Healthcare regulators back implementation of Martha’s Rule

A joint statement has been released by leaders from the Nursing and Midwifery Council (NMC), General Medical Council (GMC) and Care Quality Commission (CQC).

The statement, signed by NMC chief executive and registrar Andrea Sutcliffe, GMC chief executive and registrar Charlie Massey, and CQC chief executive Ian Trenholm, said Martha’s Rule “aligns” with their principles and codes, and backed the scheme’s implementation.

“Actively involving people in their care decisions and addressing their concerns promptly is critical to safety”

Joint statement

Martha’s Rule is named after a teenager who died of sepsis after her family’s requests for an escalation in care were ignored. An inquest ruled that the death of 13-year-old Martha Mills was potentially avoidable.

The Department of Health and Social Care announced last year that the rule would be implemented and rollout is set to begin at around 100 locations over the next year, starting this month.

Its implementation will take a “phased” approach, beginning with at least 100 adult and paediatric acute provider sites which already offer a 24/7 critical care outreach capability, according to NHS England.

In a hospital or service where Martha’s Rule is implemented, any patient or family member may request for a “rapid review” of the patient’s case to check if deterioration has been missed.

This review will be carried out by an independent critical care team, which may include nurses, doctors and other clinicians. In addition, clinicians, themselves, are able to trigger Martha’s Rule.

The regulators, in their statement, said they supported the rule being rolled out across England, and that it would ensure the interests of patients and families remained at the “heart of decision-making”. They added that it promoted safe, effective and kind care.

The statement read: “Martha’s Rule reinforces the fundamental principles of listening to people who use health and care services and their families, and acting on what they say.

“Actively involving people in their care decisions and addressing their concerns promptly is critical to safety,” it said.

Martha was rushed to King’s College Hospital NHS Foundation Trust in 2021 after falling off a bike while on a family holiday turned out to have caused a pancreatic rupture.

She deteriorated in hospital, and pleas from parents Merope Mills and Paul Laity to escalate her care due to fears of sepsis were ignored by both doctors and nurses, who reassured the family that Martha would recover without an escalation.

The 13-year-old was, eventually, escalated to paediatric intensive care, but it was too late and she died shortly after admission to Great Ormond Street Hospital.

Martha Mills

Since their daughter’s death, Ms Mills and Mr Laity have campaigned for the implementation of Martha’s Rule, modelled after a similar system in Australia named Ryan’s Rule.

In statements made as part of this campaign, the pair have said they did not feel listened to or respected by clinicians.

The regulators, in their statement, noted that Martha’s Rule supports “care that is person-centred, responsive, and aligned with high standards of professional practice”.

“We welcome the way that Martha’s Rule emphasises effective teamwork, mutual respect, and open communication,” they said.

“The emphasis on professionals working together encourages active listening, promotes person-centred care and supports a culture of learning and improvement.”

The regulators said the rule aligned with both the NMC and GMC’s professional codes, stating: “These emphasise the importance of people being at the centre of services, listening and communication, and effective multidisciplinary working. It also supports our ambition for open cultures.

“In ensuring that families are at the heart of care and recognising the importance of listening and acting in response to their concerns, Martha’s Rule also reflects the vital role that people’s experiences have in CQC’s assessment of quality and safety.

“We look forward to working together, along with professionals, people they care for and their families and carers, to ensure the successful implementation and oversight of Martha’s Rule,” they added.