‘Martha’s Rule’ right to request urgent second opinion to be rolled out to 100 hospitals


Hospital patients and their families will soon be able to request an urgent review if their condition deteriorates with the introduction of Martha’s Rule.

The patient safety initiative is set to be rolled out to at least 100 NHS sites from this April and will give patients and their families round-the-clock access to a rapid review from an independent critical care team if they are worried about their or a loved one’s condition.

This escalation process will be available 24/7 to patients, families and NHS staff, and will be advertised throughout hospitals, making it quickly and easily accessible.

The initiative is named after 13-year-old Martha Mills who died from sepsis at King’s College Hospital, London, in 2021, due to a failure to escalate her to intensive care and after her family’s concerns about her deteriorating condition were not responded to promptly.

Extensive campaigning by her parents Merope and Paul has seen widespread support for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.

Saving lives

NHS chief Amanda Pritchard said the programme had the potential to “save many lives in the future” and thanked Martha’s family for their important campaigning and collaboration to help the NHS improve the care of patients experiencing acute deterioration.

The national programme will build on NHS England’s Worry and Concern pilots launched at seven trusts last year, which developed and tested escalation methods for patients’ and families’ concerns.

Merope Mills and Paul Laity, Martha’s parents, said: “We are pleased that the implementation of Martha’s Rule will begin in April. We want it to be in place as quickly and as widely as possible, to prevent what happened to our daughter from happening to other patients in hospital.

“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 recognised 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.”

Expanding Martha’s Rule

As part of Martha’s Rule, health staff at participating hospitals will also formally record daily insights and information about a patient’s health directly from their parents or families making sure any changes in behaviour or condition are noted by the people who know the patient best.

Evaluation of the initial roll-out from at least 100 yet to be announced trust sites during 2024/25 will inform proposals for Martha’s Rule to be expanded further across all acute hospitals, subject to government funding.

NHS teams will also identify ways to roll out an adapted Martha’s Rule model across other settings, including community and mental health hospitals, where the processes may not apply in the same way.

The introduction of Martha’s Rule comes alongside other measures to improve the identification of deterioration, including the rollout last November of a new early warning system for staff treating children.

The Paediatric Early Warning System is built on similar processes already in place for adult, newborn, and maternity services. Here clinicians are able to track potential deterioration by formally recording changes in vital signs like blood pressure, heart rate, oxygen levels and levels of consciousness, with different scores representing the level of concern.

East Kent Hospitals

East Kent Hospitals already run a Call For Concern scheme which allows inpatients or their loved ones to directly report a decline in their condition that has been reported but not addressed by healthcare staff on the ward.

The service is the same as ‘Martha’s Rule’ and is run by the Trust’s Critical Care Outreach Team.

Find out more about it here


    • Yep, most will be lucky to get a first opinion-let along a second. Doctors/Consultants barely have enough time to see patients as it is.

  1. Every NHS patient of specialist services has a right to see their consultant
    Every patient has a centuries old right toa Second Opinion, which must be granted by the doctor
    Its just that it needs to be spelt out in law also.

    • And where are the doctors/consultants going to come from to do it? Every person should also have the right to see their doctor & access NHS dentistry-but it isn’t a reality, as GP’s have used Covid as an excuse not see their patients for years now, while getting paid in full & bonuses for sitting in centres for months sticking needles in the arms of unvaccinated people, when magically they were happy to see them (wouldn’t we all be at 15-30 quid a pop?) & despite their promises to see them after then refused on safety grounds & that isn’t going to change.

      Not to mention the NHS being on strike, cancelling operations so they can ‘pay their respects’ to the royals passing & getting coronated-who get private treatment right away-while virtue signalling about men getting their bum issues looked at, when the reality is ordinary plebeians cannot see their doctors, the two week urgent cancer referrals don’t happen most of the time now & then you can join the list of 8 million waiting for treatment.

  2. Having spent 42 years working in nursing at all levels it’s been common practice for nursing staff of all grades to past patients concerns onward and upwards to senior staff doctors and consultants. In this tragic case it just shouldn’t have happened.

  3. Last year my father was in Margate, mis-diagnosed on admission, had 2 bad falls on the ward, then after a failed rapid discharge, was re admitted at William Harvey. He suffered for months. ultimately dying on the ward in WHH.
    I & my 63 year married mother, had to fight every single day to get decent care for my father.
    The very first words out of any of the nurses & doctors when issues were raised was “Do you have Power of Attorney?” If the answer is no then you have no voice at all, let alone a request for a second opinion.

    It was utterly disgraceful, shameful & scary, experiencing this situation. So much so my mother is now terrified that she may end up there herself in the future.

    My advice would be to ensure you have a Health & Wellbeing Power of Attorney in place now, just in case, as even 63 years of marriage means nothing when it comes to your loved ones care.

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