NHS England will roll out a new patient safety initiative called ‘Martha’s Rule’ in one hundred hospitals from April 2024.

Seriously ill patients and their loved ones will now have the legal right to an urgent second opinion by an independent team of doctors if requested. Round-the-clock access to a rapid clinical review will now help ensure that those experiencing acute deterioration can be identified and treated much more quickly.

Patients do already have the right to a second opinion, but NHS trusts operate different systems. Some patients aren’t aware of their rights and so are afraid to challenge a doctor’s decision. Others have been conditioned to trust what a doctor says and dismiss their own gut feelings. However, doctors are not infallible and they can make mistakes.

Under Martha’s Rule, patients whose condition is worsening will be entitled to a rapid review carried out a senior doctor or nurse from elsewhere in the building, not directly involved in the current care of a patient. This will be a team who specialise in the care of patients who are deteriorating and will be available 24/7.

The new Martha’s Rule will be a major boost for patient safety and has the potential to save lives in the future.

Who is Martha’s Rule in memory of?

Martha’s Rule follows a campaign by the parents of 13-year-old Martha Mills who died from sepsis in 2021. She had been treated at King’s College Hospital, London for an injury to her pancreas sustained while riding her bike.

Her condition worsened and she later developed sepsis. However, many symptoms were missed by doctors and her parents’ concerns were ignored. They were told a rash she developed was just an allergic reaction to antibiotics. Her parents repeatedly requested Martha be transferred to intensive care for treatment. She sadly died in hospital.

An Inquest found that, had she been moved to ICU earlier, Martha would probably have survived. The hospital apologised to Martha’s parents, Merope and Paul.

After plans for Martha’s Rule were formally announced on Wednesday 21st February, Martha’s mother Merope 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.

“Our incredible daughter, Martha, lost her life needlessly, far too young. We hope this new rule will put some power back into the hands of patients and prevent unnecessary deaths.”

When does Martha’s Rule come into effect and what will happen?

Initially, two-thirds of hospitals in England (at least 100) will be part of the pilot scheme for Martha’s Rule from April 2024. This will mainly be larger NHS trusts where there is scope to have a team of medics on-hand 24/7 for urgent reviews.

The three proposed components for Martha’s Rule are:

  1. All staff in NHS trusts must have 24/7 access to a rapid review from a critical care outreach team, who they can contact should they have concerns about a patient.
  2. All patients, their families, carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team, which they can contact via mechanisms advertised around the hospital, and more widely if they are worried about the patient’s condition. This is Martha’s Rule.
  3. The NHS must implement a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least daily. In the first instance, this will cover all inpatients in acute and specialist trusts.

Funding will be available to these hospitals to use for leaflets, posters and other promotional material aimed at raising awareness for patients and their families.

NHS doctors and the government have fully endorsed Martha’s Rule. Health secretary, Victoria Atkins said: “Martha’s Rule will provide a major boost to patient safety by putting in place a system that can be triggered by patients, or by their family and friends, when they are worried that their condition is worsening. This will give vital reassurance that the best care possible is being given. 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.”

Depending on government funding, the plan is then to extend Martha’s Rule to all acute hospitals from next year.

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