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What is Martha's Rule? Second opinion to be adopted in 100 English hospitals

Martha Mills died after doctors failed to admit her to intensive care (Mills/Laity family photograph/PA) (Mills / Laity family photograph / PA)
Martha Mills died after doctors failed to admit her to intensive care (Mills/Laity family photograph/PA) (Mills / Laity family photograph / PA)

A law to protect patients will soon be introduced at 100 English hospitals imminently.

The Government has committed to introducing Martha’s Rule in England’s hospitals within weeks to give patients the right to a second opinion if they believe their concerns are being dismissed by NHS staff.

Merope Mills, whose daughter Martha, 13, died of sepsis after doctors failed to admit her to intensive care, has pushed for the changes, which are set to be introduced from April as the start of a nationwide rollout.

Announcing the move on Wednesday (February 21), NHS England chief executive Amanda Pritchard 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.”

Here is everything we know.

What is Martha’s rule?

The rule will give patients, families, and carers the chance to easily request a second opinion from senior medics in the same hospital, in the event of a suspected deterioration or serious concern.

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 assess the situation.

It means that in cases where parents are not convinced by the care, or believe they have a ‘gut feeling’ there is something wrong, they can officially ask – and must be given – a second opinion by another group of experts not directly involved in the current care of the patient.

Who is Martha’s Rule inspired by?

The law is coming into play thanks to a push by two grieving parents who lost their daughter in tragic circumstances, and is fully endorsed by NHS doctors.

Mother Merope Mills, a senior editor at the Guardian, and her husband, Paul Laity, have campaigned for change after what happened to their daughter, 13-year-old Martha, who died of sepsis at King’s College hospital in London in 2021.

Martha had fallen from her bike while playing and sustained an injury to her pancreas.

She was taken to hospital but doctors 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.

“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.”

Are there similar rules in other countries?

Yes, in Australia there is already legislation in place which is a three-step process, called Ryan's Rule.

Ryan’s Rule has been developed in response to the tragic death of Ryan Saunders, who died in 2007 from an undiagnosed streptococcal infection, which led to Toxic Shock Syndrome. When Ryan’s parents were worried he was getting worse, they did not feel their concerns were acted on in time. In light of his death, the Australian department of health made a commitment to introduce a patient, family, and carer escalation process (Ryan’s Rule), to minimise the possibility of a similar event occurring.

People with concerns with Ryan’s Rule are asked to contact a nurse or doctor in the first step, escalate to a nurse in charge if still not happy, and finally phone a specialist phone line that has been set up to request a ‘Ryan’s Rule Clinical Review’.

Germany also have a similar system in place.