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Martha’s Rule to be rolled out in coming months

A system allowing patients and families to request an independent care review, if they think deterioration is being ignored by clinicians, will be rolled out in the coming months.

NHS England today announced that Martha’s Rule would be implemented in a minimum of 100 hospitals across the next year starting April 2024 – and nurses will also be able to trigger it.

“The roll-out of this scheme will be vital in helping improve the quality and safety of care for patients at risk of their condition worsening”

Ruth May

The rule, named after a teenager who died of sepsis after her family’s pleas for an escalation of her care were ignored in 2021, will give patients and their families more power if they think their care team is not listening to their concerns.

When Martha’s Rule is triggered, an independent critical care team will perform a “rapid review” of the case to check if deterioration has been missed. NHS staff, including nurses and other clinicians, will also be allowed to trigger Martha’s Rule.

This reporting system will be available 24/7 and advertised around hospitals, the health service said.

As well as the reporting system itself, Martha’s Rule will require health staff to record “daily insights” about a patient’s health from families.

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Martha Mills, 13, was rushed to King’s College Hospital NHS Foundation Trust after falling onto the handlebars of a bike while on holiday with her family, causing a pancreatic rupture.

Her condition deteriorated while she was in hospital, but pleas from the family to escalate her care were ignored by consultants until it was too late.

Parents Merope Mills and Paul Laity have campaigned since their daughter’s death for the introduction of Martha’s Rule, modelled after Ryan’s Rule, a similar system introduced in Australia.

Ms Mills, speaking in November, aired her frustration towards nursing staff who she said failed to speak up to consultants about her daughter’s condition.

Martha’s Rule will sit alongside the new Paediatric Early Warning System (PEWS) which is being introduced to help clinicians track potential deterioration in young patients in a standardised way.

The health service said the initial launch of Martha’s Rule in a minimum of 100 hospitals in 2024-25 would be used to decide how it is expanded, with an aim to implement it in all acute settings and, potentially, community services and mental health hospitals in the future.

England’s national chief nursing officer Dame Ruth May described the introduction as a “hugely important step” in the empowerment of patients and their families.

“I pay enormous tribute to Martha’s parents for their determined campaigning on this issue,” she said.

“Improving the detection and treatment of acute deterioration remains a critical patient safety priority for the NHS, and the roll-out of this scheme will be vital in helping improve the quality and safety of care for patients at risk of their condition worsening.”

Merope Mills speaking at the Chief Nursing Officer for England (CNO)'s annual summit, 2023

Merope Mills, speaking at the 2023 CNO Summit

Martha’s parents said, in a joint statement, that they were pleased the system was being rolled out soon.

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“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,” they said.

“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.”

The parents added that they hoped Martha’s Rule would “alter medical culture” by giving patients more power and encouraging doctors to welcome being challenged.

They added: “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.”

Amanda Pritchard, NHS England chief executive, said she thought the programme would save lives.

“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,” said Ms Pritchard.

“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.”

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Former health and social care secretary Steve Barclay said last year that his department was exploring ways to to implement Martha’s Rule . His successor, Victoria Atkins, said today the system would give “vital reassurance” to patients that their loved ones were receiving the best care possible.

Ms Atkins added: “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.”

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