More than 1,000 NHS staff across England used Martha’s Rule helplines to help identify rapid patient deterioration in the first 18 months of the scheme, new NHS England figures show.
Latest NHS England data shows that between September 2024 and February 2026, hospital staff made 1,781 calls to Martha’s Rule helplines to trigger rapid reviews of care. Of those staff calls, 1,080 (61%) identified acute deterioration. The NHS is expanding the initiative to all acute adult and paediatric inpatient services; hundreds of staff have attended NHS England webinars to support rollout and access.
Hospitals have run communications campaigns, including posters on wards, to raise awareness and normalise use for patients, families and staff. New data shows that among calls found to relate to acute deterioration, 26.1% concerned patients from the most deprived groups versus 14.5% from the least deprived.
An interim evaluation report, funded by the NIHR Policy Research Unit in Quality, Safety and Outcomes and published today, examined three early-adopter hospital sites between November 2024 and February 2026. The evaluation found patients, families and staff felt Martha’s Rule amplified their voices and promoted collaborative care. It also identified barriers to awareness and access and suggested ways to improve implementation, including more consistent use of patient wellness questionnaires and clearer communication to patients about actions taken after a rule is triggered.
The evaluation highlighted access barriers for people who are isolated, young people without a guardian, older adults, people with cognitive impairment or disabilities, those with poor literacy, lower socio-economic groups, people facing language challenges, and some ethnic minority groups.
A public awareness survey of 2,047 people in September 2025 (conducted with Picker and YouGov) found 32% were aware of Martha’s Rule; 83% of those had heard about it via the news. People with higher education were four times more likely to be aware, and awareness was 40% higher in upper income groups.
The interim report will inform the ongoing national rollout following the start of pilots at 143 sites in May 2024. The NIHR will fund a comprehensive national evaluation to analyse outcomes, staffing and resources and to identify how Martha’s Rule works in practice.
Across the first 18 months, more than 12,300 calls (12,301) were made to Martha’s Rule helplines by staff, patients and families. Overall, 4,047 calls identified acute deterioration, leading to 2,310 patients receiving changes in treatment; 524 of these involved transfers to enhanced levels of care that were potentially life-saving.
Calls not classified as acute deterioration have still supported improved care: 2,951 calls led to clinical concerns such as medication or investigation delays being addressed, and a further 3,054 calls helped resolve communication and discharge planning issues.
Professor Aidan Fowler, National Director of Patient Safety at NHS England, said it was encouraging that more than 1,000 staff had used Martha’s Rule to flag rapid deterioration and stressed the importance of wider awareness so patients and families can seek potentially life-saving reviews. Health and Social Care Secretary Wes Streeting said the figures show Martha’s Rule is already having a lifesaving impact but that more work is needed to ensure equitable access.
Martha Mills’ parents, Merope Mills and Paul Laity, welcomed the use of the Rule by clinically trained staff and said it highlights how hierarchy, poor communication and resistance to being challenged can affect care. NIHR Chief Executive Professor Lucy Chappell said evaluations are vital to ensure schemes like Martha’s Rule work for everyone and to refine the system in real time. Dr Lavanya Thana of the NIHR Policy Research Unit said the interim findings show Martha’s Rule can strengthen communication and is valued, while also identifying implementation challenges important for ongoing learning.
Martha Mills died in 2021, aged 13, after developing sepsis in hospital following a pancreatic injury; a 2022 coroner’s finding concluded she would probably have survived had she been moved to intensive care earlier.
Martha’s Rule requires staff to use a structured approach to gather daily information about a patient’s condition from patients and families and encourages families and carers to alert the care team to changes. It provides a route for people to seek an urgent review if they are concerned deterioration is not being responded to, and staff can request a review from a different team if appropriate.
The rollout has been driven by Martha’s parents and NHS staff, supported by NHS England and the Health Innovation Network’s patient safety collaboratives.