Martha’s rule must be available 24/7, England’s patient safety commissioner says

Patients and their relatives will be able to request a second opinion from senior medics around the clock when the “Martha’s rule” system starts in hospitals in England.

The government’s patient safety commissioner, asked by the health secretary, Steve Barclay, to advise on how to implement the change, has said access to a medic’s opinion must operate 24/7.

Dr Henrietta Hughes made clear to Barclay in a letter that inpatients and families worried that their loved one’s health is deteriorating should be able to seek a second opinion at any time of day or night.

In her letter, which she published on Wednesday, Hughes also said the availability of that service must be widely advertised in hospitals, so patients know they can use it.

She told Barclay that all staff in acute and specialist medical NHS trusts in England “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”.

Critical care outreach teams are small teams of senior medics who are on call and whom staff can ask to quickly review the condition of a patient they fear is in dangerous decline.

Hughes added: “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.”

Not all hospitals have a critical care outreach team available 24/7 yet. About 70% do, while about 20% more have one that operates in traditional daytime working hours, although the NHS intends to ensure that in time all hospitals offer 24/7 access, it is understood.

Barclay announced last month that the government was committed to bringing in “Martha’s rule” in England to make it easier for patients and their families to get a second medical opinion if they believed their concerns were not being taken seriously by medical staff.

It is the result of a campaign by the parents of Martha Mills, who died in 2021 after hospital doctors failed to admit her to intensive care. Martha, 13, died after developing sepsis while under the care of King’s College hospital NHS foundation trust in south London.

A coroner ruled that Martha, who sustained a pancreatic injury after falling from her bike while on a family holiday in Wales, would probably have survived if doctors had identified the warning signs and transferred her to intensive care. She would have turned 16 in September.

Martha’s mother, Merope Mills, an editor at the Guardian, has said she and her husband, Paul Laity, raised concerns about Martha’s deteriorating health a number of times but these were not acted on.

A similar measure enforced in Queensland in Australia has been shown to have saved lives.

Barclay has not yet responded to Hughes’s recommendations but plans to do so soon.

The Department of Health and Social Care (DHSC) said it was examining how best to introduce the system. Labour has said it supports the change, which has been widely welcomed as a major improvement in patient safety and an extension of patients’ rights.

A DHSC spokesperson said: “We continue to urgently look at the implementation of Martha’s rule, and the evidence on what works to support patients and their families seeking a second opinion. The patient safety commissioner has now outlined her recommendations on how to take forward Martha’s rule, and we will work with NHS England and others to build on these findings and consider next steps.”

Meanwhile, NHS England is bringing in an early warning system to help staff looking after children and babies in hospital to quickly identify if their condition deteriorates.

Under the paediatric early warning system for patients in England aged under 18, doctors and nurses will monitor the health of a child who seems to be worsening by looking at their heart rate, blood pressure, oxygen levels and how conscious they are, with each indicator given a score.

NHS England said the new system, which mirrors one already used for adult inpatients, would help parents and carers voice their concern if a child becomes sicker than their combined score shows.

Some hospitals already use a scoring system along these lines. But all hospitals will over time start using this new approach.

It will help “dedicated clinicians to observer, track and identify deterioration in children’s conditions to get them the help they need faster and more easily”, said Prof Sir Stephen Powis, NHS England’s national medical director.