Patients and their families will have a clearer way to raise concerns about deteriorating conditions in NHS emergency departments as Martha’s Rule is extended across England.

The expansion, reported by National Health Executive, will introduce a dedicated Martha’s Rule number in A&E departments and waiting areas, allowing patients, families and NHS staff to request an urgent clinical review when they believe someone’s condition is worsening and their concerns have not been heard.

The phased rollout is due to be completed by March 2028.

Martha’s Rule was introduced following the death of 13-year-old Martha Mills, whose family had raised concerns about her deteriorating condition. The initiative was developed to give patients, families and staff a more direct role in identifying deterioration and seeking additional clinical support.

It already operates across NHS inpatient services, combining a daily question about how patients are feeling with a route for staff to request a review and an escalation process for patients, families and carers.

That approach is now moving into one of the busiest parts of the health service. A&E departments can involve crowded waiting areas, rapidly changing patient conditions and multiple teams working under pressure. From a Health & Safety perspective, having a clearly understood escalation process can help ensure that concerns are not lost in a busy clinical environment.

There is already evidence of significant use across the wider programme. NHS England’s latest data records 19,177 Martha’s Rule escalation calls between September 2024 and July 2026. Some 5,660 related to acute deterioration, while 749 resulted in transfers to a higher level of care and 2,683 involved other changes in treatment.

The A&E expansion follows a pilot involving seven NHS trusts between September 2025 and March 2026. National Health Executive reported that 69 calls were made during the pilot, with several cases leading to urgent clinical reviews, including emergency surgery and intensive care transfers.

The programme is also being extended to maternity and neonatal services, with implementation across these settings planned by March 2028.

For the sector, the development is a reminder that effective safety systems are not always about adding another control. Sometimes, they are about making it easier for people to speak up when something does not feel right. By bringing that principle into A&E, Martha’s Rule is becoming a more visible part of how the NHS approaches patient safety, communication and early intervention.

Source: National Health Executive / NHS England