What is Martha’s Rule?
From April 2024, the NHS implemented the first phase of Martha’s Rule. This rule will allow patients, families, carers, and staff round the clock access to a rapid review from a second, separate care team if they are worried about an individual’s condition once fully implemented. It is essentially a legal requirement to provide a second opinion when it is requested.
Martha’s Story:
Martha Mills was a 13 year old who died due to a delay in moving her to an intensive care ward after concerns were raised by her parents that she may be suffering with sepsis.
Martha was admitted to hospital in May 2021 after sustaining a pancreatic injury from falling off her bike. During her admission, she contracted an infection and her condition deteriorated over the course of 10 days. Between the 21st and the 29th August 2021, her parents raised concerns about her deterioration several times, once explicitly stating that they believed that she had sepsis and would develop septic shock. They were told daily that her recovery was not in doubt at that it was just a matter of time. On the 29th August 2021, she began bleeding heavily through a tube inserted into her arm. Unfortunately, Martha passed away on the 31st August 2021. Her cause of death was sepsis and refractory shock.
The inquest following Martha’s death determined that there were several opportunities to refer Martha to intensive care, all of which were missed. The coroner determined that Martha’s life could have been saved if she was transferred to intense care earlier.
What does the Rule involve?
There are three components of Martha’s Rule that have been proposed which can be found detailed at:
https://www.england.nhs.uk/patient-safety/marthas-rule/
These are also provided below:
- 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.
- 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 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 Change in Effect:
The welcome change enables a path to which concerned family members can ensure that their concerns are addressed not only by the primary team, but also by a secondary team. This way, any errors in treatment can be caught, or any reassurances can be provided.
It is the latest change introduced by the NHS in a series of measures to improve the way that the service can identify any decline in a patient’s condition that may not have been identified by the primary care provider.
The obligation imposed upon the NHS will be highly advertised via posters on wards to ensure that those unaware of Martha’s Rule will be knowledgeable on its implementation, and can use it at their discretion.
Whilst the implementation comes at a time of an NHS crisis, the process will work to ensure that critical treatments are provided where they could potentially be missed, ensuring that lives are made better, and in some cases, that lives are saved.