When we talk about mobile signal in hospitals, it can be easy to think of it as a convenience; allowing patients to message family, make a call or pass the time while they are on a ward.

But reliable communication within a hospital can have a much more important role.

The introduction of Martha’s Rule across NHS hospitals in England has put an increased focus on giving patients, families and carers a clear way to speak up when they are concerned that a patient’s condition is getting worse.

As hospitals continue to implement the initiative, it is also worth considering the infrastructure that allows people to communicate reliably from inside increasingly complex healthcare buildings.

What is Martha’s Rule?

Martha’s Rule is a patient safety initiative introduced following the death of 13-year-old Martha Mills in 2021.

Martha developed sepsis while being treated in hospital following a pancreatic injury. Her family had raised concerns about her deteriorating condition. In 2023, a coroner concluded that Martha would probably have survived had she been moved to intensive care earlier.

The initiative is designed to make sure patients, families, carers and hospital staff have a clear route for escalating concerns when they believe a patient is deteriorating and those concerns have not been adequately addressed.

There are three core elements:

• patients are asked at least daily how they are feeling and whether their condition is improving or worsening;
• staff can request a review from a different team if they are concerned about deterioration; and
• patients themselves, along with families and carers, have access to an escalation route to request a rapid review.

Martha’s Rule is now being implemented across acute NHS trusts in England, with full implementation across acute inpatient services expected during 2026/27.

What does that have to do with mobile signal?

Martha’s Rule is not a mobile connectivity regulation, and there is no requirement within the rule telling hospitals that they must install a mobile signal solution.

However, there is an obvious practical connection.

Across NHS hospitals, Martha’s Rule escalation routes are commonly being provided through dedicated telephone numbers or hospital switchboards. A patient or family member who remains concerned can make a call and request an urgent review from another clinical team.

For that process to be genuinely accessible, people need a reliable way to make that call.

Hospitals can provide ward phones and other methods of communication, and mobile connectivity should never be the only means available. But with most patients and visitors carrying their own mobile phones, good indoor mobile coverage can provide another simple and familiar route to communication.

If somebody is already worried about a loved one, finding that their phone has little or no signal should not be another obstacle they have to overcome.

Why can mobile signal be so poor inside hospitals?

Hospitals are particularly challenging environments for mobile coverage.

Large sites, thick concrete walls, steel, specialist glazing, basement areas and heavily partitioned clinical spaces can all weaken the outdoor mobile signal before it reaches the people inside.

Modern construction can create problems too. Energy-efficient building materials and coated glazing can be extremely effective at reducing the amount of external radio signal entering a building.

The result can be familiar to anyone who has spent time in a large hospital: good signal outside the entrance, one bar in a corridor and little or nothing once you reach certain wards or internal rooms.

Adding to the challenge is the size and complexity of many NHS estates. A hospital may contain buildings constructed decades apart, using completely different materials, with extensions, plant areas and clinical departments all affecting how mobile signal travels through the site.

Isn’t hospital Wi-Fi enough?

Good Wi-Fi is an essential part of a modern healthcare environment, but Wi-Fi and mobile coverage are not the same thing.

Visitors may need to find and join the guest network, accept terms or enter details before getting online. Wi-Fi calling also depends on the handset, network and settings being compatible and correctly configured.

Native mobile coverage allows a phone to work in the way its owner expects it to work, without first needing to connect to the hospital network.

That doesn’t mean hospitals need to choose between Wi-Fi and mobile coverage. In practice, they complement each other.

NHS England has itself published guidance on in-building mobile coverage for NHS IT, network, operational and estates teams, recognising the role that 4G and 5G can play alongside Wi-Fi in healthcare environments.

Connectivity is about more than Martha’s Rule

Martha’s Rule provides a particularly important example of why reliable communication matters, but it is far from the only one.

Patients and visitors rely on their phones to communicate with family and carers. Clinical and operational teams increasingly use connected devices and mobile applications as part of their working day. Reliable mobile connectivity can also provide an additional communications option where reliance on a single network or technology would otherwise create a point of failure.

For NHS estates and IT teams, the question therefore isn’t simply “Can I get a signal somewhere in this building?”

It is whether the areas where patients, visitors and staff actually need connectivity have been properly assessed.

Improving mobile coverage doesn’t always mean covering everything at once

Hospital estates can be large, complicated and constantly changing. Improving connectivity therefore doesn’t necessarily mean undertaking a complete hospital-wide installation from day one.

A professional mobile signal survey can identify where coverage is strong, where it is weak and where the most significant blackspots exist.

From there, priority areas can be considered and an appropriate in-building solution designed around the building, its users and the available external network coverage.

Depending on the site, that may mean addressing particular wards or departments first, or designing a wider system capable of providing coverage throughout the building.

The important part is understanding the existing environment before deciding on the solution.

Supporting NHS connectivity

At Mobile Signal Solutions, we survey, design and install in-building mobile signal solutions for complex commercial and public-sector environments, including NHS healthcare sites.

Our engineers begin with the building rather than assuming a particular solution. We assess existing mobile coverage, identify problem areas and consider the construction and layout of the site before designing an appropriate system.

For hospitals, where estates can include everything from older concrete buildings to new specialist clinical facilities, that assessment is particularly important.

Martha’s Rule isn’t a requirement to install better mobile coverage.

It is, however, another reminder of something increasingly important across healthcare: when patients, families and staff need to communicate, the infrastructure around them should help rather than hinder them.

For NHS estates, IT or facilities teams experiencing poor mobile coverage within a hospital or healthcare facility, Mobile Signal Solutions can carry out a mobile signal survey to establish the current coverage and identify the options available for improving it.