The patient safety initiative that lets families demand an urgent medical review is being extended to every emergency department in England in a phased rollout beginning today.
Martha’s rule — the scheme that gives patients and their families the right to call for an independent clinical review if they’re worried a condition is being missed or getting worse — is being expanded to all emergency departments in England, according to a post by the BMJ.
The rule is named after Martha Mills, a 13-year-old who died in 2021 after developing sepsis (a life-threatening response to infection) at King’s College Hospital, London. A coroner found she would likely have survived had she been moved to intensive care sooner. Her parents’ campaign for a formal escalation right for patients and families led directly to the policy.
Under Martha’s rule, anyone — patient or family member — who feels their concerns aren’t being heard can trigger a rapid review by a separate clinical team, independent of the one already providing care. It doesn’t require the treating team’s agreement.
The scheme already operates in many NHS hospital wards across England. Extending it to emergency departments means the protection will apply from the moment someone arrives for urgent care — a rollout that begins now and is expected to reach all emergency departments by March 2028.
The NHS advises anyone concerned about a patient’s condition in hospital to speak first to the nurse in charge or the treating doctor. If those concerns remain unresolved, Martha’s rule provides a formal route to escalate — without needing to wait or negotiate access. For general health concerns outside hospital, NHS 111 is available by phone or online around the clock.
Key information
- Martha’s rule: patients and families can request an urgent independent clinical review if worried about a deteriorating condition
- Who can use it: the patient themselves, or any family member or carer
- In hospital: ask the nurse in charge or treating doctor first; Martha’s rule is the next step if concerns remain unresolved
- NHS 111: call 111 or use the online service for health concerns outside hospital; call 999 in an emergency
Source: @bmj_latest