The NHS has announced the 143 hospital sites that will test and roll out “Martha’s Rule” in its first year. Named after 13-year-old Martha Mills, who died of sepsis at King’s College Hospital, London following a cycling accident, the rule gives patients and families a way to get an urgent review of a patient’s condition if it is declining.
Confirmation of the first sites to test implementation of Martha’s Rule is the next step in a major patient safety initiative, following the announcement in February of NHS England funding for this financial year.
NHS England is working with Martha’s parents to develop materials to advertise and explain the initiative in hospitals across the country, to ensure it is something that all patients, staff, and their families can recognise.
The initial target was to enrol at least 100 sites, but due to significant interest from frontline clinicians this has been expanded, meaning this first phase of the programme will be in place at 143 locations across the country by March 2025.
Evaluation of how the system works in these sites over the course of this year will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to future government funding.
Process
Martha’s Rule is to be made up of three components to ensure concerns about deterioration can be swiftly responded to.
Firstly, an escalation process will be available 24/7 at all the 143 sites, advertised throughout the hospitals on posters and leaflets, enabling patients and families to contact a critical care outreach team that can swiftly assess a case and escalate care if necessary. Secondly, NHS staff will also have access to this same process if they have concerns about a patient’s condition.
Finally, alongside this, clinicians at participating hospitals will also formally record daily insights and information about a patient’s health directly from their families, ensuring any concerning changes in behaviour or condition noticed by the people who know the patient best are considered by staff.
Extensive campaigning by Martha’s parents, Merope and Paul, supported by the cross-party think tank Demos, saw widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.
Merope Mills and Paul Laity, Martha’s parents, said: “We are pleased that the roll-out of Martha’s Rule is off to a flying start and that the need for it has been so widely recognised.
“It will save lives and encourage better, more open, communication on hospital wards, so that patients feel they are listened to, and partners in their healthcare.”
Professor Sir Stephen Powis, NHS national medical director, said: “Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years, and we are pleased to have seen such interest from hospitals right across the country, all thanks to the moving and dedicated campaigning by Martha’ parents, Merope and Paul.
“That is why today is such an important milestone, with the NHS outlining the 143 sites where this major patient safety initiative will be rolled out later this year, allowing staff, patients and families to immediately raise concerns and bring about an escalation in care in an easily recognisable and fast way.
“The inclusion of daily insights from families about their loved ones’ condition within patient records is also a really significant step and will help staff identify changes and deterioration using insights from those who know the patient best. While thankfully the need for escalation of care will hopefully only be needed in a limited number of cases, this three-step safety net has the opportunity to truly transform patient care and safety.”
Change
NHS national patient safety director and senior responsible officer for Martha’s Rule, Dr Aidan Fowler, said: “Working closely with Martha’s parents and colleagues across the NHS over the last few months on this rollout, I am in no doubt this programme will deliver clear change and it has been so encouraging to see how many hospitals have shown interest in being part of delivering these all-important patient safety measures this year.
“With new processes that enable both patients and staff to raise concerns if they see someone’s condition worsening, and the inclusion of patients and their loved ones’ insights in medical records, these measures can help us better identify and manage deterioration as part of wider work, which is a key priority for us and will no doubt lead to improvements in the care patients receive.”
- List of sites
Addenbrooke’s Hospital
Watford General Hospital
Princess Alexandra Hospital
Colchester Hospital
Bedford Hospital
Southend Hospital
Basildon Hospital
Broomfield Hospital
Peterborough City Hospital
Lister Hospital
West Suffolk Hospital
Luton and Dunstable University Hospital.
James Paget University Hospital
The Queen Elizabeth Hospital
Norwich University Hospital
Ipswich Hospital
University Hospital Lewisham
The Royal Marsden Hospital , Chelsea
The Royal Marsden Hospital, Sutton
Croydon University Hospital
St Georges Hospital
Barnet Hospital
Royal Free Hospital
Great Ormond Street Hospital for Children
North Middlesex University Hospital
University College Hospital
Kingston Hospital
Kings College Hospital (Denmark Hill Site)
Queen Elizabeth Hospital
Princess Royal University Hospital
Chelsea and Westminster Hospital
West Middlesex University Hospital
Northwick Park Hospital
Charing Cross Hospital
Hillingdon Hospital
St. Mary’s Hospital
Hammersmith Hospital
Newham University Hospital
Homerton University Hospital
St Bartholomew’s Hospital
Whipps Cross Hospital
Royal London Hospital
The Whittington Hospital
Ealing Hospital
Northampton General Hospital
Kettering General Hospital
Royal Stoke University Hospital
New Cross Hospital
Manor Hospital
Pilgrim Hospital Boston
Birmingham Heartlands Hospital
Good Hope Hospital
Queen Elizabeth Hospital
Solihull Hospital
Birmingham Children’s Hospital
Russell’s Hall Hospital
Sandwell General Hospital and City Hospital (two sites)
Glenfield Hospital
Kings Mill Hospital
Kettering General Hospital
University Hospital Coventry
Lincoln County Hospital
Leicester Royal Infirmary
Leicester General Hospital
Robert Jones and Agnes Hunt Orthopaedic Hospital
Sheffield Childrens Hospital
Barnsley Hospital
Queen Elizabeth Hospital
Sunderland Royal Hospital
South Tyneside District General Hospital
Huddersfield Royal Infirmary
York Hospital
Cumberland Infirmary
University Hospital of North Durham
Bishop Auckland Hospital
Royal Victoria Infirmary, Newcastle
Freeman Hospital
James Cook University Hospital
Darlington Memorial Hospital
West Cumberland Hospital
Pinderfields Hospital
Calderdale Royal Hospital
Leeds General Infirmary
Bradford Royal Infirmary
Airedale General Hospital
St James’s Hospital
Countess of Chester Hospital
Wirral University Teaching Hospital
Royal Liverpool University
Southport District General Hospital
Blackpool Victoria Hospital
Royal Blackburn Hospital
Burnley General Hospital
Royal Bolton Hospital
Royal Manchester Children’s Hospital
Alder Hey Childrens Hospital
The Walton Centre
Leighton Hospital
Warrington Hospital
Preston and Chorley Hospitals
Royal Blackburn Hospital
Tameside General Hospital
The Christie
Royal Oldham Hospital
Royal Albert Edward Infirmary, Wigan
St Mary’s Hospital
Frimley Park Hospital
Wexham Park hospital site
Darent Valley Hospital
The Tunbridge Wells Hospital
Maidstone Hospital
Southampton Children’s Hospital
Royal Berkshire Hospital
Stoke Mandeville Hospital
Conquest Hospital
Eastbourne District General Hospital
Royal Sussex County Hospital
Princess Royal Hospital
Medway Maritime Hospital
William Harvey Hospital, Ashford
QEQM Hospital, Margate
Queen Alexandra Hospital
Basingstoke North Hampshire Hospital
East Surrey Hospital
Southampton General Hospital
Bristol Royal Infirmary
Great Western Hospital
Salisbury District Hospital
Cheltenham General Hospital
Gloucestershire Royal Hospital
Dorset County Hospital
Royal Bournemouth Hospital
Poole Hospital
Torbay Hospital
Derriford Hospital
Musgrove Park Hospital
Yeovil District Hospital
Weston General Hospital
Southmead Hospital
Bristol Royal Hospital for Children
Royal United Hospital, Bath
Treliske Site – Royal Cornwall Hospital
See also: Nutrition and the Menopause
