Martha's Rule to give NHS patients and families right to urgent second opinion

More than 100 hospitals are preparing to introduce 'Martha's Rule', which would allow a second medical opinion if a patient's condition is rapidly worsening. Health Correspondent Rebecca Barry reports

The NHS in England will roll out ‘Martha’s Rule’ from April to give patients and families access to a rapid review if they are worried about a condition getting worse.

The escalation process, which formalises access to a critical care team for a second opinion, will be available 24/7 and will be advertised throughout hospitals.

Under the move, an urgent clinical review would be carried out by a different team in the hospital if a patient’s condition is rapidly worsening and they or their family feels they are not getting the care needed.

At least 100 NHS trusts are expected to bring in the rule, with the programme evaluated throughout this year and next.

The plan is to then extend Martha’s Rule to all acute hospitals, subject to government funding.

The move follows the death of 13-year-old Martha Mills in 2021. She developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

A coroner ruled she would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier.

Martha’s parents, Merope Mills, an editor at the Guardian, and her husband Paul Laity, raised concerns about Martha’s health a number of times but these were brushed aside.

Speaking to ITV News, Merope said: "Everyone just reassured us that this was normal, and even when I expressed my doubts to the nurse when she had a rash - which is a really serious sign - the nurse said trust the doctors, they know what they're doing".

The pair have since campaigned for Martha’s Rule to be introduced to give families more say.

The pair hope the system will give patients more power, encourage medical professionals to listen to those they are treating and to normalise the idea that doctors should welcome being challenged.

Merope told ITV News: "When I had friends or family members who went into hospital after Martha died, I'd say "if you ever feel anything is going wrong, do what I didn't do - scream the ward down". But now you don't need to, just use Martha's rule."

The described Martha as fun and determined, "with a vast appetite for life".

"We’ll never know what she would have achieved with all her talents."

Martha was being looked after at King’s after suffering a pancreatic injury following a fall from her bike while on a family holiday in Wales.

An inquest heard there were several opportunities to refer Martha to intensive care but this did not happen. The trust, which is a specialist national referral centre for children with pancreatic problems, has since apologised for mistakes in Martha’s care.

At one point, Martha began to bleed heavily through a tube inserted into her upper arm and through a drainage tube.

She also developed a rash and her mother voiced concerns to staff that Martha would go into septic shock over a bank holiday weekend.

One of the trust’s own intensive care doctors told the inquest into Martha’s death he would “100%” have admitted her if he had seen her.

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Regarding the introduction of Martha’s Rule, NHS chief executive Amanda Pritchard said it had the potential to “save many lives in the future”.

She said: “Hearing about the heartbreaking loss of Martha and the experiences of her family has had a major impact for people right across the country, with parents, patients and NHS staff welcoming her parents’ call for a simple process to escalate concerns when they can see a loved one’s condition worsening.

“I know I speak on behalf of all NHS staff when I thank Merope and Paul for their extraordinary campaigning and collaboration on this hugely important issue," she said.

NHS teams will also look at ways ways to roll out an adapted Martha’s Rule model in community and mental health hospitals.

Rory Deighton, director of the NHS Confederation’s acute network, welcomed the move but said there are still questions as to how medical settings will deliver the new scheme.

“Introducing a 24/7 clinical review process will have implementation costs and leaders will be concerned if they are just being expected to provide the additional service without any extra resources," he said.

“But this rollout is part of an important shift where the NHS is looking to change the relationship between the NHS, clinicians, patients and their families."

The Royal Berkshire Hospital in Reading introduced a similar programme back in 2009 called 'Call for Concern', which provides 24-hour access to a critical care team.

The hospital's Chief Executive Steve McManus told ITV News: "I think it has saved lives. It's about being able to involve the patient and their relatives in terms of the clinical decision-making and hear their concerns and act on them."

Health Secretary Victoria Atkins paid tribute to Martha's parents and described the new rule as a "major boost" to patient safety".

“The introduction of Martha’s Rule from April will put families at the heart of the patient’s own care, recognising the critical role they have in the treatment of loved ones.”

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