What is Martha’s Rule? NHS’s new care system roll out after teenager’s death

Seriously ill patients will have quick access to a second opinion when Martha’s rule comes into force this April.

The NHS already guarantees patients the ability to choose their healthcare provider and opt for a second opinion under the existing ‘Right to Choose’.

However, the government has offered funding to NHS hospitals to ensure patients and their families have round-the-clock access to a separate critical care team if they are worried about the patient’s condition.

It comes after the death of 13-year-old Martha Mills who died of sepsis after her symptoms were missed in 2021.

She had initially been admitted to hospital with a survivable injury to her pancreas after falling off her bike.

Her mother, Merope, had raised concerns with doctors about Martha’s care and asked that she be transferred to intensive care.

These requests ‘were not responded to promptly’, NHS England said. Martha, described as ‘fun and determined, with a vast appetite for life’, died days later.

A coroner concluded that she would likely have survived if ‘she had been referred promptly and had been appropriately treated’.

What is Martha’s Rule?

The government and NHS England formulated Martha’s Rule to reduce the possibility of this happening in the future.

NHS England said it would ‘ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon’.

Martha’s rule consists of three elements.

All staff in NHS trusts must have round-the-clock access to a rapid review from a critical care team they can contact with concerns about a patient

All patients, their families, carers, and advocates must also have access to the same review from a critical care team.

Contact methods should be advertised around hospitals and more widely if they are worried about the patient’s condition or suspect it is getting worse.

Medical staff will also record patients’ and families’ observations of a patient’s condition at least once a day.

At least 100 acute and specialist trusts – two-thirds of hospitals in England – will take part in the initial rollout of Martha’s rule.

Martha’s parents, Merope Mills and Paul Laity, said they were ‘pleased’ with the implementation of Martha’s rule from April, claiming it ‘will save lives’.

They said: ‘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.

‘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.’

The participating hospitals are yet to be decided, but for the initial phase they must have an already existing 24/7 critical care outreach infrastructure.

Once they have agreed a standardised approach to Martha’s Rule, it will be scaled up to the remaining sites in England. It may also be adapted to other settings like community and mental health hospitals.

NHS chief executive, Amanda Pritchard, said: ‘NHS teams have been piloting ways to better identify and respond in these cases over the last year, and the roll-out of a national programme to give patients and families 24/7 access to a rapid clinical review will now help ensure that those experiencing acute deterioration can be identified and treated much more quickly.

‘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 – 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.’

Victoria Atkins, Secretary of State for Health and Social Care, said: ‘Martha’s death was a terrible tragedy, and I pay tribute to her parents Merope and Paul.

‘They have 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.’

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