Martha’s Rule

The NHS introduced Martha’s Rule in April 2024. This policy is designed to empower patients, families and carers to seek urgent reviews of patient health concerns. Martha’s Rule is endorsed by the General Medical Council (GMC), Nursing and Midwifery Council (NMC), and Care Quality Commission (CQC).

The rule is named for Martha Mills, who died in 2021 at the age of 13. Her death followed failure to identify and properly treat sepsis that developed while she was in hospital after a bike accident. Martha’s mother campaigned for the NHS to create a formal strategy for requesting a second medical opinion.

Through Martha’s Rule, healthcare staff and patients, and the patients’ families and carers, will have access to a rapid review by a critical care outreach team. The goal is to respond quickly to concerns and prevent potentially avoidable harm. Healthcare providers will collect information about patients’ conditions daily to promote continuous monitoring and responsiveness. Hospitals will provide information about this process to patients and families so that they know how to raise concerns. Martha’s Rule aligns with the NMC’s Code and the GMC’s Good Medical Practice.

In care settings, carers must ensure those they support and their families feel heard. This may require training in a range of topics, including basic clinical observations, effective communication, mental health awareness and person-centred care/support. Care staff need to collaborate with healthcare professionals while advocating for those they support. The introduction of Martha’s Rule highlights the need for continuous learning and development for health and social care staff.

The NHS is currently in the First Phase of introducing Martha’s Rule. Acute provider sites with existing critical care outreach capabilities will participate. This phase will help develop a standardised approach to Martha’s Rule. Future phases are expected to begin in 2025/26. At this time, other NHS sites, including community and mental health hospitals, will incorporate Martha’s Rule.

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