Families welcome right to challenge A&E care

Families with experience of loved ones receiving critical care have welcomed the expansion of a new right to request a rapid review in A&E.

Named after 13-year-old Martha Mills, who died from sepsis in 2021, Martha's Rule allows patients, loved ones and staff to request an urgent review if they believe a patient is deteriorating and their concerns are not being heard.

The scheme is already being being piloted in A&Es in Gloucester, Cheltenham, Taunton and Yeovil and is set to be rolled out in all emergency departments in England by March 2028.

Elliott Paterson, from Cheltenham, said he "truly believes" Martha's Rule saved his 67-year-old dad's life at Gloucestershire Royal Hospital last year.

Paterson said he called GRH's critical care team about his father's deterioration after breaking his ribs, which meant they were then able to treat both his injuries and a rare autoimmune disease complicating his treatment.

"To hear that Martha's Rule is now to be rolled out across the NHS is brilliant news and I hope that for more people it will continue to save lives," he said.

"I am incredibly fortunate and grateful to have had Martha's Rule at our disposal at the time."

Martha's parents Merope and Paul campaigned for the change after concerns they raised were not listened to.

The 3 core components of Martha's Rule are:

Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted on in a "structured way".

All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.

Patients and loved ones in A&E units will also be able to call a phone number to trigger a rapid review if a patient's condition is deteriorating and they are concerned this is not being taken on board.

Ashley Hutchinson, from Trowbridge in Wiltshire, who challenged his grandmother Nancy's care at the Royal United Hospital in Bath in 2014, described the expansion as "a massive step forward".

Doctors told his family to expect the worst after Nancy's health underwent a "rapid deterioration".

But Hutchinson said a letter to the hospital board prompted doctors to discover a ruptured stomach ulcer that could be treated.

"Her transformation was incredible and the condition she got back to was also incredible - she lived a normal life for another two-and-a-half years," he said.

Hutchinson described Martha's rule as "a fantastic initiative borne out of terrible circumstances" that he hoped would encourage "a cultural shift".

"If you were more accepting and less willing to challenge medical professionals like I did, we would have lost our nan and been none the wiser."

Michelle Bresnahan from Bristol, who lost her son Ryan suddenly to meningitis B in 2010, said the option of an urgent review of someone's care would be "absolutely brilliant" for families.

"I've talked to many who have lost their kids through meningitis who were sent home because they couldn't find anything wrong - and some never made it, had to go back the next day or to the ICU," she said.

"I do think the gut feeling of a parent on the circumstances of a child is so important, you know when something is wrong."

Dr Iris Da Luz Batalha from the University of Bath, who specialises in nanoimmunology - delivering medicine in a more targeted way using tiny particles - said: "Rapid action is absolutely critical when it comes to bacterial infections.

"In conditions like sepsis, every hour matters. Sometimes the changes can be subtle at first, which is why it's so important to listen not only to clinical tests and observations, but also to patients and families."

This is why Martha's Rule is "really important", she said.

"Families often know the patient better than anyone else. They notice subtle changes when something is wrong long before it becomes obvious to others."

Gloucestershire Hospitals NHS Trust was the first in the South West to pilot Martha's Rule in its emergency departments at GRH and Cheltenham General Hospital.

A trust spokesperson said patient, family and carer voices were vital in recognising deterioration.

"Our commitment is to listen and respond to concerns and Martha's Rule provides a tool for us to enhance this by focussing on anything worrying the patient or family."

"We are pleased our patients have used Martha's Rule appropriately for clinical matters," they said, which has happened eight times since January 2026.

Somerset NHS Foundation Trust is another to have begun piloting Martha's Rule at its emergency departments at Musgrove Park Hospital in Taunton and Yeovil District Hospital.

Jayne Cooper, the trust's deputy chief nurse, said: "Our approach is.. about continuing to develop a culture where patients and families feel confident to raise concerns, colleagues feel supported to escalate issues when needed, and clinical teams have clear pathways to respond appropriately and promptly."

Health Innovation West of England, which is supporting all acute NHS hospital trusts in the region to implement Martha's Rule, said 30% of calls related to acute deterioration and had led to changes in treatment or enhanced levels of care.

The remainder of calls had led to conversations about concerns relating to things like medication, the management of long-term conditions and discharge planning.

Follow BBC Somerset on Facebook and X. Send your story ideas to us on email or via WhatsApp on 0800 313 4630.