Martha's Rule helplines receive over 1,700 calls from NHS staff in their first year
Martha's Rule patient-safety helplines, established in England, received 1,738 calls from NHS staff in the year after their launch, according to an NHS England report. The system gives hospital staff the authority to escalate concerns about a patient's deteriorating condition to an independent team. Among the 76 hospitals where the helplines are operating, the call rate reached 19 per 1,000 beds.
The programme's origin lies with 13-year-old Martha Mills, who died at King's College Hospital, London, in 2021. During treatment for sepsis following a pancreatic injury, Martha's condition deteriorated at a pace that, according to subsequent reviews, had outpaced clinical monitoring, despite her family's concerns to doctors. Her family campaigned after her death for a national patient-safety mechanism to prevent similar cases. Led by the Mills family, NHS England implemented Martha's Rule in April 2024 after a three-year consultation.
According to the NHS England report, 64 percent of staff calls led to a re-review of patient care. Of these re-reviews, 38 percent resulted in additional tests or consultations, 21 percent in escalation of care (such as transfer to intensive care or a change of antibiotic therapy), and 12 percent in a technical adjustment to care. In the remaining cases, additional intervention was deemed unnecessary.
Record-keeping shows that the majority of calls were placed by senior nurses and consultant doctors. The breakdown was: nurses 54 percent, consultant doctors 28 percent, junior doctors 11 percent and other healthcare staff 7 percent. One of the system's designers, NHS England Patient Safety Director Dr Aidan Fowler, told BBC Health: "That nurses use the system this frequently confirms what we have been saying for years: it is usually the nurse at the bedside who is the first to notice when a patient is deteriorating."
Looking at the nature of the calls, the most common concerns were respiratory deterioration (32 percent), changes in consciousness (24 percent), cardiac rhythm abnormalities (18 percent), and a sudden increase in pain (14 percent). NHS England's clinical analysis team found that 67 percent of calls in these categories overlapped with subsequently confirmed cases of clinical deterioration, indicating that the system has a low false-positive rate.
One of Martha's Rule's distinctive features is that calls are also accepted from family members. In the first year, 4,231 calls were recorded from families; 22 percent of these led to a re-review of patient care. While 78 percent of family-led calls were not clinically validated afterwards, the NHS England report stresses that the calls retain value in "reducing uncertainty and structuring communication with clinical teams." Martha's father Merope Mills told the BBC: "If Martha had lived, she would have been proud to see the system working this way."
The programme's reach remains limited. Martha's Rule is implemented in only 76 of NHS England's 217 adult hospitals; the figure is 19 out of 28 paediatric hospitals. The principal reason for the slow rollout is the budget that NHS Trusts must allocate to develop the independent clinical consultation capacity to handle the calls. According to NHS England, £36 million in additional budget has been allocated this year to extend the programme, allowing the system to be operating in 150 hospitals by the end of 2026.
Similar programmes are being tracked in other countries. Australia's Ryan's Rule, in operation in Queensland for 17 years, allows family members to escalate concerns about hospital care quality directly to an independent team. The success of Ryan's Rule was one of the reference models for NHS England's design of Martha's Rule. The US and Canada are also discussing similar measures; Massachusetts and Ontario in particular have indicated they intend to follow the NHS model.
There are areas where the system needs to be strengthened. In a feedback report published by the Royal College of Nursing (RCN), 41 percent of nurses said they were "not certain that calling the helpline would not jeopardise their relationships with colleagues." That concern suggests the real number of calls may be higher than the report shows. NHS England has announced that over the next six months it will issue a new protocol strengthening the protection policy for nurses making calls.
The service held in memory of Martha Mills's 13th birthday next month is being seen as a key moment for the programme's expansion. The Mills family has launched an independent campaign for NHS England to allocate additional budget to the programme; the campaign has gathered more than 100,000 supporters in a short time. NHS England's approach is being followed internationally as an example of how, when an independent patient-safety mechanism is in place, it can strengthen trust among family, staff and patients within a health system.