Patient safety
NHS rolls out ‘Martha’s Rule’ to help save lives
This month, ‘Martha’s Rule’ is being rolled out in hospitals across England, enabling patients and families to seek an urgent review if their condition deteriorates.
The first phase of the introduction of Martha’s Rule will be implemented in the NHS from April 2024. Once fully implemented, patients, families, carers and staff will have round-the- clock access to a rapid review from a separate care team if they are worried about a person’s condition.
Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to promptly and, in 2023, a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier. One of the key issues raised was the fact that Martha’s parents’ concerns that their daughter’s condition was deteriorating were not listened to, that they were not given vital information, and that there was culture of ‘us’ and ‘them’. Demos, a cross-party Think Tank, published a report in
September 20231 supporting calls for the NHS
to bring in Martha’s Rule. In the report, Martha’s mother, Merope Mills, wrote: “Something I think about every day is that
the doctors looking after Martha knew she had sepsis (severe sepsis in fact) seven days before she died, but not once used that word when talking to Paul or me. Everything was done to play-down our anxiety; we were indeed ‘managed’ and condescended to; euphemisms were employed. “We were told that her bleeding was a ‘normal side effect of infection’, which was dangerously misleading. Because I wasn’t dealt with honestly, I failed to sound alarms and to protect my child. I’ll never forgive myself. I had no choice but to accept what I was told; I had no access to any notes about Martha’s care (it turned out that the consultants, with one exception, didn’t actually contribute to the patient record about her). We weren’t told about a build-up of fluid around Martha’s heart, which was another sign of sepsis (perhaps because it was decided to delay the relevant scan until after the bank holiday). This was another expression of ‘us’ and ‘them’ or ‘not in front of the children.” In response to this and other cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’; to ensure the vitally important concerns of the patient and those who know the patient best
are listened to and acted upon.2 NHS England explains that the three proposed components of Martha’s Rule are: 1. All staff in NHS Trusts must have 24/7 access to a rapid review from a critical care outreach team, who they can contact should they have concerns about a patient.
2. All patients, their families, carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team, which they can contact via mechanisms advertised around the hospital, and more widely if they are worried about the patient’s condition. This is Martha’s Rule.
3. The NHS must implement a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least daily. In the first instance, this will cover all inpatients in acute and specialist Trusts.
Implementation of Martha’s Rule NHS England has reported that the implementation of Martha’s Rule will take a phased approach, beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability.2 This first phase will take place during
2024/25 and will focus on supporting participating provider sites to devise and agree a standardised approach to all three elements
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