urgent review if a patient’s condition is deteriorating and they are concerned this is not being acted upon.

This is different to a second opinion, where you’d speak to another consultant to discuss a diagnosis or treatment.

As the service is operated separately by each NHS Trust or hospital, the phone number will vary depending on location. This information will be displayed on posters and information around participating hospitals.

Between now and 2028, patients and their families can check with their local hospital or NHS trust website whether Martha’s Rule is available – you can also ask hospital staff on site.

According to the Royal Papworth Hospital NHS Foundation Trust website, you might call the Martha’s Rule number if your loved one is:

• Acting different to usual (/is not being themselves)
• Breathing differently
• Sweating or looking an unusual skin colour
• Experiencing reduced urine output or not passing urine
• More sleepy than usual or confused
• Cold or very hot to touch on their hands
• In pain and looks uncomfortable.

A pilot in seven trusts to test whether the escalation process worked in A&E environments found, over the course of eight months, 69 calls were made to dedicated Martha’s Rule phone numbers.

In some cases, this led to a patient having urgent surgery or being transferred to intensive care.

Discussing the rollout, Professor Aidan Fowler, National Director of Patient Safety at NHS England, said: “Martha’s Rule is already having a transformative effect in making our acute care even safer, and by expanding Martha’s Rule into A&Es, we are giving even more patients, their families and NHS staff a critical new lifeline to help improve care and save more lives.

“Early testing has shown that Martha’s Rule can work well in busy A&Es and builds on the evidence from our adult and children’s wards, where thousands of calls have been made by patients, families and staff to date – with many leading to changes in treatment and potentially life-saving interventions.”

So far, Martha’s Rule has been rolled out to 221 acute adult and paediatric inpatient sites. Hospitals are also expected to extend it to A&E, maternity and neonatal units by March 2028.