What you should know about Martha’s Rule as hundreds of patients given second opinion
In May 2024, the NHS rolled out Martha’s Rule in a pilot across 146 hospitals in England, an initiative that offers patients and their loved ones a right to request a second medical opinion on their condition.
The NHS describes the initiative as "a major patient safety initiative providing patients and families with a way to seek an urgent review if they or their loved one’s condition deteriorates and they are concerned this is not being responded to."
The trial, which included posting leaflets, flyers and posters with helplines numbers around hospitals, found that one in eight calls delivered a ‘potentially’ life-saving change in treatment. Data from September and October alone showed that out of 573 calls, 50% (286) of them led to a critical care review.
Prof Sir Stephen Powis, NHS England’s national medical director, told the Guardian that the introduction of Martha’s Rule is "one of the most important changes to patient care in recent years." But how did this scheme begin and what does it consist of?
Who founded Martha’s Rule?
In 2021, Martha Mills, a thirteen-year-old girl was admitted to Kings College Hospital with a pancreatic injury after falling off her bike. In hospital, her parents, Merope Mills and Paul Laity were concerned that she was deteriorating rapidly, but no immediate action was taken. Soon after, Martha developed sepsis and died in hospital.
At the inquest into her death in 2023, the coroner ruled that Martha would have ‘probably’ survived if she had been moved to intensive care earlier. After this verdict, Martha’s mother began campaigning for a system where loved ones could get a second opinion on a medical condition, if they believe their concerns are being ignored. This became Martha’s Rule.
Speaking about the campaigning, Mills Ms Mills told BBC Radio 4’s Today programme: "Losing a loved one in a preventable way compounds your grief and your devastation. But if nobody learns from it, nothing changes, it makes you feel as if their life meant nothing to the people who let them down.
"So pushing through this change has been exhausting at times but in some level it has helped us both to see that people are prepared to learn from Martha’s death and those mistakes."
What is Martha’s Rule?
Martha’s Rule is an initiative for patients and loved ones to request an urgent review of a patient’s treatment if they are deteriorating and concerned about their wellbeing.
In practice, this works as families are provided with access to an emergency telephone number where an independent team can offer a second medical opinion on that patient’s treatment. They will review that patient’s condition and suggest alternative treatment if necessary.
When the pilot was introduced earlier in the year, the first two months saw 14 people referred to intensive care after their family had called for an urgent review. Mills said this trial will "save lives" and she hopes it continues across England.
Martha’s Rule hopes to not only save lives, but also empower patients, families, staff and carers to feel heard and as though their concerns are acted upon.
How does it work?
The NHS states that there are three components to Martha’s Rule which are:
Patients will be asked daily, at a minimum, how they are feeling and staff will action a response to their concerns.
Any member of staff from any team can ask for a patient’s treatment to be reviewed if they are concerned about their condition getting worse.
The escalation process will be available to the patient, as well as their families and carers, so they can phone the independent team and ask for a medical review any time.
Read more about Martha's Rule:
Martha’s Rule ‘transforming’ patient safety in the NHS (PA Media, 6-min read)
Mother behind Martha's Rule shares scheme's early success (BBC News, 2-min read)
Lessons ‘not being learned’ from sepsis failings, ombudsman warns (PA Media, 5-min read)
