Martha’s Rule – it will be vital for patients to know about this new route to an emergency second opinion | Medical Negligence and Personal Injury Blog | Kingsley Napley

It is great news that the Secretary of State for Health and Social Care and NHS England have both committed to implement Martha’s Rule in England, having already expressed my support for the move (see my articles here and here).

The campaign to bring in the rule has been led by the parents of 13-year-old Martha, who died of sepsis in 2021. They felt that their concerns about her condition were not properly listened to. The purpose of Martha’s Rule is to give all patients and their families a right to seek an urgent second opinion if a patient’s condition is rapidly worsening or if it is felt they are not getting the care they need.

As a medical negligence lawyer, I regularly help people who have been injured by inadequate medical treatment. In my experience, not being listened to, as well as failures in communication with medical professionals, have often contributed to the problems. Consequently, Martha’s Rule has the potential to be highly significant and is likely to save lives. 

NHS England has confirmed that that ‘the first phase’ of Martha’s Rule will begin in April. This will involve at least 100 ‘adult and paediatric acute provider sites’ which will be supported during 2024 – 2025 to devise and agree a standardised approach. There will then be a ‘scale up’ to the remaining sites in England during the following years.

According to NHS England, there are three proposed components of Martha’s Rule:

• If a member of staff working within an NHS trust has concerns about a patient, they must, at any time, be able to contact a critical care outreach team for a rapid review.

• All patients, their families, carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team if they are worried about a patient’s condition. They should be able to contact the outreach team ‘via mechanisms advertised around the hospital, and more widely’.

• In addition, the NHS must implement a structured approach in order to obtain information about a patient’s condition directly from the patient themselves and from their family on at least a daily basis. NHS England states that initially, this will cover all inpatients in acute and specialist trusts.

I greatly welcome NHS England’s plan and the recognition of how vital it is that the concerns of patients, and those who know them best, are listened to and acted upon. So often it is families who are able to identify if there is something unusual when a patient is unwell and their instincts should be valued. Martha’s Rule may help patients suffering from a wide range of problems to get a correct diagnosis when initially this has not been made.

However, concerns have been reported in relation to the current workforce crisis and the need to address this in order for critical outreach teams to have the staff numbers needed to deliver Martha’s Rule.

Clearly, problems may be encountered if there are insufficient staff to provide second opinions when these are needed. However, Merope Mills, Martha’s mother, when speaking to a Guardian podcast, pointed out that evidence from similar schemes, such as in Australia, was that critical care teams were not inundated with requests. Her hope is that Martha’s Rule will help to alter medical culture and encourage listening on the part of medical professionals.

For implementation to be effective, it will be extremely important for patients and their families to be made aware of their right to obtain a second opinion and for the process of contacting the relevant critical care outreach team to be made as simple as possible. The ‘mechanisms’ used to do this will be undoubtedly key.

We are specialists in bringing legal claims for compensation relating to failures in the treatment of infections and sepsis. If you are concerned about the medical care that you or a family member has received, please contact our sensitive and supportive team for a no obligation discussion.