Martha’s Rule in 2026: When to Ask for a Rapid Review
If someone you love is becoming more unwell in hospital and you feel your concerns are not being acted on, it can be frightening. Martha’s Rule gives patients, families and carers in England a route to ask for a rapid review by a different clinical team. It is for a concern about deterioration. It is not a complaint route, and it does not promise a particular treatment or outcome.
In June 2026, the government announced a national rollout to maternity and neonatal settings. That expansion is important, but availability is still local while it is implemented. Ask the ward or trust how its Martha’s Rule route works rather than assuming there is one phone number or team everywhere.
What Martha’s Rule is designed to do
Martha’s Rule is an NHS England patient-safety escalation process. Its three core parts are a daily question about whether a patient feels better or worse; a route for any member of staff to seek a review from a different team; and a clear route for the patient, family or carer to request a rapid review when a deterioration concern has not been heard.
The review should be independent of the team currently providing care and carried out by an appropriately skilled clinician. Local trusts decide the practical route. They do not all use the same name, phone line or response model.
Situation | Is Martha’s Rule likely to fit? | Useful first step |
|---|---|---|
An inpatient is suddenly more confused, breathless, sleepy, in more pain or unable to do what they could earlier | Often, if concerns about deterioration have not been addressed | Tell the nurse or doctor what has changed, when it changed and why it worries you; then ask how to activate the local route |
You disagree with a long-term treatment plan but there is no urgent change | Usually not by itself | Ask the treating team to explain the plan and the next opportunity to discuss it |
You are in A&E, at a GP appointment or at home | Not normally the standard Martha’s Rule setting | Use the relevant urgent-care or emergency route and tell staff immediately if the condition is worsening |
You are on a maternity or neonatal ward | Rollout is expanding, but local availability may differ | Tell the maternity/neonatal team what has changed and ask whether the local Martha’s Rule route is available |
What to say when you are worried
You do not need medical language or a dossier of proof. A short, specific account is usually more useful than trying to sound clinical. For example: “Since this morning she is much sleepier, has not managed a drink and is harder to wake. I am worried she is deteriorating. I need to know what will happen next.”
If that concern is not being responded to, ask: “Does this ward have a Martha’s Rule or rapid-review route for families? How do I use it now?” Ask the person you speak to to repeat back what will happen and who is responsible. If the situation feels immediately serious, raise it with the nearest clinical staff or the hospital’s urgent emergency route straight away rather than waiting for a later conversation.
It can help to note the time, the change you noticed, who you spoke to and what they said would happen. This is not a test you have to pass. It simply helps the next clinician understand the sequence quickly.
Martha’s Rule, second opinions and medical negligence
Martha’s Rule can bring a fresh clinical assessment when concerns about acute deterioration have not been heard. It does not guarantee intensive care, admission, a specific medication, a diagnosis, or a change of treatment. It is distinct from a general second-opinion service: it is for an urgent deterioration concern, not simply because you disagree with a decision.
It is also not a medical-negligence investigation and does not decide whether care was negligent, caused harm or gives a right to compensation. If someone is worsening now, the priority is to make the concern clear and obtain the appropriate clinical response. Notes of what changed and what was said can be useful later, but they should never delay an urgent escalation.
The distinction matters. A family can be right to ask for a review even where the independent team ultimately agrees with the original plan. Being listened to, having the concern recorded and receiving a clear explanation are still meaningful outcomes during a stressful stay.
What is available now — and what is still rolling out
Martha’s Rule applies in England. It is already being implemented across adult and children’s acute inpatient care, although the practical route can still differ between wards and trusts. NHS trusts and foundation trusts must implement the three core components through the 2026/27 NHS Standard Contract by 31 March 2027.
The current boundaries matter just as much as the headline. Martha’s Rule is generally not yet the standard route in every emergency department, outpatient clinic, GP practice, mental-health setting or community hospital. These settings may have their own urgent escalation arrangements. Do not wait for a Martha’s Rule process if someone needs immediate clinical attention.
Setting | Position in September 2026 | What to do |
|---|---|---|
Adult or children’s acute inpatient ward | Core implementation is under way; local access route varies | Ask the ward how patients and families request a rapid review |
Maternity or neonatal ward | National rollout was announced on 24 June 2026 after pilots; availability is still expanding locally | Tell the team what has changed and ask whether the ward’s route is live |
A&E, outpatient clinic or GP practice | Not generally the standard Martha’s Rule setting | Use the service’s own urgent escalation process |
Mental-health or community setting | Not generally available as a standard route; new-setting work is developing | Ask staff about the local safety or urgent-review route |
The useful wording is: “Is Martha’s Rule available on this ward today? If not, what is the quickest local route for an independent clinical review?” This avoids a common and understandable mistake: assuming the June maternity announcement means the same process is already operational everywhere.
When language, disability or a child makes speaking up harder
The process is meant to be accessible. A family member or carer can raise a concern, and staff should help where a patient cannot communicate it alone. Ask for interpretation, communication support or a suitable way to explain the concern if you need it. For a child, give concrete examples: what they were able to do earlier, what has changed and what is making you afraid.
Caira can help you organise non-urgent records after the immediate situation has been dealt with: for example, a timeline of what changed, a list of questions for the ward, or a clear summary of letters and discharge notes you are authorised to share. It is not for urgent clinical assessment or emergency instructions.
Three questions people can feel awkward asking
“Will staff think I am being difficult?”
No. Martha’s Rule exists because patients and families can notice deterioration first. Be respectful and direct. You are describing a safety concern, not accusing an individual.
“Do I have to prove the patient is getting worse?”
No formal proof is required to raise a concern. Say what you have seen change, when you saw it and why it feels different. The clinical review decides what it means.
“Can I use it if I am not the patient’s next of kin?”
The route is intended for patients, families and carers. The ward will manage confidentiality and decision-making in the usual way, but you can still tell staff about an urgent deterioration concern you have observed.
This article is general information, not legal, financial, medical or tax advice.
