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, which initially 100 hospitals will adopt before a national roll-out, 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.
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, said The Times.
The first hospitals will adopt the rule in April and will be “evaluated over the next year”, with further possible funding available to include all “acute hospitals”, said the BBC.
How did Martha’s rule come about?
Merope Mills and Paul Laity, the parents of Martha, have campaigned for the rule as well as a “culture change” in hospitals since their daughter died in 2021. Doctors at King’s College Hospital had failed to move her to “intensive care quickly enough to get treatment that would save her life”, said The Times.
Mills and 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 simply tried to placate her anxiety over Martha’s condition. She said they were “not told the full truth” about what doctors knew. Medical staff had established that Martha had contracted sepsis but they did not tell Mills or her husband this, saying she had an “infection”. “It’s easy to feel cowed,” she 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.
On the announcement that Martha’s rule would be implemented after years of campaigning, Mills and Laity said that 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 “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 24/7 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 inevitable implementation costs of a 24/7 escalation service will initially be funded by £10 million of government funding for the first 100 hospitals, which is around “two-thirds of hospitals” in England, said the BBC. It is then hoped after evaluation that further funding will be unlocked to expand the scheme across all hospitals with seriously ill patients.
Health Secretary Victoria Atkins told the BBC the initiative is something the government believes “very strongly in”, but it will 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 BBC said.
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 “Today in Focus” Guardian podcast. However, she said that while patients and families should not be “afraid to challenge decisions” by doctors, it was “not a way of casting blame” over patient care.
Evidence from similar schemes around the world, including one in Australia, showed that doctors did not get “inundated with requests from patients or relatives for an urgent review”, said The Guardian.