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Martha’s Rule to be rolled out from April

‘Martha’s Rule’ will be rolled out across England from April 2024 to at least 100 NHS sites, enabling patients and families to seek round-the-clock access to a rapid review from a separate care team if they are worried about a person’s condition. The implementation of Martha’s Rule will focus on three key areas:

  • 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 in-patients in acute and specialist trusts.

This follows the family of Martha Mills campaigning to help improve the care of patients experiencing acute deterioration. Martha Mills sadly died aged 13 in 2021 from sepsis at King’s College Hospital, after her family’s concerns about Martha’s deteriorating condition were not responded to promptly. In 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.

Martha’s Rule will build on the evaluation of NHS England’s Worry and Concern Improvement Collaborative which involves seven regional pilots and began in 2023. They have been testing and implementing methods for patients, families and carers to escalate their concerns about deterioration and to input their views about their illness into the health record. This will make sure any changes in behaviour or condition are noted by the people who know the patient best.

The implementation of Martha’s Rule in the NHS will take a phased approach beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability. These sites will be asked to submit expressions of interest to participate. This will inform the development of wider national policy proposals for Martha’s Rule that can be expanded across the NHS in future years, including the 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.

More information at NHS England » NHS to roll out ‘Martha’s Rule’


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