Martha’s Rule will only be a change for good if it’s properly resourced
On the face of it, a Martha’s Rule allowing patients and their families to escalate an urgent review by a different critical care team where there are concerns about deteriorating health, seems like a no brainer.
But senior consultants, trust CEOs and other health leaders I have spoken to have serious concerns.
The first and most obvious question is: “Where will the extra resources come from?”
A very senior critical care consultant from London told me: “It’s completely impractical and I’ve no idea how it will work.”
His worry is that hospitals are short-staffed and under pressure at the best of times.
He said: “How will that work at three in the morning, when there’s no intensive care on site (for children in a district general hospital) or for an adult?
“Is the ICU really going to be able to give an opinion on a patient in another hospital?
“How will the managing team (consultant or otherwise) be involved in this decision?
“None of this has been properly worked through.
“It’s OK for those in a tertiary centre with all the specialties and intensive care on site. But even here, who is going to give those opinions and how will the primary team be involved?
“What happens in the other places, and what happens in primary care?”
Fair and valid questions, all.
Another consultant expressed concerns about “increased workload for our critical care outreach teams”, and worried the system would be “open to abuse in certain circumstances”.
This is going to happen.
When our loved ones are sick, we naturally want the best possible care and treatment.
But under these stressful conditions we are not always best placed or medically qualified to demand a second intervention.
Some might argue, rightly, that a mother would intuitively know if her child’s health is deteriorating.
Trusts where a similar escalation system is already in place reported the service being used for ward-based clinical issues, things like pain management, diagnostics chasing, chronic condition advice, or simply to make a complaint.
There is also a danger that systems like this can widen health inequalities.
A senior health leader told me: “It’s a good thing and should be embraced by the medical profession but needs to be framed from the outset to be accessible to all at all times – otherwise the articulate and affluent benefit and inequalities may increase.
“It needs to be an internal 999 once you are within the system.”
One trust that has a Martha’s Rule-type system in place says it has prevented at least three patients from getting much worse because of interventions prompted by the escalation process.
Evidence that if properly funded, and well resourced, it could be a change for good.