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NHS to roll out ‘Martha’s Rule’

The head of the NHS has 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.

Commenting on the anouncement, UK Sepsis Trust’s Founder & Joint CEO Dr Ron Daniels said: “As a charity dealing with and offering support to those affected by sepsis including the bereaved, we welcome the news that Martha’s Rule is to be rolled out nationally.

“The themes highlighted by Martha’s case — of families feeling that they’re not being listened to — are common.

“While a second opinion is not the one and only solution — avoidable harm will continue to occur — it is an important part of the broader solution and will help to prevent many families enduring the same pain as Martha’s family.”

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Upcoming Events

Infection Prevention & Control

National Conference Centre, Birmingham
23rd - 24th April 2024

ESGE Days 2024, Symposium – ‘Elevating Endoscopy: Inspiring Progress and Innovation’

Estrel Congress Center (room 15), Berlin, Germany
25th April 2024, 16:30 – 17:30 CEST

National DERS and SMART pump conference

BCEC, Birmingham
29th April 2024

World Hand Hygiene Day

Worldwide
5th May 2024

Theatres & Decontamination Conference 2024

Coventry Building Society Arena
16th May 2024

The AfPP Roadshow - Birmingham

Millennium Point, Birmingham
18th May 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

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