‘Martha’s rule’ granting urgent second opinion to be adopted in 100 English hospitals

Patients whose health is failing will be granted the right to obtain an urgent second opinion about their care, as “Martha’s rule” is initially adopted in 100 English hospitals from April at the start of a national rollout.

The initiative will allow patients and their loved ones to get a review of their condition and treatment directly from doctors and nurses not involved in the medical team treating them.

Patients at the hospitals involved in the programme will gain 24/7 access to a critical care team of doctors and nurses from elsewhere in the building, who specialise in the care of patients who are deteriorating and who will come and assess the situation.

Announcing the move on Wednesday, Amanda Pritchard, NHS England’s chief executive, said: “While the need for escalation will hopefully only be needed in a small number of cases, I have no doubt that the introduction of Martha’s rule has the potential to save many lives in the future.”

The initiative is the direct result of pressure put on politicians, NHS bosses and doctors after Merope Mills, a senior editor at the Guardian, and her husband, Paul Laity, told the story of what happened to their daughter, 13-year-old Martha, who died of sepsis at King’s College hospital in London in 2021.

Mother speaks of ‘Martha’s rule’ granting urgent medical second opinion in hospitals – video

Martha had sustained an injury to her pancreas when she fell off her bike on a summer holiday. However, doctors at the hospital did not listen to her parents’ concerns, including the possibility Martha could have had sepsis, a major cause of avoidable death that kills an estimated 40,000 people a year in the UK. In fact, some of the doctors knew days before she died that Martha had sepsis, but they did not tell her parents and failed to send Martha to intensive care.

An inquest heard that Martha would probably have survived if she had been moved to intensive care sooner, which her parents had asked doctors to do.

Mills and Laity said: “We believe Martha’s rule will save lives. In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t. Their knowledge should be treated as a resource.

“We also look to Martha’s rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged.”

The 100 hospitals adopting Martha’s rule – larger hospitals which have a critical care team on call around the clock – will advertise its existence to patients and visitors through posters and leaflets.

Speaking on the Today in Focus Guardian podcast, Mills sought to reassure doctors that Martha’s rule “is not a way of casting blame” in a dispute over a patient’s care. But it was a challenge to the perception that “doctors are gods” whose judgments were infallible, she said.

“I just want to tell people not to be afraid to challenge decisions where they have concerns,” she said.

The evidence from similar schemes elsewhere, such as Australia, showed that critical care teams did not get inundated with requests from patients or relatives for an urgent review, she added.

“The background fear [among doctors] is that [a critical care team] will be overrun; [that] suddenly patients will be calling [for] it all the time. And in every example where something similar exists already, in this country or in other countries, that’s not the case,” she said.

Paul Whiteing, the chief executive of the patient safety charity Action Against Medical Accidents, said NHS England’s planned evaluation of how the rollout in the 100 hospitals goes during 2024-25 should ask patients and relatives if they were satisfied with the response of the critical care team, given that they would be colleagues of the person’s care team.

Victoria Atkins, the health and care secretary, praised Mills and Laity for having “worked tirelessly to raise awareness of Martha’s case and of the need to introduce measures that will help ensure that no family ever has to go through anything similar again”.