NHS Announce Rollout of ‘Martha’s Rule’ in 100 Hospitals

England’s National Health Service (NHS) has announced the first phase of ‘Martha’s Rule’ that will be implemented in 100 NHS Hospitals in April. The hospitals set to use the rule are ones that already have Critical Care Outreach teams in place. 

‘Martha’s Rule’ aims to give patients and their families or carers, as well as NHS staff, “round-the-clock access to a rapid review from a separate care team if they are worried about a person’s condition.” The rule comes after 13-year-old Martha Mills died at London's King College Hospital in 2021 after contracting sepsis. 

The teenager initially was hospitalised for a pancreatic injury, after her family’s concerns about her health weren’t responded to properly, she passed away. Not long after her death, a coroner ruled that she would have survived if she was admitted to intensive care sooner. 

Martha’s death raised discussions of medical negligence within the NHS, and her mother, Merope Mills, an editor for The Guardian, co-wrote a report with Demon calling for an urgent placement of ‘Martha’s Rule’ last September. 

In this report, she stated, “Around the world, hospitals have introduced schemes that give patients or their loved ones a right to request a review from a separate team of clinicians if they feel they are not being heard or responded to. Martha’s Rule would be based on these systems and the evidence that they contribute to improved outcomes for patients.”

The NHS’s announcement details the three elements within the rule which 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.

The previous Secretary of State for Health, Steve Barclay, said last year that he would work to make sure ‘Martha’s Rule’ gets implemented quickly. Barclay also referred to Queensland’s ‘Ryan’s Rule’ that was established in 2013 after 3-year-old Ryan Saunders died from Toxic Shock Syndrome which was misdiagnosed as Mumps. ‘Ryan’s Rule’ has a similar approach to Martha’s, providing contact for Critical Care teams, for those seeking a second opinion. It has been used 10,845 times since it was first introduced.

There was an assessment conducted by Royal Berkshire Hospital in 2010, where a service called Call for Concern (C4C) was introduced so that Critical Care Outreach teams could be contacted. Across the seven years in which this assessment took place, 534 calls were made to C4C, with only 5 percent of these referrals not being critical. Currently, there is no legal right to a second opinion within healthcare, ‘Martha’s Rule’ is designed to go beyond this by allowing patients and others to get an independent clinical review. 

Of the 243 million patients treated by the NHS each year, 0.005% are misdiagnosed, leading to severe repercussions, and can prove to be fatal, just like Martha’s case. Her mother wrote for The Guardian about her experience losing her daughter, saying “Martha should have walked out of hospital like all the other children with her injury” but didn’t partly because of the “inflated egos” amongst those treating her daughter. 

Merope urges other parents or carers to trust their instincts instead of taking doctors’ words for it so they won’t be left devastated like her, “Ignore the advice and look everything up on the internet. Google like crazy, educate yourself, ask questions and, if you are unsure, insist on a second opinion, or a third. Remember that it’s entirely possible you will be “managed” and “reassured” but not told the full truth.”

If the rollout of ‘Martha’s Rule’ is successful in this phase of implementation then hopefully it will be expanded across other NHS hospitals, providing rapid reviews for patients whose needs aren’t being met. The introduction of this rule wouldn’t be possible without Melope and Paul Mills’ endless campaigning, and if done correctly, can transform England’s healthcare. 

Edited by Chloe Mansola

Image ‘NHS ribbon, Badge of Honour’ by Pete licensed by PDM 1.0

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