More than 1,000 NHS staff across England have used Martha’s Rule helplines to help identify rapid deterioration of a patient’s condition in the first 18 months of the scheme, new figures show.
Latest NHS England data shows that between September 2024 and February 2026, 1,781 calls were made by hospital staff to Martha’s Rule helplines at their trusts to trigger a rapid review of care, as the health service continues to transform its culture to improve safety.
Of these calls from staff, 1,080 (61%) helped identify acute deterioration of a patient’s condition.
The NHS is continuing to expand the lifesaving initiative to all acute adult and paediatric inpatient services in England, and hundreds of staff have now attended dedicated webinars by NHS England to help them roll out Martha’s Rule at their hospitals and ensure the scheme is accessible to everyone in their local communities.
Hospitals have rolled out communications campaigns, including dedicated posters around their wards and buildings, to help raise awareness and ensure the programme is easy to understand and that its use is normalised for patients, families and staff.
New NHS data also shows that, of the calls found to relate to acute deterioration, the greatest proportion were regarding patients belonging to the most deprived groups (26.1%), with the lowest number of calls (14.5%) regarding patients belonging to the least deprived groups.
Meanwhile a new report published today suggests that around 1 in 3 (32%) of the public are already aware of the vital initiative, thanks to the campaigning of Martha’s parents, Merope Mills and Paul Laity.
The interim evaluation report – published and funded through the National Institute for Health and Care Research (NIHR) Policy Research Unit in Quality, Safety and Outcomes for Health and Social Care – looked in-depth at 3 early-adopting hospital sites between November 2024 and February 2026.
The evaluation found that patients, families and staff felt that Martha’s Rule amplified their voices when they had a concern about deterioration and promoted collaborative care in hospital settings.
The evaluation also identified how the NHS could address some of the challenges around awareness and future take up of the scheme as it is rolled out across all hospitals.
The research highlighted a number of considerations, including how patient wellness questionnaires could be used more consistently across trusts, and the need for better communication to patients about what action has been taken after they have triggered Martha’s Rule.
It also highlighted the need to address barriers in access for some groups who may be most in need of Martha’s Rule – such as people who are isolated, young people without a guardian, older adults, people with cognitive impairments, disabilities or poor literacy and people from lower socio-economic groups. Barriers were also identified in people who experience language challenges and in people from ethnic minority groups.
As part of the evaluation, and in collaboration with Picker and YouGov, the research team conducted a public awareness survey of 2,047 people in September 2025. They found that 32% were aware of Martha’s Rule, with the majority of those (83%) having heard about it through the news. People with a higher education were 4 times more likely to be aware of the scheme and awareness was 40% higher in upper income groups.
The interim evaluation report will inform the ongoing roll out of Martha’s Rule across all hospitals, following the roll out to 143 pilot sites which began in May 2024.
Building on this, the NIHR will be funding a further comprehensive national evaluation, analysing outcomes, staffing and resources, and studying how Martha’s Rule works in practice to identify the most effective ways to ensure patients get the care they need.
The latest NHS England figures revealed that in total, more than 12,000 (12,301) calls were made to Martha’s Rule helplines in the first 18 months of the scheme by staff, patients and families. 4,047 of these calls helped identify acute deterioration, which led to 2,310 patients receiving changes in treatment, and this includes 524 potentially life-saving interventions to transfer them to enhanced levels of care.
Where calls were not categorised as being related to acute deterioration, they are still supporting staff to provide better care for patients and address concerns. For example, 2,951 calls led to clinical concerns such as medication or investigation delays being addressed. A further 3,054 calls helped to resolve communication and discharge planning issues.
Professor Aidan Fowler, National Director of Patient Safety at NHS England, said: “It’s really encouraging that more than 1000 staff have used Martha’s Rule to help flag rapid deterioration in patents as we continue to roll out this lifesaving scheme.
“And today’s independent evaluation shows that even in the early days of Martha’s Rule, 1 in 3 people already knew about it, but there is more to do to ensure Martha’s Rule is helping every patient and family it could be.
“We know that when concerns are raised, hospital teams are ready to respond, so it’s important that as many people as possible are aware of Martha’s Rule, and hospitals are making it clear and straightforward for patients and families to seek a potentially lifesaving review of care”.
Health and Social Care Secretary Wes Streeting said: “Martha’s Rule is already having a lifesaving impact, and these figures show the real difference it is making to NHS staff, patients and families across the country.
“But this early research also shows there is more to do to ensure that this crucial initiative can be accessed by everyone who needs it.
“I want a health service that listens – to patients, to families, and to the staff who care for them. Work to roll out Martha’s Rule is a crucial part of this as we build a health service fit for the future”.
Martha Mills’ parents, Merope and Paul, said: “It is hugely encouraging for us that a thousand clinically trained staff have already used Martha’s Rule. This is also clear evidence that issues such as hierarchy, poor communication and some doctors’ resistance to being challenged affect hospital care every day. Such factors were crucial to any explanation as to why Martha lost her life.
“We welcome a public conversation about healthcare that explores culture and goes beyond the real problem of stretched resources. And we are very grateful to all those NHS staff who have worked so hard to introduce Martha’s Rule”.
NIHR Chief Executive and Department of Health and Social Care Chief Scientific Adviser Professor Lucy Chappell said: “Evaluations such as this are vital to ensure lifesaving initiatives like Martha’s Rule work effectively for everyone – the insight produced will underpin any move from pilot phase to a robust, national standard.
“By identifying both where the scheme succeeds and where barriers to access remain, we can refine the system in real-time. Further NIHR evaluations can and will build on these insights, helping to ensure the NHS delivers a safer, more equitable culture of care for every patient”.
Dr Lavanya Thana, Senior Policy Research Fellow, NIHR Policy Research Unit in Quality, Safety and Outcomes of Health and Social Care, said: “Martha’s Rule reflects a clear commitment by NHS England to ensure that when patients and families have worries about deterioration, they are heard.
“Our interim findings show encouraging signs that it can strengthen communication and is valued by patients and families. As with any complex intervention, we have also identified challenges in how Martha’s Rule is being implemented in practice.
“These insights are vital for policy makers and to support ongoing learning and patient safety improvement in the NHS”.
Martha Mills died in 2021, aged 13, after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike.
Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2022 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.
Martha’s Rule requires staff to use a structured approach to obtaining information about a patient’s condition from patients and their families at least daily and encourages patients, families and carers to speak to the care team if they notice changes in someone’s condition.
It also provides them with a way to seek an urgent review if their or their loved one’s condition deteriorates – and they are concerned this is not being responded to.
Staff can ask for a review from a different team if they are concerned the appropriate action is not being taken.
The roll out of Martha’s Rule has been made possible by the dedication of Martha’s parents, Merope and Paul, and the hard work of NHS staff across the country, supported by NHS England and the Health Innovation Network’s patient safety collaboratives.
