RCPCH responds to Patient Safety Commissioner’s recommendations on Martha’s Rule

This week the Patient Safety Commissioner wrote to Health Secretary, Steve Barclay outlining her recommendations for Martha’s Rule.
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Martha’s Rule stipulates a right to request a clinical review: In the event of a suspected deterioration or serious concern, a patient on a hospital ward, or their family or carer, would have the right to call for a rapid review or second opinion from an ICU / HDU doctor within the same hospital. You can read RCPCH’s initial reflections on Martha’s Rule

These Patient Safety Commissioner’s recommendations include:

  • Implementing a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least on a daily basis. In the first instance this will cover all in-patients in acute and specialist Trusts. 
  • All staff in those 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. 

The Patient Safety Commissioner notes: “We have heard that the structures in paediatrics are different to adult care and special consideration will need to be made for escalation of concerns about paediatric in-patients for staff and families.” You can find the report here.  

In response to the recommendations, RCPCH President, Dr Camilla Kingdon, said: 

We were deeply saddened by the circumstances around Martha’s death, and our condolences are with her family.

As a College, we welcome any initiative that drives forward patient safety for children and young people in our care. We feel that Martha’s Rule can herald a much needed and positive change, and we stand ready to bring it forward and shape its implementation across paediatric settings. At the same time, we must ensure that this initiative is fit for purpose and will continuously improve health outcomes for our patients. 

First and foremost, rapid reviews for children and young people must be undertaken by health professionals with paediatric training and competence. As the Patient Safety Commissioner described, applying Martha’s Rule in paediatrics is different, and so additional resources will be needed. It is essential that staff are not taken away from other areas of service provision as we run the risk of destabilising an already stretched system. 

We will need time to understand whether the resource provided is sufficient to ensure safe and effective care for children under Martha’s Rule. It is important that the long-term pressures in the paediatric workforce are addressed in tandem with the implementation of Martha’s Rule. 

Fundamentally we want Martha’s Rule to succeed, but in its implementation, it has highlighted where the Long Term Workforce Plan falls short for children and young people as a population. We must ensure that children, young people and paediatric workforce are front and centre of these plans as they progress.   We will continue to update members once the Secretary of State responds to the recommendations made by the Patient Safety Commissioner.

Carli Whitaker, President at Paediatric Critical Care Society (PCCS), said:

I’m pleased to see the Patient Safety Commissioner acknowledge the differences in paediatric care system when implementing Martha’s Rule. Martha’s Rule does pose some challenges across paediatric care, but there are solutions available to us. 

Martha's Rule is an incredibly important tool to support the views and voices of patients, families, and carers to be central in their care. There is a real opportunity for the Secretary of State to allocate much needed resource to strengthen paediatric critical care services, which will be needed to ensure Martha's Rule is applied equitably across the country. There are significant workforce challenges in paediatrics across the board, and we will work with our members to shape and support successful delivery of Martha's Rule.