Landmark for Martha's Rule implementation

Health Innovation North West Coast’s Patient Safety Collaborative has supported the testing and implementation of a major patient safety initiative in our region.

Martha’s Rule gives patients and families a way to seek an urgent review if their condition, or that of a loved one, deteriorates and they are concerned it is not being responded to.

NHS England announced in May 2024 the implementation of Martha’s Rule in 143 pilot sites in England, including 12 in the North West Coast. That implementation has now reached the end of its first stage.

The Health Innovation North West Coast team collaborated with the regional Paediatric Critical Care Operational Delivery Network and the Adult Critical Care Operational Delivery Network to support the testing and implementation.

They also supported trust-based provider teams to test and implement Martha’s Rule in a systematic and consistent way and to scale up the project. The work was delivered as part of our contribution to the National Patient Safety Improvement Programmes.

The Health Innovation North West Coast team:

• Provided expertise and coaching in Quality Improvement (QI) methods, supplying enhanced QI support where desired
• Brought together phase one sites and relevant system stakeholders by establishing communities of practice to facilitate and nurture learning
• Regularly met with phase one sites on an individual basis to provide support and act as a critical friend

The team also delivered a series of one-to-one coaching sessions at provider sites as part of the support package.

Nathan Askew, Chief Nursing, AHP and Experience Officer at Alder Hey Children’s NHS Foundation Trust, worked with our team on the implementation in Cheshire and Merseyside.

He said: “Working with Health Innovation North West Coast was really helpful during the implementation of the phase one pilot for Martha’s Rule. The team were helpful and friendly and made all the logistics come together seamlessly.

“Through their support we have had great attendance at our collaborative events, supported sites with shared learning, been able to respond to concerns and share best practice across the patch which has led to great implementation at all sites.”

Nathan, who is also Chair of the Association of Chief Children’s Nurses, added: “As the lead for the ICS, I have been well supported and feel that the success of all our sites would not have been achieved without the support and connections to the team.”

Senior Programme Manager Rebecca Wardle, who led Health Innovation North West Coast’s support programme, said the work highlighted the importance of constructive collaboration.

“We knew there would be opportunities for provider teams to learn from one another as the first phase of testing and implementation got under way, and our role was to make sure that happened.

“Each team has benefited from working alongside all the others and that’s happened because they enthusiastically embraced the chance to share best practice. It was a real pleasure to work with such a dedicated and committed group of people.”

NHS England plans to expand Martha’s Rule to all providers in the coming years as part of a programme to improve the management of deterioration, incorporating work to improve prevention, identification, escalation and response to acute deterioration.

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, and in 2023 a coroner ruled that Martha, aged 13, would probably have survived had she been moved to intensive care earlier.

Phase one of Martha’s Rule ended in March when representatives from all 12 North West Coast implementation sites attended an event at Alder Hey Children’s NHS Foundation Trust to mark their involvement.

The team at Health Innovation North West Coast is looking forward to providing continued support into 2025/2026.