Martha’s Rule extended to A&Es to make asking for second opinion easier

Patients, families and healthcare staff across England will soon find it much easier to request a second opinion as Martha’s Rule expands into hospital accident and emergency departments (A&Es).

The scheme guarantees formal, 24-hour access to urgent clinical reviews and was established following the death of 13-year-old Martha Mills.

Martha contracted sepsis while being treated by King’s College Hospital NHS Foundation Trust in south London in 2021.

A coroner later ruled that she would have survived if clinicians had moved her to intensive care sooner.

Martha’s parents Merope Mills and Paul Laity said that their repeated warnings regarding her worsening condition were constantly ignored by medical staff.

Under new plans, the NHS will widen Martha’s Rule, which is currently being introduced across all inpatient hospital wards.

The move allows patients, families and staff in A&Es to call a dedicated helpline for an urgent assessment if someone’s health declines and they believe their concerns are not being heard.

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

A trial across seven hospital trusts has evaluated whether Martha’s Rule can operate safely within emergency settings.

During an eight-month pilot, 69 calls were made to Martha’s Rule phone numbers, with some patients going on to have urgent surgery or being transferred to intensive care, NHS England said.

Professor Aidan Fowler, national director of patient safety at NHS England, said: “A&Es see some of our most vulnerable patients, so the ability to raise concerns about deterioration quickly and trigger a rapid review of care is essential.

“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.”

Health minister Baroness Merron said: “Martha’s Rule is about making sure patients and their loved ones are heard when they raise concerns about their care.

“Expanding it to A&E will give patients, families and staff another way to speak up when they are worried that someone’s condition is getting worse, ensuring concerns are acted on quickly.

“This is part of our wider efforts to put patient safety at the heart of the NHS.”

Hospitals are also expected to extend Martha’s Rule to maternity and neonatal units by March 2028.

The latest figures, for July 2026, show the highest-ever monthly total of calls made via Martha’s Rule (1,678).

In January, a report found the UK could be trailing countries such as Norway, Switzerland, Japan, Spain and Italy when it comes to patient safety.

A chart of the safest places to receive care from 38 countries in the Organisation for Economic Co-operation and Development (OECD) ranked the UK in 21st place, but this was based on 2021 data.

The global state of patient safety 2025 study, from Imperial College London, included key aspects of patient safety, one of which was deaths from treatable causes, such as from sepsis and blood clots like venous thromboembolism.