NHS data reveals how patient escalation scheme is catching deteriorating conditions and preventing deaths across England’s hospitals
Martha’s Rule, the NHS patient safety initiative that allows patients, families and staff to raise urgent concerns about a patient’s condition, has delivered remarkable early results. New data from NHS England shows that one in three calls to Martha’s Rule helplines in the first 16 months helped staff identify that a patient’s condition was deteriorating, triggering potentially lifesaving interventions.
Between September 2024 and December 2025, healthcare workers and families made 10,119 calls to Martha’s Rule helplines across NHS England. Of these, 3,457 calls—approximately one third—helped identify acute deterioration in patients. These escalations led to 1,885 patients receiving changes in their treatment, including 446 potentially lifesaving interventions where patients were transferred to enhanced levels of care, intensive care units, or specialist services. A further 6,000 calls resulted in meaningful improvements in care or better system navigation for patients and their families, even when acute deterioration was not identified.
The scheme emerged from a heartbreaking tragedy. Martha Mills, a 13-year-old girl, died from sepsis in 2021 after her family’s concerns about her deteriorating condition were not acted upon. A coroner later concluded that Martha would likely have survived had she been transferred to intensive care earlier. The initiative, championed by Martha’s parents Merope and Paul Mills, empowers patients, families and healthcare staff to escalate concerns formally when they believe a patient’s health is worsening but their worries are not being adequately addressed.
How Martha’s Rule works
Martha’s Rule operates through three escalation pathways. Patients themselves can raise concerns with their clinical team. Families and carers can request an urgent review if they believe a patient’s condition is deteriorating. Healthcare staff can also trigger the process if they have concerns that their colleagues are not addressing appropriately. Each escalation is documented in the patient’s health records and investigated by senior clinical staff, ensuring concerns receive formal attention and scrutiny.
Data shows that 72% of calls come through the family and carer escalation route, reflecting the crucial role families play in monitoring their relatives’ wellbeing. This figure underscores the importance of involving loved ones in patient safety and the value of having formal mechanisms to escalate their observations.
Rapid expansion across England
The programme began with a pilot phase in May 2024, rolling out across 143 acute hospital sites in England. The early success prompted NHS England to announce its expansion in April 2025, extending Martha’s Rule to all remaining acute hospitals providing adult and paediatric inpatient services. The scheme is now available across all 210 acute hospitals in England, making it a standard feature of hospital care nationwide.
NHS National Medical Director Professor Meghana Pandit has stated that Martha’s Rule is having a “transformative impact” on how hospitals engage with patients and families in addressing deterioration and care concerns. The data supports this assessment: the escalation pathway is not just documenting concerns, it is triggering meaningful clinical action and preventing harm.
Beyond acute deterioration
Whilst 446 lifesaving transfers of care represent the most dramatic outcomes, the scheme’s impact extends further. Of the 3,457 acute deterioration calls, 793 resulted in other changes in treatment—such as the introduction of new medications, investigations including scans, or procedural interventions. A further 1,219 calls received documented advice from senior clinicians even where immediate intervention was not required, providing reassurance and formal clinical assessment.
For the calls not categorised as acute deterioration—approximately 6,600 of the total—the scheme still adds value. Over 2,000 calls addressed clinical concerns including medication or investigation delays. A further 2,165 calls helped resolve communication and discharge planning issues, improving the patient experience beyond immediate safety concerns.
Integration with wider safety measures
Martha’s Rule sits within a broader NHS approach to identifying and managing deterioration. The health service uses the National Early Warning Score to detect declining patients and has introduced early warning systems for children. The PIER approach—prevention, identification, escalation and response—guides NHS thinking about deterioration as a complete patient pathway rather than isolated incidents.
Martha’s Rule also builds on learning from the NHS England Worry and Concern Improvement Collaborative, which began testing approaches for escalation across seven regional pilot sites in 2023. This groundwork helped shape how the formal escalation process works today.
Source: @bmj_latest
Key Takeaways
- One in three Martha’s Rule calls identified acute patient deterioration, leading to 446 potentially lifesaving transfers of care
- Between September 2024 and December 2025, over 10,100 calls were made to Martha’s Rule helplines across England
- Families and carers made 72% of escalation calls, reflecting their vital role in monitoring patient safety
- Beyond lifesaving interventions, the scheme is improving communication, resolving treatment delays and addressing care concerns
What This Means for Kent Residents
For patients and families in Kent using NHS acute hospital services, Martha’s Rule is now embedded across all adult and children’s inpatient hospital settings. Kent and Medway NHS Trust, which operates Maidstone and Tunbridge Wells hospitals, has fully implemented the scheme. If you or a family member is concerned that a hospitalised patient’s condition is deteriorating and you feel staff are not responding adequately, you can formally escalate your concerns through Martha’s Rule. All acute hospitals across Kent have dedicated helplines and escalation pathways in place. Discussing your concerns with your clinical team first is recommended, but if you remain worried, ask staff how to access the formal Martha’s Rule escalation process. Your observations as a patient or family member are valued and deserve formal investigation by senior clinicians.
