Supporting Martha’s rule at UHMBT

You will have seen the announcement that the NHS will be implementing Martha’s Rule. Once fully implemented, patients, families, carers and colleagues 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.

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.

What does Martha’s Rule involve?

The three proposed components of Martha’s Rule are:

  • 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
  • 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
  • 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

National Implementation of Martha’s Rule

The first phase of the introduction of Martha’s Rule will be implemented from April 2024, beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability. This phase will focus on supporting participating provider sites to devise and agree a standardised approach to all three elements of Martha’s Rule, ahead of implementing in the remaining sites in England in the following years.

Criteria for participation will be set out in an expression of interest document. The document will also outline the support offer from NHS England – including additional funding for project resources, and access to specialist implementation support and expertise from the Health Innovation Network’s Patient Safety Collaboratives.

UHMBT approach

As a Trust, we are committed to supporting Martha’s Rule across our hospitals. We are currently awaiting further information on the criteria for being part of the first 100 trusts to implement it; and if we meet these criteria, we will be putting ourselves forward.

However, we aren’t waiting to find out whether we can be included in the first phase of implementation. We are already taking actions to support the principles of Martha’s Rule, including:

  • Expediting our plan to provide contact details for the Critical Care Outreach Team on the back of their leaflets for follow up/step down patients in our Intensive Care Units as a first step. It will involve scanning a QR code which provides information to relatives on who to contact if they have concerns re deterioration. We hope to have this in place by early March
  • Understanding what is currently in place for paediatric patients and how that can be supported if required
  • Relevant members of our teams registering for the national virtual conference on 14 March to find out more about Martha’s Rule and how it will be applied in NHS trusts

We will update you on progress in the coming weeks and months. More information on Martha’s Rule can be found on the NHS website here.


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