25/09/2026
In an article published by BBC News, NHS England has announced it is extending Martha’s Rule to every A&E department in England. It is an important shift for a scheme that, until now, has mostly run on hospital wards. For anyone who has sat in a busy emergency department worried that a relative was getting worse and not being heard, it matters even more.
We recently promoted Sepsis Awareness Month with our blog, ‘Could It Be Sepsis? When a Delay in Treatment Becomes Medical Negligence’. This announcement comes from the same place. Martha’s Rule exists because a young girl died when the signs of a deteriorating condition were missed, and because her family’s concerns were not acted on in time.
What Has Been Announced?
NHS England has confirmed that hospital trusts will extend Martha’s Rule into emergency departments and waiting rooms, alongside maternity and neonatal units, with the rollout phased and due to be completed by March 2028. The A&E expansion follows a pilot across seven trusts between September 2025 and March 2026, which found the escalation process could work in a fast-moving A&E without needing extra medical staff. During that pilot, the latest report shows that 69 calls led to urgent surgery or a transfer to intensive care.
Martha’s Rule is already live in 221 acute adult and children’s inpatient sites, with that inpatient rollout expected to finish during 2026-27. The numbers give a sense of how much this scheme is needed and being used in practice.
Source: BBC News - Martha's Rule rolled out at every A&E department in England.
What Is Martha’s Rule?
Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family raised concerns about her deteriorating condition. However, they were not responded to, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.
Martha’s Rule, ‘detecting deterioration’, was the response, and many NHS trusts have introduced these principles. It is designed to help spot any unexpected signs of deterioration early and give you the right to request a rapid review if you are worried that you or your loved one’s condition is getting worse. It is recognised that you are more likely to spot small changes before they show up in a routine measurement and that these changes could be early warning signs of deterioration.
The rule that carries her name has three parts. Patients are asked each day how they feel, and the answer is recorded. There is a route, open 24 hours a day, for patients, families or staff to call a critical care team directly and ask for a rapid review. A senior clinician from outside the team already treating the patient carries out that review. The A&E expansion extends that same right to people in emergency departments, who will be able to call a dedicated number if they feel a deterioration is being missed.
Martha’s Rule has been rolled out to several acute hospitals across the North West, including Royal Bolton Hospital, Royal Manchester Children’s Hospital and Royal Oldham Hospital. Find the list of sites available here: Martha’s Rule Rolled Out to Acute Hospitals in the North West.
Why Martha’s Rule in A&E Departments Matters
An emergency department is busy by design, and it is exactly the kind of setting where a patient who is quietly getting worse can be overlooked. Giving families and staff a direct way to escalate, in the place where the first few hours are so often decided, is the point of this change.
Prof Aidan Fowler, national director of patient safety at NHS England, said the expansion of Martha’s Rule would give families and NHS staff “a critical new lifeline” to help improve care and save more lives.
Having Your Voice Heard and What to Do If Signs Are Missed
Martha’s Rule is an England scheme, and it is being introduced in stages, so it is worth checking whether your hospital has it in place yet and how to trigger it. Using it is not making a fuss. Most calls so far have come from patients and families, which is exactly what it was built for.
Not every bad outcome is down to poor care. But where deterioration was evident, where observations were not acted on, or where a family raised the alarm and nothing happened, the question of negligence is a fair one to ask. Martha’s Rule is meant to prevent those moments. When it, or the care around it, fails, families are often left looking for answers.
If you or someone in your family was harmed because warning signs were missed or concerns were ignored, our personal injury and medical negligence team can help you understand what happened. We can obtain the medical records, advise on whether an inquest is likely, and tell you honestly whether there is a case to pursue.
Medical Negligence Solicitors Bolton and Greater Manchester
Our medical negligence team handles claims involving delayed diagnosis and delayed treatment, including cases resulting in amputation, serious injury and supporting families in fatal medical negligence claims. We can review what happened, obtain the medical records, advise on whether an inquest is likely, and tell you honestly whether there is a case to pursue.
We work with clients across Bolton, Horwich, Farnworth, Bury, Atherton, Middleton, Chester, and the wider Greater Manchester area. Speak to one of our personal injury solicitors today by calling 0800 103 2600 or by completing our online contact form.
Please note that this article is meant as general guidance and not intended as legal or professional advice. Updates to the law may have changed since this article was published.