Martha's Rule helplines field more than 1,700 calls from worried NHS staff in first year

The Martha's Rule helplines, set up by the NHS to let patients, their families and staff request an urgent second opinion when a patient's condition is deteriorating, received 1,728 calls in their first year of operation. The figure comes from an NHS England audit published Monday, and one finding stands out: about 65 per cent of those calls came from worried staff rather than from families.

Martha's Rule is named after Martha Mills, who died at 13 in 2021 of complications from bacterial sepsis at King's College Hospital. Her parents said warnings about her deterioration were repeatedly raised with doctors during her care and were not acted on. In response to the family's campaign, the NHS rolled out helplines at 213 hospitals across England from April 2025 — the largest patient-safety reform of its kind in NHS history.

The vast majority of calls — 1,124, or 65 per cent of the total — came from clinical staff. The NHS England report described the trend as evidence that "professional norms within hospitals materially shape how patient care is escalated": staff who cannot raise a concern through the formal hierarchy are using the helpline instead. The most common reason cited was "nurse warnings not being acted on by the responsible doctor."

Family calls accounted for the remaining 35 per cent — 604 of the total. About 80 per cent of those calls were prompted by observation of a "general appearance significantly worsening": sudden changes in consciousness, refusal of food, or breathing pattern shifts in the bed-bound patient were the most-cited concerns. Like staff, families were turning to the helpline when they had been unable to reach the responsible medical team directly.

Nearly half of the calls (47 per cent) led to a clinical intervention. NHS England recorded 814 cases in which there was "a direct change to the medical plan" — antibiotics initiated, transfer to intensive care, or surgical consultation expedited. Eighty-nine of these resulted in transfer to ICU, and 12 led to emergency surgery. In most of the remaining calls the existing care plan was reviewed without modification.

Merope Mills, one of the campaign's founders, told the BBC: "That so many staff are using the helpline isn't what we expected, but it's meaningful. A nurse's years on a ward will educate them in patient observation in ways no junior doctor's daily round can match — but the hierarchy often silences that. The helpline is reflecting that structural problem." Mills said the system is now functioning not just as an error-correction tool but as a critique of medical culture.

Professor Lutz Schwarz, chief physician at Berlin's Charité hospital, wrote in a comment in The Lancet's May issue after reviewing the audit: "Mechanisms like this should spread to other major European health systems. Time is critical for sepsis and other rapidly deteriorating conditions; communication that is hardened by hierarchy directly affects mortality." In continental Europe, similar mechanisms remain rare outside pilot programmes in Austria and the Netherlands.

The report also flagged some weaknesses. About 12 per cent of calls were classified as "inappropriate" — for instance, complaints about care plan satisfaction or administrative issues. NHS England said these calls did not detract from genuine cases and that clearer training materials for staff would be prepared next year. The audit also recorded that running the helplines round the clock costs £8.4 million a year.

For next year, the NHS is planning to extend the system to children's hospitals. Alongside that, structural protections will be introduced for staff making calls, after some clinicians said in an anonymous survey that they feared retaliation. "Without protecting the staff who use the system, the mechanism isn't sustainable," said Professor Sir Stephen Powis, NHS England's chief medical officer.

Merope Mills closed: "These numbers don't make Martha's death feel like an acceptable price. But every call that saves a life means the figure is bigger than 1,728. If this mechanism triggered 12 emergency surgeries, the system has spared at least 12 other families from what we went through. That is something to keep going."