More than 1,000 hospital patients whose conditions were rapidly deteriorating have been identified by NHS staff using Martha’s Rule in the first 18 months of the scheme, according to newly published figures.
Staff interventions
The data, released by NHS England, shows that between September 2024 and February 2026, staff made 1,781 calls to Martha’s Rule helplines to trigger a rapid review of a patient’s care. Of those, 1,080 – almost two-thirds – successfully flagged individuals whose health was worsening quickly.
In total, 12,301 calls were logged across all helplines, with the majority (72 per cent) coming through the family and carer escalation process. Around a third of all callers reported concerns about acute deterioration. Among the 4,047 calls that related to a patient’s worsening condition, 1,786 prompted changes in treatment, and 534 resulted in life-saving interventions such as a transfer to a specialist ward or intensive care.
Calls not directly linked to deterioration also brought improvements: nearly 3,000 helped resolve clinical issues including medication or investigation delays, while more than 3,000 addressed communication or discharge planning problems.
Martha’s Rule is designed to give patients, families and staff a formal, round-the-clock pathway to request an urgent second opinion when a patient’s condition deteriorates. It is advertised prominently in hospitals and is intended to cut through the hierarchy and poor communication that campaigners say can prevent concerns from being heard.
Worrying awareness gap
Despite the impact, a new interim report from the National Institute for Health and Care Research (NIHR) reveals that only 32 per cent of the public are aware of the escalation process. The survey of 2,047 people found that those with higher education were four times more likely to know about Martha’s Rule, while individuals in higher income brackets were 40 per cent more likely to have heard of it. Among those who were aware, 83 per cent learned about it through news coverage.
The NIHR’s evaluation also identified barriers to access for certain groups, including people with language difficulties, those from ethnic minority backgrounds, and patients with cognitive impairments. Health Secretary Wes Streeting acknowledged the gap, saying “there is more to do to ensure that this crucial initiative can be accessed by everyone who needs it”. Professor Aidan Fowler, national director of patient safety at NHS England, added: “It’s really encouraging that more than 1,000 staff have used Martha’s Rule to help flag rapid deterioration… so it’s important that as many people as possible are aware of Martha’s Rule.”
Origin and impact
The rule was established after the death of 13-year-old Martha Mills, who died from sepsis in 2021 while under the care of King’s College Hospital NHS Foundation Trust in south London. A coroner later ruled she would have survived had her warning signs been recognised and had she been transferred to intensive care sooner. Her parents, Guardian editor Merope Mills and Paul Laity, had repeatedly voiced concerns about their daughter’s condition but were not listened to.
The couple have campaigned relentlessly for the reform, arguing that “hierarchy, poor communication and some doctors’ resistance to being challenged affect hospital care every day”. They welcomed the latest figures as “clear evidence” of these ongoing problems. In a separate development in June 2025, Professor Richard Thompson, a senior doctor involved in Martha’s care, was found guilty of misconduct by the Medical Practitioners Tribunal Service for failing to escalate her treatment. The tribunal deemed his failings “particularly grave” and amounting to “gross negligence”. King’s College Hospital has previously apologised for failing Martha.
Martha’s Rule began a phased rollout in May 2024, initially at 143 pilot sites. In September 2025, the government announced it would be extended to all 210 acute hospitals in England, with full implementation across acute inpatient settings expected by the end of the 2026/27 period. The NHS Standard Contract for 2026/27 now mandates that every trust implement the rule’s three core components by March 31, 2027.
Dr Lavanya Thana, senior policy research fellow at the NIHR, said the scheme “reflects a clear commitment by NHS England to ensure that when patients and families have worries about deterioration, they are heard”. The NIHR is funding further comprehensive national evaluations to analyse outcomes, staffing and resources, and to identify the most effective ways to ensure patients receive the care they need.