NHS England is expanding Martha’s Rule to all hospital A&E departments in England, including waiting rooms, as part of a phased roll-out due to be completed by March 2028.
Martha’s Rule is designed to make sure concerns about a patient whose condition is getting worse are listened to and acted upon. Where the Rule is available, a patient, family member, carer or member of staff can request a rapid review from a different clinical team if they remain worried about deterioration and feel their concerns have not been addressed.
This is particularly relevant for social care. Care professionals often know the people they support extremely well and may notice subtle but important changes in presentation, behaviour, communication or wellbeing. Their knowledge can be valuable when someone is in A&E, particularly where the person may have dementia, a learning disability, autism, communication difficulties or other needs that can make it harder to explain that something has changed.
Care providers should consider:
- making staff who may accompany people to hospital aware of Martha’s Rule and the developing A&E roll-out;
- encouraging staff to clearly share concerns and relevant baseline information with the A&E clinical team;
- supporting people and families to speak up if they believe a condition is deteriorating or their concerns are not being heard;
- asking hospital staff whether Martha’s Rule is available locally and how the rapid review process can be accessed; and
- ensuring staff understand that Martha’s Rule complements normal clinical escalation processes rather than replacing them. If someone appears to be deteriorating, concerns should always be raised with the clinical team straight away.
The A&E roll-out is phased, so Martha’s Rule will not yet be available in every emergency department. Arrangements and contact details are set locally by individual NHS trusts. Staff, people using services and families should therefore check the relevant hospital or NHS trust website, or ask hospital staff, to find out whether Martha’s Rule is available and how to use it.
For providers, the key message is simple: know the person, notice changes and speak up. Care professionals and families can provide vital information about what is normal for an individual and should feel confident raising concerns when something does not seem right.