Martha's Rule Explained — and What the US Equivalent Actually Is

Martha’s Rule lets a patient, a relative or a member of hospital staff in England call a dedicated number and demand an urgent review of a deteriorating patient by a clinician from a different team. On 22 September 2026 NHS England announced it will reach every A&E department in England by March 2028. It is an England programme, so it confers nothing on a patient in an American hospital — but the thing it does exists here too, under other names, and almost nobody is told to ask for it.

What is Martha’s Rule?

Martha’s Rule is a patient-safety escalation programme in NHS hospitals in England, named after Martha Mills, who died at King’s College Hospital in London on 31 August 2021, aged 13. Its best-known part is a route, open around the clock, that patients, families and carers can use — not only staff — to demand a rapid review by a clinician from another team.

NHS England defines three components, and that route is the third. The first asks patients at least daily whether they feel better or worse, and requires the answer to be acted on in a structured way. The second lets any staff member call for a review when a patient is deteriorating and they are not being heard.

It is not a law. Clause 33.13 of the NHS Standard Contract 2026/27 requires trusts to “implement the three core components of Martha’s Rule by 31 March 2027”. NHS England reads that as covering adult and paediatric inpatient settings; the clause itself does not say so.

What did NHS England announce on 22 September 2026?

NHS England announced that Martha’s Rule will be extended to all hospital A&E departments and waiting rooms in England, in a phased rollout it says will be complete by March 2028. That is a rollout beginning, not a service you can use in every English A&E now.

It follows a pilot across seven unnamed trusts between September 2025 and March 2026, which produced 69 calls. NHS England says some led to urgent surgery or a transfer to intensive care, and that the process worked without additional clinical staff.

Availability is not even uniform inside one hospital. NHS England warns that Martha’s Rule may be running only on certain wards.

How do you actually use Martha’s Rule?

You speak to the care team first. If you are still worried and feel the concern is not being acted on, you call your hospital’s dedicated Martha’s Rule number and ask for a rapid review by a different team. NHS England is blunt that there is no central line: “There is not 1 single Martha’s Rule phone number.”

To find the local one, check the hospital’s website, look for posters, or ask staff. NHS England’s implementation letter of 21 February 2024 defines it as round-the-clock access to a critical care outreach team.

Six core standards published on 2 March 2026 govern what follows. The review must be triggered promptly, must involve a clinician not directly responsible for the patient’s care who can assess deterioration, and its outcome must be communicated back to whoever raised the concern. Operational detail is left to local judgement — and as far as we can find, no national target exists for how fast a review must happen.

Is Martha’s Rule a second opinion?

No, and NHS England says so in those words: “Martha’s Rule is not a second opinion.” A second opinion is the established process of choosing to see another healthcare professional after a diagnosis or a treatment plan. Martha’s Rule is an urgent review of someone who may be deteriorating right now, triggered by a phone call.

The distinction went wrong on the day. Wire copy reprinted across dozens of aggregators on 22 September 2026 called the expansion a right to an urgent second opinion; NHS England’s own release says the call triggers an urgent review, and never uses the phrase.

Does Martha’s Rule work?

The usage data is substantial, but nobody has published evidence that Martha’s Rule saves lives. NHS England’s own wording is that early evidence suggests a benefit. A three-year evaluation covering mortality across 16 trusts was announced on 17 June 2026 and has not reported.

Between September 2024 and July 2026, in figures published on 10 September 2026, NHS England recorded 19,177 escalation calls.

Of those, 5,660 — 30% — related to acute deterioration. Within that group, 749 led to a transfer of care, to intensive care or a specialist centre; 2,683 to another change in treatment; 2,228 to documented advice and no intervention.

The strongest evidence sits in a statistics table and in almost no coverage. Between June 2025 and July 2026, an early warning score had been recorded before 94% of acute-deterioration calls. In 82% of those cases, the score would not by itself have triggered escalation. Of that group — 2,861 calls — 13% ended in a transfer of care and 56% in another change of treatment. The programme is catching deteriorating patients whose vital signs were not yet flagging them.

The binding constraint looks like awareness. A peer-reviewed evaluation published on 8 July 2026 surveyed 168 patients and relatives at a hospital in North Wales where a patient-activated escalation service had run for over two years alongside a communication campaign: only 6.5% had heard of it. A separate survey of 2,047 people in September 2025, reported by NHS England, found 32% aware.

Who was Martha Mills?

Martha Poppy Mills was 13 when she died at King’s College Hospital in London on 31 August 2021. She had sustained an abdominal injury in a cycling accident during a family holiday in Wales, was transferred to King’s, and died roughly a month later. An inquest concluded on Friday 25 February 2022 with a narrative determination.

The coroner found that at King’s she was not referred to the paediatric intensivists promptly, and that had she been referred promptly and treated appropriately, “the likelihood is that she would have survived her injuries”. There is no finding of unlawful killing and none of neglect in the record.

A Regulation 28 Prevention of Future Deaths report signed on 28 February 2022 raised two concerns with the trust: the paediatric early warning system was still paper-based, and a programme for proactive paediatric intensive care outreach had stalled.

🔴 Get the year right, because NHS England’s own website does not. Its policy page and its February 2024 implementation letter both say a coroner ruled in 2023. The coroner’s record says 25 February 2022 — and NHS England’s newest page, the 22 September 2026 press release, says 2022 too.

Does Martha’s Rule apply in Scotland, Wales and Northern Ireland?

As of 22 September 2026, only England has Martha’s Rule running. Wales runs a parallel scheme called Call4Concern; Scotland committed in September 2026 to rolling out Martha’s Rule by name, with no deadline set.

Call4Concern is set out in Welsh Health Circular WHC/2026/001, issued 8 January 2026 and updated 24 August 2026, across every NHS Wales health board and Velindre University NHS Trust. Its deadlines run to 31 December 2026, and a Welsh Government release on 16 September 2026 announced the maternity and neonatal rollout.

Scotland’s commitment is in the Programme for Government 2026 to 2031, published 1 September 2026, which pledges “rolling out Martha’s Rule across Scotland” with a dedicated 24/7 number. It carries no deadline and no implementation detail, so nothing is live nationally. What exists is a round-the-clock Call 4 Concern pilot at University Hospital Hairmyres in NHS Lanarkshire.

⚠️ For Northern Ireland we found no Department of Health publication on Martha’s Rule or on patient-activated escalation. That is a statement about what we could check, not a confirmed absence of policy.

What is the US equivalent of Martha’s Rule?

There is no national American equivalent, and Martha’s Rule gives a patient in a US hospital nothing. The closest things are patient- and family-activated rapid response systems — often branded Condition H, for Help — which hospitals run voluntarily, and one state law: South Carolina’s Lewis Blackman Hospital Patient Safety Act, 2005.

Condition H was developed at UPMC and spread after the deaths of Josie King at Johns Hopkins and Lewis Blackman. The mechanism is close to identical: a number a patient or family member can call to summon a rapid response team directly, rather than routing the concern back through the ward staff they are worried about. It is documented in AHRQ’s patient-safety literature, not in any federal rule: whether your hospital has one is a hospital-by-hospital question.

South Carolina’s law is the one genuine entitlement: it requires hospitals in that state to give families a way to summon help when they believe a patient is deteriorating and the response is inadequate.

What should you do before you need this?

Ask your own hospital what its rapid response or Condition H number is and who may call it — on the day of admission, not on the night it matters. In the US that is the only question that produces an answer you can use.

• In the US: ask the charge nurse whether there is a patient- or family-activated rapid response line, and write the number down. If there is not, ask how a family member reaches the rapid response team.
• In England: find your trust’s Martha’s Rule number now, from the trust website, ward posters or staff. Raise the concern with the care team first, then call if you are still not being heard.
• In Wales: ask for Call4Concern by name. Research at one Welsh hospital found the branding confused people, so “Martha’s Rule” may draw a blank.
• Everywhere: the sentence that does the work is that the patient is worse than they were earlier. Between September 2024 and July 2026, 749 Martha’s Rule calls ended with the patient moved to a higher level of care.

For another story about the gap between what an institution announces and what the published evidence shows, see our explainer on the first Phase 3 win for an mRNA cancer therapy .