Martha’s Rule Will Reach Every A&E Waiting Room

NHS England is rolling Martha’s Rule into every accident and emergency department in England, including waiting rooms, with the work due to finish in March 2028. The scheme, named after Martha Mills, who died of sepsis at 13 in 2021, lets patients, families and staff call for a rapid review if they think a worsening patient is being ignored.

On hospital wards the helpline has become a busy safety net. In A&E it will meet a different problem: people who deteriorate in a queue, on a chair, or in a corridor, often before they have a named team at all.

Every A&E Waiting Room Gets the Helpline

From September 2026, emergency departments begin a phased introduction of the same three-part system already going into adult and children’s inpatient wards. Patients, loved ones and staff will be able to ring a hospital-run number if they think someone’s condition is getting worse and the concern is not being heard. NHS England said early tests showed the process can work in busy A&Es, and Dr Aidan Fowler, national director of patient safety, called it a new way to raise the alarm for “some of our most vulnerable patients.”

There is no single national number. Each trust sets its own line, advertised on posters and the hospital website, and staff are told to point people to it. NHS England is also clear about what the scheme is not. It is not a second opinion after a diagnosis. It is a route to an urgent review by a different team when deterioration is the worry.

THE THREE PARTS OF MARTHA’S RULE

• Daily wellness question: Patients are asked at least once a day how they feel and whether they are getting better or worse, and the answer is recorded and acted on.
• Staff escalation: Any member of staff can, at any time, ask a different team to review a patient they think is deteriorating if they are not being heard.
• Public escalation: The same route is open to patients, families and carers and must be advertised around the hospital.

Those three parts are now written into the NHS Standard Contract for inpatient care, with a deadline of 31 March 2027. The A&E timetable is slower. Maternity and neonatal units were added in June 2026. Same Day Emergency Care, urgent treatment centres, minor injury units, birth centres and homebirths are outside this expansion.

19,177 Calls Caught What Scores Missed

NHS England’s programme page now records 19,177 Martha’s Rule calls from September 2024 to July 2026. Families and carers made 72% of them. 5,660 calls, 30% of the total, were classed as acute deterioration. Those calls led to 3,432 changes in treatment, including 749 transfers to intensive care, high dependency, enhanced care, a specialist ward or a tertiary centre, and 2,683 other changes such as antibiotics, scans or a trip to theatre.

July 2026 was the busiest month so far, with 1,678 calls. A further 5,215 calls dealt with clinical problems such as delayed medicines or tests, and 4,940 helped with communication or discharge planning. The National Institute for Health and Care Research is funding a full evaluation of outcomes, staffing and how the rule works on the ground.

The figure that should follow the scheme into A&E is not the raw call count. Between June 2025 and July 2026, 82% of the deterioration calls would not have triggered escalation on the early warning score alone. That score tracks things such as heart rate and temperature. Families, patients and staff were noticing change the charts had not yet labelled as an emergency.

WHERE THE CALLS LED THROUGH JULY 2026

Shares are of the 19,177 calls and are rounded; some calls sit in more than one useful description, so the rows are not a single pie. The practical point is simpler. A lot of the value sits in catching decline that routine scoring missed, then moving a patient, starting drugs, or fixing a delay.

The process is not being overused and has obviously met a need, giving patients and families real agency.

Merope Mills, Martha’s mother, NHS England briefing, March 2026

Mills, who campaigned for the rule with Martha’s father, Paul Laity, also said the growing data showed a marked improvement in care from more than a third of calls. That March briefing used the phrase not being overused and has met a need after 10,119 calls in the first 16 months. The line still holds as volume has risen.

Why a Review in A&E Hits a Full Hospital

On a ward, Martha’s Rule assumes there is already a team, a bed, and a critical care outreach service that can walk over. In emergency departments the first failure is often time and space. People wait to be triaged, then wait for a cubicle, then wait for a ward bed that does not exist.

The National Audit Office’s September 2026 study of patient flow found that the share of people waiting 12 hours or more from arrival in A&E to discharge, transfer or admission rose from about 3% before Covid to about 10% in 2025-26. In calendar 2025 it estimated that 1.2 million patients waited 12 to 24 hours, and that more than 500,000 waited more than 24 hours. Office for National Statistics analysis cited in that report found that people who wait 12 hours or more are twice as likely to die within 30 days of leaving A&E as people who wait two hours.

WHAT A&E LOOKED LIKE IN 2025 AND 2026

• Corridor care: In May 2026, England averaged 2,241 patients waiting in A&E corridors in any 24-hour period, and 669 waiting in corridors on wards.
• Attendances: There were 28 million A&E attendances in 2025-26, up from 21.5 million in 2011-12.
• Beds: General and acute bed occupancy averaged 92% in 2025-26, above the 85% level the Royal College of Emergency Medicine links to safer working.
• Deaths linked to waits: The college estimated 15,860 excess deaths associated with long emergency waits in England in 2025.

In March 2026 the college surveyed leads from 80 emergency departments and found that more than half of emergency leads said their department was fairly or very unsafe. Overcrowding was a daily event for 88% of those who replied. Dr Ian Higginson, the college president, has said patients should feel safe, that skilled staff still miss things, and that the risk is higher in overcrowded, understaffed departments. He welcomed the further rollout.

That is the second job being handed to Martha’s Rule. On wards it was built to punch through hierarchy when a family or a junior nurse could see decline that the named team would not act on. In a waiting room the named team may not have arrived. A parent who cannot find a doctor to give a first look will not get far with a number that summons a second look. The May 2026 accounts of long paediatric waits, including a mother who said she could not ask for a review because no doctors were there, are the same constraint written in ordinary language.

Seven Trusts, 69 Calls, and a Slow Finish

NHS England tested the model in A&E at seven trusts over eight months. Dedicated lines took 69 calls. Officials said some patients then had urgent surgery or were moved to intensive care. They have not published the trust names, a breakdown of who called, or how many of those 69 calls were waiting-room cases rather than patients already in majors.

Sixty-nine calls in seven trusts is a thin base next to 19,177 ward calls. It is also a different use of the same brand. Fowler said the tests showed the rule can work well in busy A&Es and builds on the ward evidence. Matthew Hopkins, acute and ambulance director at the NHS Alliance, said health bosses backed a chance for the most vulnerable patients, families and staff to be heard. Gillian Merron, a health minister, cast it as another way to speak up when someone is getting worse.

The finish date is still March 2028. Inpatient services are meant to complete during 2026/27, with the contract date of 31 March 2027 sitting a year earlier than full A&E coverage. Hospitals will be at different stages. In some places the rule already runs only on certain wards.

FROM A PREVENTABLE DEATH TO EVERY A&E

1. 31 August 2021: Martha Mills, 13, dies of sepsis after a pancreatic injury from a bicycle fall, having been treated at King’s College Hospital in London.
2. 25 February 2022: An inquest concludes; the coroner says she would probably have survived if she had been moved to intensive care earlier.
3. May 2024: Martha’s Rule starts at 143 phase 1 acute sites in England.
4. April 2025: Phase 2 extends the programme to remaining adult and paediatric acute inpatient sites.
5. June 2026: The rule is expanded to maternity and neonatal units.
6. September 2026: The A&E rollout, including waiting rooms, begins after the seven-trust pilot.
7. 31 March 2027: NHS trusts must have the three inpatient components in place under the Standard Contract.
8. March 2028: NHS England says the A&E expansion should be complete.

Community hospitals and mental health settings are still in testing. Wales and Scotland have not adopted the English model, something Mills has already asked them to do.

Martha Died on a Ward With a PICU Bed Free

Martha was on a specialist children’s ward, not in an A&E queue. She had been admitted after a handlebar injury on a family holiday in Wales. She developed sepsis. Her parents said their warnings were not acted on. She would have turned 19 in September 2026.

Senior coroner ME Hassell, sitting in Inner North London, recorded that Martha was not referred to paediatric intensivists promptly. The prevention of future deaths report said that if she had been referred promptly and treated appropriately, “the likelihood is that she would have survived her injuries.” A bed in the paediatric intensive care unit was available. The failure was culture and response, not the absence of a cubicle.

That origin still matters, because it is not the same as a 12-hour wait on a chair. The ward scheme is a formal way to force a second pair of eyes when the first team will not move. The A&E scheme will be used in rooms where the shortage is eyes, trolleys and beds at once. Both can save a patient. They do not fix the same fault.

The Split Between Staff and Family Calls

Families make most of the calls. Staff make the ones most likely to be about a patient crashing. NHS England’s March 2026 statistical report, covering September 2024 to March 2026, counted 13,481 calls: 9,682 from families or carers, 1,937 from staff and 1,862 from patients. Sixty percent of staff calls were about acute deterioration, against 29% of family calls and 20% of patient calls.

Junior nurses were one of the groups Mills had in mind. In interviews she has described a nurse who might have used a helpline had it existed during Martha’s last days. Staff using the number is also a verdict on the ordinary escalation ladder. If the official channel worked every time, a separate line would be quiet. It is not.

The Intensive Care Society said when the policy was first announced that it would depend on a properly resourced critical care outreach service in every unit. That warning travels into A&E in a sharper form. Outreach nurses cannot review a waiting-room patient if they are already running a full hospital. A poster over a row of chairs does not staff the phone at 3am.

March 2028 Will Not Clear the Corridors

By March 2028 every English A&E is supposed to offer the same advertised number that wards now print on the wall. If the ward pattern holds, most callers will be families, a minority of calls will be true deterioration, and a smaller group will move to intensive care or theatre. If the 82% finding holds, many of those deterioration calls will involve patients whose charts had not yet screamed.

None of that reduces 2,241 people in A&E corridors, or a 10% rate of 12-hour stays, or a review that arrives to find there is still no monitored bed. The seven-trust pilot showed that a call can still send someone to surgery. It did not show that a helpline can drain a waiting room.

Martha’s Rule is going where deterioration now happens in public, under strip lights, before admission. The parents who fought for it wanted to be heard. Hearing them in A&E will count for little if the next step is another hour on a chair.

Disclaimer: This article is news reporting on an NHS patient-safety policy in England and is for information only. It is not medical advice, and it does not tell anyone when to go to A&E, how to judge sepsis, or whether to call a hospital helpline. Anyone worried about a patient’s condition should speak to the clinical staff in front of them, use the local Martha’s Rule number if the hospital advertises one, or contact emergency services. Call counts, transfer figures and rollout dates reflect NHS England and other public sources as of the dates given in the piece and can change as more sites report.