Martha’s rule is now available in every acute hospital in England following a successful pilot across the country and in numerous North West hospitals, as new data shows hundreds of patients have benefitted from potentially lifesaving changes to their care thanks to its rollout.

Between September 2024 and June 2025, there were 4,906 calls made to Martha’s Rule helplines to escalate concerns about care – leading to 241 potentially life-saving interventions being triggered.

The positive results from the first year have led the NHS to expand its use to an additional 67 sites – meaning all 210 acute inpatient sites in England now offer the service.

Martha Mills died in 2021 aged 13 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

In May 2024, NHS England announced the rollout of Martha’s Rule across 143 pilot sites following the campaigning of Martha Mills’ parents, Merope and Paul.

Of those 143 sites, 19 were in the North West, including:

• Countess of Chester Hospital
• Wirral University Teaching Hospital
• Royal Liverpool University
• Southport District General Hospital
• Blackpool Victoria Hospital
• Royal Blackburn Hospital
• Burnley General Hospital
• Royal Bolton Hospital
• Royal Manchester Children’s Hospital
• Alder Hey Children’s Hospital
• The Walton Centre
• Leighton Hospital
• Warrington Hospital
• Preston and Chorley Hospitals
• Royal Blackburn Hospital
• Tameside General Hospital
• The Christie
• Royal Oldham Hospital
• Royal Albert Edward Infirmary, Wigan

The new data published by the NHS shows almost three quarters (71.9%) of calls have been from families seeking help, with 720 calls leading to changes in care. This could include patients receiving a new medication such as an antibiotic.

Almost 800 (794) calls led to clinical concerns such as medication or investigation delays being addressed. A further 1,030 calls helped to resolve communication and discharge planning issues.

Martha’s Rule is a major patient safety initiative in hospitals encouraging patients, families and carers to speak to the care team if they notice changes in someone’s condition.

It also provides them with a way to seek an urgent review if their or their loved one’s condition deteriorates – and are concerned this is not being responded to.  Staff can themselves ask for a review from a different team if they are concerned the appropriate action is not being taken.

Dr Redmond Tully, Consultant in Intensive Care at the Royal Oldham Hospital, said colleagues had been proud to be part of the pilot.

He said: “When it comes to keeping patients safe, we can’t offer enough routes for patients, relatives and colleagues to speak up if they’re worried.

“Thanks to Martha’s Rule, we’ve been able to intervene earlier in some cases – admitting patients to intensive care who might otherwise have deteriorated on the ward they were on. It’s also helped us adjust treatment plans for patients on general wards.

“As we’ve introduced Martha’s Rule across the hospital, we’ve listened closely to feedback from patients and families who’ve used it. So far, the response has been positive, indicating that it helps patients to feel more satisfied with their care.”

The NHS has rolled out consistent branding and materials, including posters around hospitals, to ensure the programme is easy to understand for patients and their families.

Full evaluation of the programme is ongoing and will help inform proposals to expand to other settings.

Merope Mills and Paul Laity, Martha’s parents, said: “It would be Martha’s 18th birthday today, another milestone she has missed as a result of the poor care and hospital errors that led to her unnecessary death.

“We feel her absence every day, but at least Martha’s Rule is already preventing many families from experiencing something similar.

“The figures prove that lives are saved when patients and families are given power to act on their suspicions when they feel doctors might have got it wrong and their voice isn’t being heard.

“We are pleased to know more hospitals are taking up Martha’s Rule and look forward to a time when every patient in the UK knows about the initiative and has easy access to it.”

Health and Social Care Secretary, Wes Streeting, said: “No family should ever have to go through what Merope and Paul Mills endured when they lost Martha, but her parents’ tireless campaigning has created a lasting legacy that is already having a potentially lifesaving impact across England.

“Martha’s Rule puts patients and families at the heart of their care. By rolling this out to every acute hospital in England, we’re delivering on our promise through our Plan for Change to rebuild trust in the NHS and put patient safety first.

“With hundreds of potentially life-saving interventions and changes in care triggered so far, Martha’s Rule is about ensuring that patients and their families have their voices heard when it is needed most.

“This is exactly the kind of reform our health service needs – listening to patients, learning from tragedy, and taking action to prevent it happening again. Martha’s memory will live on through every life this rule helps to save.”

Professor Meghana Pandit, NHS national medical director, said: “There is no shadow of a doubt that Martha’s Rule is having a transformative impact on the way hospitals are able to work with patients and families to address deterioration or concerns about care.

“There has now been almost 5,000 calls made to the hotlines, with hundreds of potentially life-saving interventions triggered, which is why we are now expanding Martha’s Rule to all acute hospitals in England.

“I want to take this opportunity to thank Merope and Paul who have campaigned tirelessly on this issue and continue to work with us to ensure Martha’s Rule is at the centre of our efforts to boost patient safety and quality of care.

“I also want to thank clinical staff up and down the country who have swiftly implemented this potentially lifesaving intervention and ensured it’s success.”

Blackpool Teaching Hospital NHS FT, Associate Director of Nursing, Lisa Horkin said: “We were really happy to have been one of the first Trusts to have been chosen to pilot Martha’s Rule. We’ve always had a way for people with concerns to raise them directly with their medical team, but we’ve felt there are ways the process could be improved, and this was a great opportunity to both review things and to get our patients involved in helping design what came next.

“We put patients’ voices at the heart of this roll-out, alongside our own colleagues. Everyone came together to help develop the system which is enabling patients, their loved ones and our own teams to prevent deterioration and spot the signs early.

“Martha’s Rule has never been about just promoting a phone number that people – whether patients themselves or their families or friends – could call if they had a worry, although that is very important. It’s also about stopping issues from getting worse at a much earlier stage.

“One of the key elements of Martha’s rule is the introduction of a wellness questionnaire that every patient now receives at least once daily. We’ve also worked hard to help educate our colleagues, as well as providing more information to patients themselves on how to spot signs earlier and make sure that the right steps are taken.”