More than 1,000 NHS staff across England used Martha’s Rule helplines to flag rapid patient deterioration during the scheme’s first 18 months, new NHS England data shows. Between September 2024 and February 2026, hospital staff made 1,781 calls to the helplines to request urgent reviews; 1,080 of those calls (61%) identified acute deterioration.
Taken together with contacts from patients and families, helplines handled 12,301 calls in the same period. Of those, 4,047 were judged to relate to acute deterioration. Those calls led to changes in treatment for 2,310 patients, and 524 of those cases involved transfers to higher levels of care that were potentially life‑saving. Calls that did not meet the acute deterioration threshold also supported improvements in care: 2,951 calls prompted action on clinical concerns such as delayed medication or investigations, and a further 3,054 calls helped resolve communication and discharge planning issues.
NHS England is scaling Martha’s Rule to all acute adult and paediatric inpatient services. Hundreds of staff have taken part in national webinars to support the rollout, and hospitals have run local awareness campaigns—posters on wards and staff briefings—to normalise use by patients, families and clinicians.
An interim evaluation, funded by the NIHR Policy Research Unit in Quality, Safety and Outcomes and published today, reviewed three early-adopter hospital sites between November 2024 and February 2026. The evaluation found that patients, families and staff felt Martha’s Rule amplified their voices and supported more collaborative care. At the same time, the evaluation identified barriers to awareness and access and recommended practical changes, including more consistent use of patient wellness questionnaires and clearer communication to patients and families about what happens after a rule is triggered.
The report highlights specific groups who can face access challenges: people who are isolated, young patients without a guardian, older adults, people with cognitive impairments or disabilities, those with low literacy or limited English, lower socio-economic groups, and some ethnic minority communities. The findings point to the need for targeted communications and support to ensure equitable access.
A public awareness survey of 2,047 people conducted in September 2025 with Picker and YouGov found that 32% of respondents were aware of Martha’s Rule, and of those aware, 83% had heard about it through news coverage. Awareness was strongly linked to education and income: people with higher education were about four times more likely to know about the Rule, and awareness was roughly 40% higher among higher-income groups.
The interim findings will inform the continuing national rollout. Pilots at 143 sites began in May 2024, and the NIHR has committed to fund a comprehensive national evaluation to examine outcomes, staffing and resources, and how Martha’s Rule operates in different settings.
Patient safety leaders welcomed the data. Professor Aidan Fowler, NHS England’s National Director of Patient Safety, said it was encouraging that so many staff had used the Rule to flag rapid deterioration and stressed the importance of wider awareness so patients and families can seek urgent reviews when needed. Health and Social Care Secretary Wes Streeting said the figures demonstrate a potential life‑saving impact but underlined the need to improve equitable access.
Martha Mills’ parents, Merope Mills and Paul Laity, have been central to promoting the Rule and welcomed its adoption by clinically trained staff. They have highlighted how hierarchy, poor communication and reluctance to be challenged can harm care. NIHR Chief Executive Professor Lucy Chappell emphasised that evaluations are essential to ensure schemes like Martha’s Rule work for everyone and to refine the approach in real time. Dr Lavanya Thana of the NIHR Policy Research Unit noted that the interim findings show the Rule strengthens communication and is valued by users while also pointing to implementation challenges that require ongoing attention.
Martha’s Rule was developed following the death of 13‑year‑old Martha Mills in 2021 from sepsis after a pancreatic injury; a 2022 coroner’s finding concluded she would probably have survived if moved to intensive care sooner. The Rule asks staff to use a structured method to collect daily information from patients and families about their condition, encourages families and carers to tell the team about any worrying changes, and provides a route to request an urgent review if concerns are not being addressed. Staff can also request a review from a different team if appropriate.
The rollout has been driven by Martha’s parents alongside NHS staff, supported by NHS England and the Health Innovation Network’s patient safety collaboratives. The interim report’s recommendations—better use of wellness questionnaires, clearer feedback to families, and targeted measures to reach underrepresented groups—will guide the next phase of national implementation and evaluation.