Chief Medical Officer’s blog

Date of release: 17 April 2024

For my latest blog I want to address a topical issue and new legislation which everyone should be aware of – Martha’s Rule.

Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike.

Martha’s family’s concerns about her deteriorating condition were not responded to promptly, and in 2023 a coroner ruled she would probably have survived had she been moved to intensive care earlier.

In response to this and other cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’.

Saibal Ganguly, Consultant, Anaesthesia and Intensive Care Medicine, and Samantha Sewell, Matron, Critical Care Outreach, Sepsis Team, Acute Pain Team and Advanced Critical Care Practitioners, who have led the work to express RWT’s interest in the first phase of the programme to introduce Martha’s Rule

This is to ensure the vitally important concerns of the patient – and those who know the patient best – are listened to and acted upon.

From April 2024, NHS hospitals will have to have some sort of contingency whereby if a family member, relative or friend – or the patient – has a concern about their condition, they are able to contact a designated department for that second opinion.

• All staff in NHS Trusts must have 24/7 access to a rapid review from a Critical Care Outreach Team (CCOT), which 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 CCOT, 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
• 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

The implementation of Martha’s Rule 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.

RWT has expressed interest to be part of the first phase of the programme. This contact will be the CCOT, available via a mobile number that will be advertised throughout the Trust.

With up to 15 staff, our combined CCOT and the Sepsis Team is one of the biggest deteriorating patient teams in the country. The joining of the Sepsis Team to the CCOT two years ago has enabled us to have 24-hour cover.

Martha’s Rule applies to all patients, so, as our CCOT is only trained to treat adults, Dr Ananth Viswanath, Deputy Chief Medical Officer, is heading a group to find out how we can respond to calls about concerns for all patients.

Once fully implemented, patients, families, carers and staff will have round-the-clock access to a rapid review from a separate care team if they are worried about a person’s condition.

Our partner Walsall Healthcare NHS Trust has also expressed interest to be in the first phase of implementation of Martha’s Rule.