How Martha’s Rule Could Improve Digital Access to Hospital Care

The short answer: Martha’s Rule could improve digital access to hospital care if hospitals use technology to make the patient-safety right visible, easy to reach, and connected to a human clinical response. It should not become a digital-only system. A phone line, bedside conversation, interpreter, paper notice, or staff member must remain available for people who cannot or do not want to use an app.

Martha’s Rule is an NHS England patient-safety initiative created after the death of Martha Mills. It gives patients, families, carers, and staff a route to request a rapid review when they are worried that a patient is getting worse and their concern is not being addressed. The policy has three core components: asking patients at least daily how they are feeling; allowing staff to request review by a different team; and making an escalation route available to patients, families, and carers.

What Martha’s Rule is—and what it is not

Martha’s Rule is not a general right to demand any treatment, a guaranteed second opinion from a chosen specialist, or a replacement for emergency care. It is a structured way to make a concern heard and trigger an appropriate clinical review when deterioration may not be receiving a sufficient response.

The policy is being implemented in England, so readers in the United States or elsewhere should not assume that a hospital has the same process. NHS England says local implementation can vary, and its core standards do not prescribe one specific technology, job title, or workflow. As of the 2026/27 NHS Standard Contract, NHS trusts and NHS foundation trusts are required to implement the three core components by March 31, 2027. Patients should check the hospital’s website or ask ward staff whether Martha’s Rule is available and how to use it.

That distinction matters for digital access. A hospital may publish a dedicated telephone number, use a bedside card, add a form to its patient portal, or combine several channels. A QR code or online form can make the route easier to find, but the technology is only useful if it leads promptly to a trained team that can assess the patient.

How a digital pathway could make the rule easier to use

1. Make the escalation route visible at the moment it matters

Patients and relatives do not usually arrive at a hospital knowing the name of every safety policy. A digital hospital welcome page, patient portal banner, text message, bedside display, or accessible QR code could explain, in plain language, what to do if a patient appears to be getting worse and ordinary requests have not been answered.

The best design would show the phone number and the human alternative first, with digital options alongside them. It could also state where the process applies, who may use it, what information to prepare, and what to do in an immediate emergency. This reduces a common access problem: a right exists on paper, but the person who needs it cannot find the route quickly.

2. Turn a worried observation into usable information

Families often notice changes that are difficult to summarize under pressure: a patient is unusually confused, breathing differently, much harder to wake, or simply “not acting like themselves.” A short digital form could prompt for the patient’s name or identifier, ward, time of the change, what the person looked like before, what has changed, and whether staff have already been told.

That does not mean a form should diagnose the patient. Its value would be organization. A structured record can help the receiving team understand the concern quickly, reduce repeated retelling, and preserve the exact time at which the issue was raised. Free-text space and a telephone option would still be important because families cannot always fit a complex situation into checkboxes.

3. Route the concern to a different clinical team

The safety benefit of Martha’s Rule depends on escalation reaching someone able to review the situation independently of the immediate care team. A digital pathway could send an alert to the hospital’s critical-care outreach or rapid-review service, display the request in a monitored work queue, and record when it was acknowledged and what action followed.

This is where a digital tool could improve reliability rather than merely convenience. A phone call may be appropriate and fast, but a properly designed system can add timestamps, escalation status, ownership, and audit trails. It can help a hospital identify requests that were not acknowledged, were delayed, or repeatedly involved communication problems.

4. Include family and carer access without weakening privacy

Martha’s Rule specifically recognizes the role of families and carers. A digital system could offer a proxy-access route, a temporary link, or a staff-assisted submission so an authorized relative can raise a concern when the patient is too unwell, confused, very young, or unable to use a device.

However, access must be designed around confidentiality. A hospital should verify the relationship and authority required in the circumstances, limit the information shown to what is necessary, and make clear that submitting a concern is not the same as obtaining unrestricted access to the medical record. The system also needs an alternative for people without a smartphone, data plan, digital skills, English fluency, or stable internet access.

5. Connect the concern to the clinical record and handoffs

If a family reports a change at 2:15 p.m. and the patient moves between teams at 3 p.m., the concern should not disappear during the handoff. A carefully integrated electronic patient record could display the escalation, the response, and any agreed follow-up to the clinicians who need that information.

Integration also prevents a dangerous illusion of completion. A green “submitted” message only proves that data entered a system; it does not prove that a clinician has assessed the patient. The patient and family should receive a clear acknowledgement, an expected response time where appropriate, and instructions for what to do if the condition worsens or no one responds.

A practical example: when digital access would help

Imagine a hypothetical patient on an acute ward whose daughter notices that he has become much more drowsy and is breathing differently. She tells a staff member but does not feel the change is being acted on. A bedside poster points to the hospital’s Martha’s Rule information page. The page shows the dedicated phone number, a large “call now” option, and a short accessible form. She phones rather than completing the form because the situation feels urgent.

The outreach team records the concern, confirms the ward and patient, contacts the bedside team, and conducts a rapid review. The digital record timestamps the call and makes the outcome visible at handoff. The technology has not decided what treatment the patient needs. It has helped the family find the right route, helped the reviewer receive organized information, and helped the hospital demonstrate whether the concern was acknowledged.

This approach is suitable when the hospital has a monitored escalation service, clear response responsibilities, reliable identity checks, and staff training. It is not suitable if the form goes to an unmonitored inbox, if alerts are mixed with routine administrative messages, or if staff treat a submitted form as a substitute for seeing the patient.

What could prevent digital access from improving care?

How hospitals could judge whether it is working

Success should not be measured by the number of app downloads or online submissions. A better evaluation would ask whether patients and families can find the route, whether people who need an alternative channel can use one, how quickly concerns are acknowledged, whether reviews lead to appropriate changes, and whether communication problems are being reduced.

Hospitals should examine results by age, disability, language, ethnicity, deprivation, ward, and contact method where lawful and proportionate. A system that appears efficient overall but is rarely used by people with limited English or low digital confidence may be widening the very access gap it was meant to close.

What patients and families can do now

• Ask the ward whether Martha’s Rule is available and what number or process applies there.
• Ask for an interpreter or communication support if needed; do not let language or disability become a reason not to raise a concern.
• Explain what has changed, when it changed, and why the change worries you.
• Write down who you told and when, especially if you need to escalate later.
• If the patient appears to be in immediate danger, use the ward’s emergency call process rather than waiting for an online form.

For general digital hospital access, the NHS App can show hospital and specialist appointments and referrals, but that is different from Martha’s Rule. The app should not be assumed to be the escalation channel unless the particular hospital explicitly says so.

Bottom line

Martha’s Rule could improve digital access to hospital care by making a patient-safety right easier to discover, giving families more than one practical route to raise a concern, creating a traceable handoff, and helping hospitals learn from delays or communication failures. The condition is simple but non-negotiable: digital access must strengthen human clinical attention, not replace it. The strongest model is therefore hybrid—fast technology where it helps, and an equally clear human route for everyone else.

Sources and further reading

• NHS England: Martha’s Rule
• NHS England: Martha’s Rule core standards
• NHS England: Martha’s Rule statistics and data publications
• NHS England: NHS App features
• NHS England: Inclusive digital healthcare framework
• NHS England: Accessible Information Standard