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Martha’s Rule: severely unwell patients entitled to second opinion

NHS England has announced it will roll out a new patient safety initiative known as ‘Martha’s Rule’ from April.

NHS England has announced it will roll out a new patient safety initiative known as ‘Martha’s Rule’ from April.

Martha’s Rule, which allows patients and their families to seek an urgent review if the patient’s condition deteriorates rapidly, will be rolled out to at least 100 NHS sites.

Health staff at participating hospitals will also be required to formally record daily insights and information about a patient’s health. This can then be reported directly from their parents or families to ensure any behaviour changes are noted.

Hope that Martha’s Rule will ‘alter medical culture’

The initiative was sparked after Martha Mills, 13, died from sepsis at King’s College Hospital in 2021 following a cycling accident. She injured her pancreas but could have survived if she received better care, an inquest found.

Martha’s parents, Merope and Paul, continuously raised concerns about Martha’s condition, but they were not responded to promptly.

In response to the implementation of Martha’s Rule, Merope and Paul 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 recognised 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.”

They are now calling on NHS clinicians to back the initiative. They accept that the large majority doctors do listen and are open with patients, but they say some hospital cultures ‘need to change’.

Government must ensure staffing levels are adequate to support the initiative

Health leaders have welcomed the new patient safety initiative, and the Royal College of Physicians says Martha’s Rule is a ‘welcome reminder’ for doctors to listen to patients’ concerns.

An evaluation of Martha’s Rule will be conducted throughout 2024/25, with the hope of expanding the initiative across all acute hospitals, with an adapted version rolled out to community and mental health hospitals.

John Dean, RCP clinical vice president, said: “We support the expansion of the pilot as a welcome step for patient safety, and are guided in this area by our experts in acute deterioration.”

The Royal College of Nursing has also backed the initiative, but says the government must ensure there are enough nursing staff in place to ensure it is effective.

RCN Director for England Patricia Marquis said: “Nursing staff are patients’ greatest advocates and stand ready to ensure Martha’s Rule has an immediate impact and leaves a lasting legacy.

“Safe and effective levels of nursing staff will be crucial to the implementation of Martha’s Rule, ensuring there are enough professionals with capacity to provide a second opinion when called upon to do so. We welcome the evaluation that will be undertaken as part of the rollout into the NHS in England.”

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