A patient’s family, carer or support worker may notice a change in someone’s condition before anyone else.

They may notice that the person is more confused than usual, unusually tired, struggling to breathe, in more pain or simply does not seem like themselves.

Martha’s Rule was introduced to make sure those concerns can be heard and acted on when a patient’s condition is deteriorating.

The latest expansion means the initiative is now being rolled out to A&E departments across England, bringing renewed attention to the importance of listening to patients, families, carers and staff.

For care providers, the changes are worth understanding, particularly where staff regularly support people who may need to attend hospital.

 

What is Martha’s Rule?

Martha’s Rule is a patient safety initiative designed to support the early identification of deterioration.

It was introduced following the death of 13-year-old Martha Mills, who developed sepsis while in hospital in 2021. Her family had raised concerns about her deteriorating condition. A coroner later concluded that Martha would probably have survived if she had been transferred to intensive care earlier.

The principle behind Martha’s Rule is straightforward: people who know a patient well may notice changes that need attention, and their concerns should be listened to.

 

What has changed?

Martha’s Rule has already been introduced across NHS inpatient settings.

In September 2026, NHS England began extending it to every A&E department in England. The rollout is being phased in and is expected to be completed by March 2028.

Patients, relatives and staff in A&E will have access to a dedicated route for requesting an urgent review when they are concerned that a patient’s condition is getting worse and their concerns are not being acted on.

The expansion follows an eight-month trial across seven NHS trusts. NHS England reported that 69 calls were made during the A&E pilot, with some patients subsequently receiving urgent surgery or being transferred to intensive care.

Martha’s Rule is also being extended to maternity services, with NHS England’s 2026/27 planning setting out implementation across maternity and neonatal services by March 2028.

 

What does this mean for care providers?

Martha’s Rule is an NHS patient safety initiative, so care homes and other social care services should not assume that they are directly required to implement the NHS process.

However, the underlying principle is highly relevant to social care and patient safety.

Care staff are often in a strong position to notice changes in the people they support.

A support worker, carer or family member may know what is normal for a person and recognise when something has changed.

That information can be important when a person is admitted to hospital.

 

Supporting staff to recognise deterioration

Good communication starts before a hospital admission.

Care teams should have clear processes for recognising and reporting changes in a person’s health. Staff need to know what signs to look for, who to report concerns to and what information should be recorded.

This is particularly important for people with:

• Learning disabilities
• Dementia
• Autism
• Complex health needs
• Communication difficulties
• Long-term health conditions
• Conditions that can make changes in health difficult to recognise

Knowing how someone normally behaves, communicates, eats, sleeps or moves can make it easier to spot when something is different.

 

Speaking up should be part of everyday care

Martha’s Rule has brought national attention to speaking up in healthcare, but the principle should not only apply when someone is seriously unwell.

Care providers can create an environment where staff are expected to raise concerns when something does not look right.

That means staff need to know that raising a concern is part of their role, not something they should avoid because they are worried about challenging a colleague or professional.

Managers can support this by making escalation procedures clear and regularly discussing them with teams.

 

Communication with hospitals matters too

When someone from a care setting goes into hospital, information can sometimes be lost between different teams.

Care providers can help by making sure relevant information is available, including changes in presentation, known health conditions, medication, communication needs and the person’s usual baseline.

A clear handover can help hospital staff understand what has changed and why the care team is concerned.

This is particularly important for people who may find it difficult to communicate changes in their own health.

 

Training can support safer escalation

Staff cannot be expected to recognise and respond to deterioration if they have not been given the knowledge and confidence to do so.

Training in areas such as first aid, recognising deterioration, communication, safeguarding and person-centred care can support frontline teams.

The aim is not to turn care workers into clinicians. It is to help staff recognise when something may be wrong, record relevant information and escalate concerns appropriately.

 

A culture where people are listened to

The wider message from Martha’s Rule is about more than one NHS policy.

It highlights the importance of listening when patients, families, carers or staff say that something has changed.

For social care providers, that can mean looking at how concerns are raised within the service, how staff are supported to escalate them and whether people’s families are included when appropriate.

A concern does not need to be correct for it to be worth listening to.

Sometimes raising the concern is what prompts a closer look and helps identify a problem early.

 

What should care providers take from Martha’s Rule?

Care providers do not need to treat Martha’s Rule as an NHS requirement that automatically applies to their service.

Instead, it provides an opportunity to review existing patient safety and escalation procedures.

Ask your team:

• Do staff know how to report a change in someone’s condition?
• Are escalation routes clear?
• Do staff feel confident speaking up?
• Are people’s families and carers listened to?
• Is important information shared clearly when someone goes to hospital?
• Do staff receive appropriate training to recognise deterioration?
• Are concerns recorded and followed up?

These questions can help strengthen the systems already in place.

 

Listening can make a difference

The latest expansion of Martha’s Rule is a reminder that patients, families, carers and frontline staff can all have important information about someone’s health.

For care providers, the practical lesson is simple: make it easy for staff to raise concerns, make sure those concerns are taken seriously and give teams the knowledge they need to recognise when something has changed.

Patient safety depends on more than policies. It also depends on people being willing and able to speak up.