NHS to roll out ‘Martha’s Rule’ from April in England

The NHS in England will roll out ‘Martha’s Rule’ from April to give patients and families access to a rapid review if they are worried about a condition getting worse.

The escalation process, which formalises access to a critical care team for a second opinion, will be available 24/7 and will be advertised throughout hospitals.

Under the move, an urgent clinical review would be carried out by a different team in the hospital if a patient’s condition is rapidly worsening and they or their family feels they are not getting the care needed.

At least 100 NHS trusts are expected to bring in the rule, with the programme evaluated throughout this year and next.

The plan is to then extend Martha’s Rule to all acute hospitals, subject to Government funding.

The move follows the death of 13-year-old Martha Mills in 2021. She developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

A coroner ruled she would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier.

Martha’s parents, Merope Mills, an editor at the Guardian, and her husband Paul Laity, raised concerns about Martha’s health a number of times but these were brushed aside.

The pair have since campaigned for Martha’s Rule to be introduced to give families more say.

They said in a statement: “We are pleased that the implementation of Martha’s Rule will begin in April.

“We want it to be in place as quickly and as widely as possible, to prevent what happened to our daughter from happening to other patients in hospital.

“We believe Martha’s Rule will save lives. In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t; their knowledge should be recognised as a resource.

“We also look to Martha’s Rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged.

“We call on all NHS clinicians to back the initiative: we know that the large majority do listen, are open with patients and never complacent – but Martha’s doctors worked in a different culture, so some situations need to change.

“Our daughter was quite something: fun and determined, with a vast appetite for life and so many plans and ambitions – we’ll never know what she would have achieved with all her talents.

“Hers was a preventable death but Martha’s Rule will mean that she didn’t die completely in vain.”

Martha was being looked after at King’s after suffering a pancreatic injury following a fall from her bike while on a family holiday in Wales.

An inquest heard there were several opportunities to refer Martha to intensive care but this did not happen. The trust, which is a specialist national referral centre for children with pancreatic problems, has since apologised for mistakes in Martha’s care.

At one point, Martha began to bleed heavily through a tube inserted into her upper arm and through a drainage tube.

She also developed a rash and her mother voiced concerns to staff that Martha would go into septic shock over a bank holiday weekend.

One of the trust’s own intensive care doctors told the inquest into Martha’s death he would “100%” have admitted her if he had seen her.

Regarding the introduction of Martha’s Rule, NHS chief executive Amanda Pritchard said it had the potential to “save many lives in the future”.

She said: “Hearing about the heartbreaking loss of Martha and the experiences of her family has had a major impact for people right across the country, with parents, patients and NHS staff welcoming her parents’ call for a simple process to escalate concerns when they can see a loved one’s condition worsening.

“NHS teams have been piloting ways to better identify and respond in these cases over the last year, and the roll-out of a national programme to give patients and families 24/7 access to a rapid clinical review will now help ensure that those experiencing acute deterioration can be identified and treated much more quickly.

“I know I speak on behalf of all NHS staff when I thank Merope and Paul for their extraordinary campaigning and collaboration on this hugely important issue.

“While the need for escalation will hopefully only be needed in a small number of cases, I have no doubt that the introduction of Martha’s Rule has the potential to save many lives in the future.”

NHS teams will also look at ways ways to roll out an adapted Martha’s Rule model in community and mental health hospitals.

Rory Deighton, director of the NHS Confederation’s acute network, welcomed the move.

He said: “Questions remain about what resources hospitals and other providers will be given to deliver the new scheme.

“Introducing a 24/7 clinical review process will have implementation costs and leaders will be concerned if they are just being expected to provide the additional service without any extra resources.

“But this rollout is part of an important shift where the NHS is looking to change the relationship between the NHS, clinicians, patients and their families.

“The future model of care is one where patients and their families are active partners in healthy communities, not just consumers of NHS services.”

Health Secretary Victoria Atkins said: “Martha’s death was a terrible tragedy, and I pay tribute to her parents Merope and Paul.

“Martha’s Rule will provide a major boost to patient safety by putting in place a system that can be triggered by patients, or by their family and friends, when they are worried that their condition is worsening. This will give vital reassurance that the best care possible is being given.

“The introduction of Martha’s Rule from April will put families at the heart of the patient’s own care, recognising the critical role they have in the treatment of loved ones.”

Published: 21/02/2024 by Radio NewsHub