Martha's Rule: patients given right to urgent second opinion

Hospitals in England will give families the right to an urgent second opinion on the condition of seriously ill patients under the new "Martha's Rule".

The rule will be adopted in 100 hospitals from April, with plans for a national roll-out, and allows a patient's family to access a review by other "doctors and nurses not involved in the medical team treating them", said The Guardian.

How did Martha's Rule come about?

The initiative is named after Martha Mills, the 13-year-old who died from sepsis after "catastrophic failings" by doctors at a south London hospital in 2021, said The Times. Doctors at King's College Hospital had failed to move her to "intensive care quickly enough to get treatment that would save her life".

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Martha's parents, Merope Mills and Paul Laity, had concerns over Martha's "rapidly deteriorating" condition – which began after a holiday cycling accident injured her pancreas – but they were "brushed aside" by doctors. 

Mills wrote in The Guardian that clinicians had tried to placate her anxiety over Martha's condition and that she and her husband were "not told the full truth" about what doctors knew. Medical staff had established that Martha had contracted sepsis but they did not tell the couple, saying she had an "infection". 

"It's easy to feel cowed," Mills wrote, "but hold your ground". No matter how "indebted you feel to the NHS", it is right to "challenge decisions if you have good reason to".

A coroner ruled that Martha would "most likely have survived" if doctors had heeded warning signs and moved her to intensive care earlier, said The Telegraph. After years of campaigning, her parents said that the implementation of Martha's Rule meant their daughter had not died "completely in vain".

What will it change?

The key change that Martha's Rule will establish is that doctors and nurses will be "obliged to accept any request for a second opinion". They will also be told to note the observations of those closest to the patient, who spend the most time with them, and to "formally record daily insights and information", as well as "take account of changes in behaviour or condition".

The initiative will entitle patients' families to a "rapid review" from a critical-care team if the condition is worsening.

Amanda Pritchard, chief executive of the NHS, said the rule will "hopefully only be needed in a small number of cases", but had the "potential to save many lives in the future". It will also be advertised on leaflets and posters in hospitals to ensure awareness.

How will it be rolled out?

The implementation costs of a 24/7 escalation service will initially be funded by £10 million of government funding for the first 100 hospitals, which account for around "two-thirds" of those in England, said the BBC. After evaluation, further funding may be unlocked to expand the scheme across all hospitals with seriously ill patients.

Health Secretary Victoria Atkins told the BBC that while the initiative was something the government believes in "very strongly", it would be rolled out "step by step" to ensure that the "service is as we'd all expect it to be".

A successful first year could see Martha's Rule adapted for "community hospitals and mental-health trusts", the broadcaster reported.

What are the concerns?

There is a "background fear" from doctors that the rule could see them "overrun" with patients calling for a second opinion "all the time", Mills told The Guardian's "Today in Focus" podcast. But patients and families should not be "afraid to challenge decisions" by doctors, she said, adding that it is "not a way of casting blame" over patient care.

Evidence from similar schemes around the world, including in Australia, showed that doctors did not get "inundated with requests from patients or relatives for an urgent review", said the paper.