In the NHS, new regulations and rules are often being implemented into the system to help better the care patients are receiving. It is crucial as development is needed within the NHS to ensure that the pillars of medical ethics (beneficence, non-maleficence, justice, and autonomy) are furthered to the greatest extent and that they feasible as they can be. 

One of the most recent examples showcasing development in the NHS is Martha’s Rule.

So, what does this new rule entail?

From April 2024 the Martha’s Rule will undergo trials in 100 NHS sites. As stated on the NHS England website there are three proposed components to Martha’s rule:

1. All staff in NHS trusts must have 24/7 access to a rapid review from a critical care outreach team, whom 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.

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. It will cover, in the first place, all inpatients in acute and specialist trusts.

4. In addition to this, hospitals participating in the Martha’s Rule trial will be given additional government funding to allow for the production of leaflets and posters advertising the availability of a rapid review from critical care medics when families believe the condition of their loved one is declining.

Why has this rule been a subject of interest for the NHS?

It's a notable breakthrough for the NHS as it could help improve the care and treatment of deteriorating patients to prevent cases such as the death of Martha Mills. She sadly passed away from sepsis after failing to be moved to intensive care when concerns were brought to light by her parents.

This case has unveiled the ignorance that Martha’s parents were subject to, thus Martha’s rule has been proposed to combat the failure to recognize the parent’s/caregiver’s concerns. It is widely known that the rule prevents people from being ignored when they raise concerns regarding the condition of their loved ones. Especially as loved ones may be able to recognize abnormalities in a patient's condition that the doctor may not be aware of. Moreover, these responding teams will be senior doctors or nurses who specialize in cases of patients who are deteriorating. Therefore, these Healthcare professionals shall have the ability to bring further insight into the well-being and condition of these patients. Hopefully, this will be adequate in taking the correct steps to improve the care of patients.

However, Martha’s rule has not been short of criticism and limitations. A problem that arises when analyzing the efficacy of Martha’s rule is the availability of NHS staff. How will these critical care outreach teams be organized when, in England, as of December 2023, there were 110,781 vacancies in secondary care? Consequently, this could place further strain upon the already often overstretched MDT, which could potentially extend beyond the members of the critical care outreach teams to include other MDT members and their respective patients.

A distinct issue that also surfaces when examining Martha’s rule is how the implications may result in a breakdown of trust between patients and Health care practitioners (HCP). When patients and their companions are aware of the possible limitations of an HCP’s resolutions - the infrequent yet not entirely impossible shortcomings of the HCP - trust may no longer be maintained.

There are principles behind Martha’s rule, which underscore the potential for an HCP to be wrong and thus catalyze the dissolution of patient HCP trust. Nonetheless, when viewing Martha’s rule through a wider lens, trust between the nation and the NHS is magnified. By responding to the devastation of Martha Mill’s case, the healthcare system has displayed its competency in reflecting and making amendments when failure within the NHS occurs. In light of this, when evaluating Martha’s rule, one must weigh the importance of wide-scale trust against more personal HCP-to-patient trust. 

Furthermore, the issue of abuse of Martha’s rule and the ramifications of this must be addressed before Martha’s rule is fully accepted. If patients and their companions raise false alarms for unjustifiable reasons, this could intensify tensions within the NHS and again (as implied earlier stretch) HCPs beyond their capacity.

How does one find the fine line between recognizing and observing the patient's concern without unnecessarily augmenting the workload of HCPS? 

After taking all of this into account, it is evident that Martha’s rule should be thoroughly evaluated before it is permanently implemented into the healthcare system. Nonetheless, Martha’s rule is a promising advancement in the NHS. The principles underpinning Martha’s rule promote communication within the healthcare system and prevent parents of patients from being neglected simply because they have been labeled as overtly emotional, and unstable. Once fine-tuned, Martha’s rule could serve as a route for patients to provide their insight into healthcare and thus improve the overall quality of care patients receive. With some calling for the implementation of Martha’s rule in community hospitals and mental health trusts, it’s apparent that many are seeking an improvement in the quality of care provided by the NHS. Hopefully, Martha’s rule will be the right step toward this goal.

Written by Ayanfe O.

Moderated by Joanna