NHS to roll out ‘Martha’s Rule’ from April in bid to help patients and families

The NHS in England will roll out ‘Martha’s Rule’ from April to give patients and families access to a rapid review if they are worried about a condition getting worse.

The escalation process, which formalises access to a critical care team for a second opinion, will be available 24/7 and will be advertised throughout hospitals.

Under the move, an urgent clinical review would be carried out by a different team in the hospital if a patient’s condition is rapidly worsening and they or their family feels they are not getting the care needed.

At least 100 NHS trusts are expected to bring in the rule, with the programme evaluated throughout this year and next.

The plan is to then extend Martha’s Rule to all acute hospitals, subject to Government funding.

The move follows the death of 13-year-old Martha Mills in 2021. She developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

A coroner ruled she would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier.

Martha’s parents, Merope Mills, an editor at the Guardian, and her husband Paul Laity, raised concerns about Martha’s health a number of times but these were brushed aside.

The pair have since campaigned for Martha’s Rule to be introduced to give families more say.

They said in a statement: “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.

“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.”

Martha was being looked after at King’s after suffering a pancreatic injury following a fall from her bike while on a family holiday in Wales.

An inquest heard there were several opportunities to refer Martha to intensive care but this did not happen. The trust, which is a specialist national referral centre for children with pancreatic problems, has since apologised for mistakes in Martha’s care.

At one point, Martha began to bleed heavily through a tube inserted into her upper arm and through a drainage tube.

She also developed a rash and her mother voiced concerns to staff that Martha would go into septic shock over a bank holiday weekend.

One of the trust’s own intensive care doctors told the inquest into Martha’s death he would “100%” have admitted her if he had seen her.

Ms Mills told Radio 4’s Today programme the patient or family are ”another expert in the room” and a “valuable resource” that should be listened to.

She said there is still a long way to go to fully roll out the scheme, but added: “What we really want now is for healthcare professionals to get behind it, we want doctors to support it, we really want nurses to press the relevant numbers into people’s hands when they arrive in hospital and tell them it’s available to them.”

On what difference Martha’s rule would have made in Martha’s case, Ms Mills said: “Well, obviously, I think she’d still be alive because I had my doubts. I was telling a nurse ‘I think he’s got this wrong’. I had to kind of give myself a talking to, which I’ve never done, saying ‘trust the doctors’.

“Since Martha’s death, I’ve said to people who’ve gone into hospital ‘if you’re worried if you think something’s going wrong, you should scream the ward down’ because that’s what I didn’t do and I regret it. I will regret it for the for the rest of my days. But the very existence of Martha’s rule says you don’t need to scream the ward down, all you need to do is call this number because you’ve got Martha’s rule.”

She said good doctors are attentive listeners, but there is a “small minority, I hope a small minority, of bad actors whose arrogance, complacency or pride stops them listening and doing the right thing. And that’s what we’re trying to challenge with Martha’s rule.”

Ms Mills said in Martha’s case, nurses thought and documented that they thought there was something wrong, but “nobody looked at the nurse’s system, and they didn’t feel the power to speak up”.

NHS England chief executive Amanda Pritchard said Martha’s Rule had the potential to “save many lives in the future”.

She 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.

“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.”