A doctor discussing a child's health with their family, providing medical advice and support.

The introduction of Martha’s Rule

We are pleased to be providing an update on Martha’s rule. The aim of the upcoming implementation of this rule will improve the ability for patients and families to obtain an urgent second opinion.

The first phase of Martha’s rule will be implemented in the NHS from April 2024.

The implementation of Marthas rule is the direct result of campaigning by Merope Mills, mother of Martha who dies of sepsis at King’s College hospital in London in 2021. Read the background of Martha’s rule here.

What does the rule involve?

There are three components of Martha’s rule:

  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.

Implementation of Martha’s Rule

The NHS have announced that this rule will take a phased approached. It will begin in April 2024 with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability.

This first phase will take place during 2024/25, its focus will be on supporting participating provider sites to devise and agree a standardised approach to all three elements of Martha’s Rule and to prepare for the implementation to any remaining sites in England over the next few years.

Following this focused approach, the NHS are looking to identify a way to adapt the Martha’s Rule model so it can be implemented across other settings such as community and mental health hospitals, where the process may not be applicable in the same way.

Other developments

Alongside Martha’s rule the NHS are implementing a new framework called ‘PIER’ which will help systems to Prevent, Identify, Escalate and Respond to physical deterioration. This framework aims to improve how the NHS support staff to manage deterioration and encourage greater involvement from patients, families, and carers.

Elizabeth Wickson, Senior Associate at Medical Accident Group said ‘ I am pleased to see that the first phase of Martha’s rule will be available from April in some Hospitals in England. I hope the recent changes the NHS are making for staff, patients and families gives patients and families the confidence to ask for a second opinion. I am looking forward to following the implementation of Martha’s rule over the next few years and see the positive impact it will have within our healthcare system.’

A doctor discussing a child's health with their family, providing medical advice and support. A doctor discussing a child's health with their family, providing medical advice and support.

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Meet the Team

Elizabeth Wickson, Senior Associate

Elizabeth’s legal studies at the University of Warwick encouraged her interest in medicine and the law. Elizabeth joined Medical Accident Group in March 2016, following 6 years working at Plexus Law where she trained and qualified as a Solicitor, specialising in personal injury.

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