Classification: Official

To: 

• All NHS trusts and foundation trusts:
  • chief executive officers
  • medical directors
  • chief nurses

cc:

• Integrated care boards:
  • chief executive officers
  • medical directors
  • chief nurses

Dear colleagues,

Martha’s Rule expression of interest regulation

Last month I wrote to inform you that the first phase of the introduction of Martha’s Rule will commence in the NHS from April 2024.

I am writing today to notify you that we are starting the process of recruiting the first 100 or more provider sites who will implement Martha’s Rule. We are inviting NHS providers of acute adult and/or children and young people’s inpatient care, with an existing on-site 24/7 critical care outreach team (CCOT) or paediatric critical care outreach team (PCCOT) infrastructure, to formally submit expressions of interest to participate in the first phase of the programme throughout 2024/25.

For sites that do not meet these criteria as they do not have on-site 24/7 CCOT/PCCOT, and those providing mental health and community care, we are aiming to work with a small number this year to help us plan for 2025/26, and we will advise more on this at a later date.

Please note we are working at site level for this programme. If, as a provider, you have 24/7 on-site CCOT/PCCOT coverage in only a subset of your sites, please do consider expressing an interest in participating, making clear which sites you are putting forward to participate.

Martha’s Rule will build on the evaluation of NHS England’s Worry and Concern Improvement Collaborative which involves 7 regional pilots and began in 2023. They have been testing and implementing methods for patients, families and carers to escalate their concerns about deterioration and to input their views about their illness into the health record.

Being part of this first phase, presents an opportunity to help the NHS to devise and agree a standardised approach to all 3 elements of Martha’s Rule, ahead of scaling up to further sites in England in the following years. Once fully implemented, patients, families, carers and staff will have round-the-clock access to a rapid review from a critical care team if they are worried about a person’s condition deteriorating.

More information about the expression of interest process, and what participation in the first phase will involve, can be found in the expression of interest support pack which is linked on our Martha’s Rule webpage. This includes information around the support offer from NHS England, detailing additional funding for activity including the production of project resources, clinical backfill and procurement of data collection/quality improvement/project management support, etc.

The pack will also outline the role of the adult and paediatric critical care operational delivery networks in relation to Martha’s Rule and describe the offer of specialist implementation support and expertise from the Health Innovation Network’s patient safety collaboratives. The deadline to register an interest is 9am on Wednesday 10 April 2024, and we hope to notify sites they have been selected to be part of phase 1 of Martha’s Rule by the end of next month. Please note, we will not make a public announcement around the successful sites until after the local elections taking place 2 May 2024.

We will use what we learn from working with the first phase of participating sites to inform the development of wider national policy proposals for Martha’s Rule that can be expanded across the NHS from 2025/26. We will also explore the implementation of the Martha’s Rule model across other settings including community and mental health hospitals where the approach may not apply in the same way.

Many thanks for your support in implementing this important initiative for our patients and their families.

Yours sincerely,

Dr Aidan Fowler, NHS Director of Patient Safety

Publication reference: PRN01239_i