More than 1,500 NHS staff have invoked Martha’s Rule within its first 18 months, flagging concerns about patients on their wards, according to newly released figures.
Crucially, over 1,000 of these interventions successfully identified individuals experiencing rapid deterioration.
The data emerges as a new report highlights a significant awareness gap, revealing that only around one in three people are familiar with the formal escalation process.
Martha’s Rule was established in the wake of the death of 13-year-old Martha Mills.
Her parents, Merope Mills and Paul Laity, assert that the number of staff calls provides “clear evidence” that “hierarchy, poor communication and some doctors’ resistance to being challenged affect hospital care every day”.
Martha succumbed to sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London in 2021.
A coroner later ruled she would have survived had medics recognised the warning signs of her condition and transferred her to intensive care sooner.
Guardian editor Ms Mills and her husband Mr Laity had raised concerns about Martha’s health a number of times but were not listened to.
The rule, which began a phased rollout two years ago, gives families formalised, 24/7 access to a second opinion and is now advertised throughout hospitals.
New figures published by NHS England show that between September 2024 and February 2026, some 1,781 calls were made to Martha’s rule helplines by hospital staff to trigger a rapid review of care.
Of these, almost two-thirds (1,080) helped identify deteriorating patients.
Ms Mills and Mr Laity said: “It is hugely encouraging for us that 1,000 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.”
The figures show a total of 12,301 calls were made to Martha’s rule helplines in its first 18 months.
Almost three-quarters (72%) were via the family/carer escalation process.
A third of escalation calls related to the acute deterioration of a patient.
Of the 4,047 calls about deterioration, some 1,786 required changes in treatment, while 534 led to life-saving interventions for patients, such as a transfer to a specialist ward.
Of the calls that were not related to patient deterioration, almost 3,000 led to clinical issues such as medication or investigation delays being addressed. A further 3,054 calls helped resolve communication or discharge planning issues.
Health 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.
“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.”
In September, it was announced that Martha’s rule would be rolled out across all hospitals in England following a pilot scheme involving 143 sites.
Meanwhile a survey carried out as part of a new interim report by the National Institute for Health and Care Research (NIHR), which included 2,047 people, found only 32% were aware of the escalation process.
Those with higher education were four times more likely to be aware of the scheme, the report found.
Mr Streeting said “there is more to do to ensure that this crucial initiative can be accessed by everyone who needs it”.
Professor Aidan Fowler, national director of patient safety at NHS England, said: “It’s really encouraging that more than 1,000 staff have used Martha’s rule to help flag rapid deterioration in patents as we continue to roll out this life-saving scheme.
“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 life-saving review of care.”
Dr Lavanya Thana, senior policy research fellow at the 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.
“These insights are vital for policy-makers and to support ongoing learning and patient safety improvement in the NHS.”
