Implement Martha’s Rule ‘meaningfully’, nurses urged
The mother of Martha Mills, a child who died of sepsis after concerns about her condition were ignored, has urged NHS leaders and staff to roll out Martha’s Rule meaningfully, not performatively.
Merope Mills said this week that nurses clearly communicating the new rule to patients would be essential to the success of the roll out.
“The nurse is such a big piece of the care – they’re the people you see every day”
Merope Mills
Martha’s Rule aims to make it easier for patients and families to get an urgent care review of their own or their family member’s condition if concerns about deterioration are not being responded to.
The initiative is named after 13-year-old Martha, who died in 2021 from sepsis after staff at King’s College Hospital NHS Foundation Trust ignored her family’s concerns.
Last month, NHS England announced that Martha’s Rule would be rolled out across 143 hospitals in England before March 2025.
Merope Mills, who has been campaigning for the introduction of the policy, this week praised the pace at which rule had been introduced.
Speaking during a session at NHS ConfedExpo 2024, Ms Mills said: “I’ve learned enough to know that patient safety initiatives too often happen at a snail’s pace.
“Freedom to speak up took seven years to introduce, a national [paediatric early warning system] chart for children took nearly a decade for everyone to agree on.
“I can’t imagine how many children’s lives could have been saved in that time.
“For that reason, we’re extremely pleased action has been taken to bring Martha’s Rule into effect quickly.”
Martha was admitted to hospital in 2021 after falling off a bicycle while on holiday and was treated for a pancreatic rupture at King’s College Hospital.
She subsequently contracted sepsis and then her condition deteriorated in the weeks that followed. Treatment was not escalated until it was too late.
Merope Mills addressing NHS ConfedExpo 2024
The coroner’s report concluded that if Martha had been referred promptly and had been appropriately treated, “the likelihood is that she would have survived her injuries”.
Ms Mills has been vocal about the “hierarchy” that exists in the NHS, which she has argued can prevent some healthcare staff, patients and families from speaking out.
“It’s a very unequal place, a hospital ward, there’s a hierarchy and it’s very steep and very strict,” she told the conference this week.
“And when I first started talking about that, I sort of thought the nurses were at the bottom of the hierarchy.
“And I refer to that because they didn’t feel that ability to speak up in Martha’s case.
“But I’ve actually come to realise that the people at the bottom of the hierarchy are the patients.
“They are the ones with the least power and I just would like to upend that and just have a sense of mutual respect between doctor and patient.”
Martha’s Rule means that NHS trusts in England must provide staff, patients, families, carers and advocates with 24/7 access to a critical care outreach team which can perform a rapid review of a patient, if there are concerns about their condition.
It also stipulates that staff at acute and specialist hospitals must implement a structured approach to obtaining information relating to a patient’s condition directly from patients and their families at least daily.
Ms Mills noted the important role that nurses will play in the roll out of Martha’s Rule in the coming months.
“I think [it’s about] being clear at the point of admission, and the nurses communicating,” she explained.
“The nurse is such a big piece of the care – they’re the people you see every day.
“Just having that direct conversation and somebody saying ‘this is your emergency number, this is what you call if you think you’re not being heard’.
“This is the purpose of this, not just ignoring it, not pretending it’s not there, not doing it performatively but being honest, and treating people as if they aren’t stupid and they aren’t going to overuse it.
“If you are a senior leader here, I would say don’t implement it performatively, implement it meaningfully.”
Martha’s Rule has built on NHS England’s ‘worry and concern improvement collaborative’, which was launched in 2023 as a pilot.
Under the pilot, a hospital trust in each region has been testing and implementing different methods for patients, families and carers to escalate their concerns about deterioration.
Helen Lidbetter, associate director of quality and governance at Northampton General Hospital NHS Trust, described the work that her organisation had been undertaking as part of the pilot.
This involved the trust rolling out the ‘call 4 concern’ system, which already exists in other NHS trusts, across all adult inpatient wards.
Like Martha’s Rule, call 4 concern allows patients or their families to escalate their care to a critical care outreach team if they feel that deterioration is being missed.
In the first 12 months, the hospital had 81 calls, of which 21 were related to deterioration.
“Every single one of those 21 patients has been stabilised by our outreach team and has not needed critical care,” said Ms Lidbetter.
Ms Lidbetter, who has been a registered nurse for over 40 years, said it was important for nurses to remember that some diverse populations may be more reluctant to use Martha’s Rule.
“It is just recognising that not everybody finds it easy to talk to a healthcare professional,” she said.
“We talk about deference, culturally that can vary, [and also] having the language, [because] not everybody is equal on that.
“At its core it has to be recognising that our patients are individuals and have different ways of communicating with us, and that’s part of being a nurse at the end of the day.”
