Martha’s Rule - North Thames Paediatric Network

Martha's Rule - What we know so far...

The tragic death of thirteen year old Martha Mills in the UK has driven her parents to advocate for a systematic change in how second opinions are sought by families in emergency situations.

Martha’s Rule is a commitment from Secretary of State for Health and Social Care and NHS England to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.

The right to a second opinion of course already exists, but the proposed legislation change will specifically apply to emergencies where there is a perceived rapid deterioration of the patient.

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, which 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.

Current advice is to start with a focus on robust recognition of deterioration and a consistent response to escalation of concerns.

The new National PEWS will support obtaining information from families and carers in a structured way, with the recording of parental concern alongside regular clinical observations. Examples of achievable systems for District General Hospitals include clear signage for parents and carers to escalate their concerns along the Nursing hierarchy. These include the PACE system in Sheffield and the Parental Concerns poster in Newcastle.

Some tertiary services have Paediatric Critical Care Outreach Nursing teams, which both staff and patients can contact directly to raise concerns around deterioration. This is successful in Leeds.

A pilot phase will be integral in identifying and establishing the necessary governance, infrastructure, education and finance required for successful implementation with children and young people in acute care.

It’s not yet clear how smaller hospitals or those without a paediatric 24/7 Critical Care Outreach service would provide the requested response.

The Paediatric Critical Care Society & CYP Teams remain integral to national level discussions and shaping any subsequent decisions surrounding implementation within paediatric services in the UK.

You may wish to sign up as one of the first 100 adult and paediatric acute provider sites if you already offer a 24/7 critical care outreach capability.

This first phase will take place during 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.

This will inform the development of wider national policy proposals for Martha’s Rule to be expanded in a phased way across the NHS from 2025/26.

The support offer from NHS England will include additional funding for project resources, and access to specialist implementation support and expertise from the Health Innovation Network’s Patient Safety Collaboratives.