Martha’s Rule Enters A&E Waiting Rooms After a Thin Pilot

NHS England is expanding Martha’s Rule to every hospital A&E in England, including waiting rooms, after a 69-call pilot. The phased rollout, announced on 22 September 2026, is due to finish in March 2028 and, officials said, does not require extra clinical staff.

On wards the same helpline already takes thousands of calls a month. Accident and emergency is a different machine: no named bed, no daily stay, and a queue that can last overnight.

A Phone Line Is Going Into Rooms With No Named Bed

The new promise is that patients, relatives and staff in all hospital A&E departments and waiting rooms can ring a dedicated number if someone is getting worse and they think nobody is listening. A separate team is then meant to review the care. Until now the rule has applied to people already admitted.

Martha’s Rule is to be expanded to A&Es across England.

Patients, loved ones and NHS staff will be able to call a dedicated number to request an urgent review if a patient’s condition is getting worse and they’re concerned it’s not being listened to.

➡️ https://t.co/ofwHKLtFyP pic.twitter.com/OT8rECQSUb

— NHS England (@NHSEngland) September 22, 2026

That shift matters because a waiting room is not a ward. There is often no named nurse for the person in the plastic chair, and the first component of Martha’s Rule, a structured daily question about whether the patient feels better or worse, assumes someone is still there the next morning. Many A&E patients are not.

The National Audit Office, in a September 2026 report on flow out of emergency departments, said that in May 2026 England averaged 2,241 patients waiting in corridors in A&E during any 24-hour period, plus 669 on wards. In 2025-26, about 10% of people at Type 1 and Type 2 A&Es waited 12 hours or more from arrival to discharge, transfer or admission, up from about 3% before Covid-19.

THE QUEUE THE HELPLINE NOW ENTERS

• Summer load: June to August 2026 saw 7,268,445 A&E attendances, 241,061 more than the same months in 2025, which NHS England called its busiest summer.
• Long stays: The audit office estimated that in 2025, 1.2 million patients waited 12 to 24 hours in A&E and more than 500,000 waited over 24 hours.
• Death risk: Office for National Statistics analysis cited in that report found people who wait 12 hours or more are twice as likely to die within 30 days of leaving A&E as people who wait two hours.
• College estimate: The Royal College of Emergency Medicine estimates one extra death for every 72 patients who spend eight to 12 hours in A&E.

Those figures are why a family in the waiting room can see a slide that monitors miss. They are also why a phone line with no extra staff is being asked to work in the most crowded part of the hospital.

Seven Trusts Logged 69 Calls in Eight Months

NHS England tested the process in seven trusts between September 2025 and March 2026. Over those eight months, 69 calls were made to dedicated Martha’s Rule numbers. Officials said some related to acute decline after an urgent review, and that in some cases a patient went for urgent surgery or to intensive care. They have not named the trusts, and they have not published how many of the 69 calls changed treatment.

The trial’s other finding is the one that will sit with duty consultants: the process, they said, could run beside existing A&E procedures without extra clinical staff. In a department already using corridor care, that is the operational bet. Someone still has to leave a cubicle, or a queue, and look again.

A&Es see some of our most vulnerable patients, so the ability to raise concerns about deterioration quickly and trigger a rapid review of care is essential.

Professor Aidan Fowler, National Director of Patient Safety, NHS England

Fowler said early testing showed the rule can work in busy emergency departments. The inpatient programme is the larger evidence base sitting behind that claim, not the 69 calls on their own.

What 19,177 Ward Calls Changed

On adult and children’s wards the helpline is already a working system. NHS England’s programme figures for September 2024 to July 2026 show 19,177 calls, with July 2026 the busiest month so far at 1,678. The rule is in place at 221 acute adult and paediatric inpatient sites, with that inpatient rollout due to finish in 2026/27. The NHS Standard Contract requires the three core parts of the rule in those settings by 31 March 2027.

WARD CALLS, SEPTEMBER 2024 TO JULY 2026

Staff use the line less often than families, and they find decline more often when they do. Between September 2024 and February 2026, hospital staff placed 1,781 of the calls; 1,080 of those, 61%, flagged acute deterioration. Martha’s parents, Merope Mills and Paul Laity, treated that staff figure as evidence of the hierarchy problem that cost their daughter her life.

It is hugely encouraging for us that a thousand clinically trained staff have already used Martha’s Rule. This is also clear evidence that issues such as hierarchy, poor communication and some doctors’ resistance to being challenged affect hospital care every day.

Merope Mills and Paul Laity, May 2026

Knowing the number exists is still uneven. An NIHR-funded evaluation, working with Picker and YouGov, surveyed 2,047 people in September 2025 and found 32% had heard of Martha’s Rule, 83% of them through the news. People with a higher education were four times more likely to know about it, and awareness was 40% higher in upper income groups. The same evaluation flagged barriers for people who are isolated, young people without a guardian, older adults, and people with cognitive impairment, poor literacy, language barriers or a minority ethnic background. A waiting-room poster does not close that gap on its own.

Early Warning Scores Missed Four in Five Cases

The clinical case for putting a family on the call list is already in the ward data. Between June 2025 and July 2026, 82% of Martha’s Rule calls about acute deterioration would not have triggered escalation via the early warning score, the routine set of heart rate, temperature and other readings used to spot a patient in trouble. Of that group, 13% still led to a transfer of care and 56% to another change in treatment, such as antibiotics, a scan or a trip to theatre.

That is the second-order fact behind the A&E move. Monitors in a crowded department are worse, not better, at catching a slow slide. Relatives watching a person in a chair for six hours often have the longer look. The open design question, the one an intensive-care doctor asked as the announcement landed, is how an emergency department builds a second clinical route when the first team is already the whole shop.

There is not one national Martha’s Rule number. Each hospital runs its own line, advertised on posters, the trust website and by staff. In A&E that means a family must find a local number while they are still in the queue, which is a different task from spotting a poster above a named bed.

A Coroner Ruled She Would Have Survived

The rule is named after Martha Mills, who died in 2021, aged 13, after developing sepsis at King’s College Hospital in London. She had been admitted with a pancreatic injury from a handlebar blow after falling off her bike on a family holiday in Wales, and she died about a month later. Her parents said their worries about her decline were not acted on.

FROM THE INQUEST TO THE WAITING ROOM

1. 2021: Martha Mills dies at King’s College Hospital. The medical cause recorded later is refractory shock, sepsis, a pancreatic transection that had been operated on, and abdominal trauma.
2. 25 February 2022: The inquest ends. Senior coroner Mary Hassell of Inner North London finds Martha was not referred promptly to paediatric intensive care.
3. 28 February 2022: Hassell’s prevention of future deaths report tells the trust the likelihood is that she would have survived her injuries if she had been referred promptly and treated properly.
4. May 2024: Phase 1 of Martha’s Rule begins at 143 acute inpatient sites.
5. April 2025: Phase 2 extends the programme to remaining adult and paediatric acute inpatient services.
6. September 2025 to March 2026: Seven trusts trial the process in emergency departments (69 calls).
7. 22 September 2026: NHS England announces a national A&E and waiting-room expansion, to be completed by March 2028, alongside maternity and neonatal units.

Hassell wrote that if Martha had been referred promptly to paediatric intensivists and treated appropriately, she would probably have survived. The original failure was on a specialist children’s ward, not in A&E. The waiting-room extension is still a reply to the same pattern: a family sees the decline, the home team is slow to move, and the intensive-care door stays shut.

Queensland Put the Same Right in Emergency Departments

England is late to putting a family-triggered review into emergency care. Queensland Health’s Ryan’s Rule, named after Ryan Saunders, who died in 2007 from an undiagnosed streptococcal infection, already applies to public hospital emergency departments. It is a three-step process in Queensland hospitals: speak to the nurse or doctor, then the nurse in charge, then call 13 HEALTH for a clinical review.

HOW RYAN’S RULE ESCALATES

• Step 1: The patient, family or carer talks to the treating nurse or doctor about a condition that is getting worse or not improving as expected.
• Step 2: If they are still not satisfied, they talk to the nurse in charge of the shift.
• Step 3: They call 13 HEALTH (13 43 25 84), or ask a nurse to call, and request a Ryan’s Rule clinical review, giving the hospital, the patient’s name, the ward and bed if known, and a contact number.

The first facility went live on 2 December 2013 and the last public hospital followed on 19 May 2015. Hospitals had to train at least 80% of staff before they could use the statewide number. In 2023 there were 2,355 activations, about seven calls a day across 177 facilities. About 60% of calls were about communication. Nearly 50% of the clinical reviews that followed led to no change in planned care. Where feedback was collected, 61% of callers agreed or strongly agreed that their concerns were addressed.

Queensland’s lesson for English A&E is not that the phone never rings. It is that many rings are about not being heard, that half the reviews leave the plan untouched, and that the person who takes the call needs to be on site, not on call from home. England’s version skips the staged local conversation and goes straight to a hospital-run rapid-review number, which may be faster, and may also dump more work on whoever is carrying the phone in a full department.

Walk-in Centres Stay Outside the Rule Until 2028

The expansion now announced still has holes. NHS England says the A&E and maternity-neonatal rollouts currently exclude homebirth settings, birth centres, same day emergency care units, urgent treatment centres and minor injury units. Testing is still going on in community hospitals and mental health settings. A family in a walk-in centre down the road from a Type 1 A&E will not have the same number to call.

WHERE THE RULE STILL DOES NOT RUN

• Urgent treatment centres and minor injury units: Left out of the A&E expansion, even though they take a large share of less severe emergency demand.
• Same day emergency care: Also excluded, despite sitting on the same site as many acute hospitals.
• Homebirths and birth centres: Outside the maternity and neonatal extension.
• Community hospitals and mental health: Still in testing, with no national completion date in the A&E announcement.

Baroness Merron, the health and social care minister, said the A&E move would give patients, families and staff another way to speak up when they worry that someone’s condition is getting worse. Hospitals will add the line at different speeds. Until March 2028, whether a deteriorating patient in an English emergency department can force a second look still depends on which door they came through, and on whether anyone in the queue knows the local number is there.

Disclaimer: This article is news reporting on an NHS patient-safety policy. It is for information only and is not medical advice, a diagnosis, or a guide to what any individual patient should do in an emergency. It does not tell readers whether to call a Martha’s Rule number, wait for a review, or seek other care, and it is not a substitute for advice from a doctor, nurse or other qualified clinician. Anyone who is worried about a person’s condition in hospital should speak to the staff caring for them and, if needed, ask that hospital for its own Martha’s Rule number. Call figures, site counts and rollout dates reflect NHS England and related official sources as of 22 September 2026 and may change as the programme is rolled out.