RCPCH responds to the rollout of ‘Martha’s Rule’

NHS England has announced the rollout of ‘Martha’s Rule’ in selected hospitals from April 2024.
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The plans announced today (21 February) for the first year of the rollout of Martha’s Rule with an allocation of £10 million pounds funding to support. The initiative is due to be rolled out to at least 100 NHS sites, where 24/7 adult critical care outreach is available. 

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 promptly, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

The three 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. This is Martha’s Rule.
  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.

The implementation of Martha’s Rule will accompany other key patient safety initiatives, including the rollout of the Paediatric Early Warning System last November. 

RCPCH President, Dr Camilla Kingdon, said:

We strongly support any initiative that improves patient safety for children and young people. The opportunity to implement Martha’s Rule across selected hospitals, with already established critical care outreach will be extremely useful to understand just how many children are in need of this type of escalation. For this important patient safety initiative to be fully embedded in children’s services, we need to find a model that is both properly resourced and where there are genuine neonatal and paediatric capabilities available. 

The College stands ready to inform the further development and implementation of Martha’s Rule on a national level in the years to come. In the long term, implementing Martha’s Rule across all hospitals will present an opportunity to address serious shortfalls in the paediatric workforce, and to bolster up fragile critical care services that continue to be under immense pressure each winter.