The first phase of the introduction of Martha’s Rule will be implemented in the NHS from April 2024. Once fully implemented, patients, families, carers and staff 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, 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 3 proposed components of Martha’s Rule are:

1. 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.
2. 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.
3. 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.

Implementation of Martha’s Rule and expression of interest

The implementation of Martha’s Rule in the NHS will take a phased approach, beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability.

Provider sites that offer these services are asked to formally register an expression of interest in being part of the first phase of the programme. Providers are asked to submit this by 9am on Wednesday 10 April 2024.

Our Martha’s Rule expression of interest information pack supports providers to do this and includes instructions on how expressions of interest should be submitted.

The pack also provides detail on the criteria for participation, and outlines the support offer from NHS England, detailing additional funding for activity including, the production of project resources, clinical backfill and procurement of quality improvement/project management support. The pack will also outline the role of the adult and paediatric critical care operational delivery networks (ODNs) in relation to Martha’s Rule and describe the offer of specialist implementation support and expertise from the Health Innovation Network’s patient safety collaboratives.

We will announce the first phase sites as soon as possible, once we have completed our assessment of the expressions of interest.

The first phase will take place across 2024/25 and will focus on supporting participating provider sites to devise and agree a standardised approach to all 3 elements of Martha’s Rule, ahead of scale up to the remaining sites in England in the following years.

Further developments

The focused approach at the initial provider sites will inform the development of wider national policy proposals for Martha’s Rule that can be expanded in a phased way across the NHS from 2025/26. We 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.

Other measures to improve the identification of deterioration

Martha’s Rule will build on the evaluation of NHS England’s Worry and Concern Improvement Collaborative which involves 7 regional pilots and began in 2023. They have been testing and implementing methods for patients, families and carers to escalate their concerns about deterioration and to input their views about their illness into the health record.

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, built on similar systems already in place for adult, newborn, and maternity services.

To ensure that Martha’s Rule is effective, it will be implemented alongside an integrated programme to improve the management of deterioration using the ‘PIER’ framework, which helps systems to prevent, identify, escalate and respond to physical deterioration. This work will improve how the NHS supports staff to manage deterioration and encourage greater involvement from patients, families, and carers.