NHS to roll out ‘Martha’s Rule’

The head of the NHS has today announced the rollout of ‘Martha’s Rule’ in hospitals across England from April, enabling patients and families to seek an urgent review if their condition deteriorates.

The patient safety initiative is set to be rolled out to at least 100 NHS sites and will give patients and their families round-the-clock access to a rapid review from an independent critical care team if they are worried about their or a loved one’s condition.

This escalation process will be available 24/7 to patients, families and NHS staff, and will be advertised throughout hospitals, making it quickly and easily accessible.

NHS chief Amanda Pritchard said the programme had the potential to “save many lives in the future” and thanked Martha’s family for their important campaigning and collaboration to help the NHS improve the care of patients experiencing acute deterioration.

Thirteen-year-old Martha Mills died from sepsis at King’s College Hospital, London, in 2021, due to a failure to escalate her to intensive care and after her family’s concerns about her deteriorating condition were not responded to promptly.

Extensive campaigning by her parents Merope and Paul, supported by the cross-party think tank Demos, has seen widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.

This national programme will build on NHS England’s Worry and Concern pilots launched at seven trusts last year, which developed and tested escalation methods for patients’ and families’ concerns.

Merope Mills and Paul Laity, Martha’s parents, said: “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.”

As part of Martha’s Rule, health staff at participating hospitals will also formally record daily insights and information about a patient’s health directly from their parents or families making sure any changes in behaviour or condition are noted by the people who know the patient best. 

NHS chief executive, Amanda Pritchard, 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.”

Evaluation of the initial roll-out from at least 100 trust sites during 2024/25 will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to government funding.

NHS teams will also identify ways to roll out an adapted Martha’s Rule model across other settings, including community and mental health hospitals, where the processes may not apply in the same way.

Patient safety commissioner for England, Dr Henrietta Hughes, said: “I’m delighted by today’s announcement in regard to Martha’s Rule. It’s a great step forward in the way that we listen to patients and families.

“I would like to thank everyone for their hard work in getting us to this point and I look forward to seeing the rollout across England.” 

NHS national medical director, Professor Sir Stephen Powis, said: “This new programme will make a real difference to not only the way staff can care for patients but also in ensuring parents and families have a clear pathway to raise any concerns about their loved one’s condition and seek a rapid clinical review, to ensure that tragic cases like that of Martha Mills are prevented in future.

“Throughout this process we have worked hard to ensure that the concerns of families and carers are right at the heart of this new system, because parents and their wider family are uniquely able to spot the signs of a child getting sicker.”

Victoria Atkins, Secretary of State for Health and Social Care, said: “Martha’s death was a terrible tragedy, and I pay tribute to her parents Merope and Paul. They have worked tirelessly to raise awareness of Martha’s case and of the need to introduce measures that will help ensure that no family ever has to go through anything similar again.

“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.” 

NHS national patient safety director, Dr Aidan Fowler, said: “I have worked closely with Martha’s parents, the patient safety commissioner, and colleagues across the NHS over the last year to identify how best to put Martha’s Rule into practice and it is excellent news that from April, more than a hundred hospitals across the country will have these processes in place to better involve parents and families in the care of their loved ones.

“Better identification and management of deterioration is one of our key priorities in improving patient safety and there is no doubt that around the clock access to a critical care team and the option of a rapid review, alongside existing measures such as our early warning systems, will have a significant impact on the care patients receive.”

Chief nursing officer for England, Dame Ruth May, said: “This is a hugely important step in empowering the voices of patients, families and carers, and ensuring their concerns are heard – and I pay enormous tribute to Martha’s parents for their determined campaigning on this issue.

“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.”

The introduction of Martha’s Rule comes alongside other measures to improve the identification of deterioration, including the rollout last November of a new early warning system for staff treating children.

The Paediatric Early Warning System is built on similar processes already in place for adult, newborn, and maternity services. Here clinicians are able to track potential deterioration by formally recording changes in vital signs like blood pressure, heart rate, oxygen levels and levels of consciousness, with different scores representing the level of concern.

This is all part of wider work to improve how the NHS uses data, better supports staff to manage deterioration, and see greater involvement from patients, families, and carers.