Martha’s rule - a law to protect patients - has had a “transformative effect”, recent data has shown.
Medical experts said they have been greatly encouraged to see the difference it has made to caregiving in hospitals since its introduction in a number of hospitals over 2024.
Patients have been moved to intensive care or received potentially life-saving treatment such as oxygen as a direct result of hospitals adopting Martha’s rule, which gives patients and their loved ones the right to request an urgent review of the person in hospital’s treatment. That triggers their care being looked at urgently by a team of specialists, who offer a second opinion.
The data shows doctors and nurses have changed how they care for dozens of very sick patients since its introduction.
Professor Sir Stephen Powis, NHS England’s national medical director, said: “The introduction of Martha’s rule represents one of the most important changes to patient care in recent years, and we are really encouraged to see the impact it is already having for patients in this first phase.”
NHS England data has shown the law has led to 573 calls, across the 143 hospitals using it, in which someone has sought an urgent review. About half (286) have prompted an urgent review by critical care staff. And about one in five of those reviews – 57 cases – has led to the person’s care being escalated, for example by being given potentially life-saving antibiotics or other drugs.
During September and October alone, 14 patients were transferred to intensive care after Martha’s rule was deployed.
The law is named after Martha, age 13, who died of sepsis after doctors failed to admit her to intensive care.
What is Martha’s rule?
The rule enables patients, families and carers to request a second opinion from senior medics in the same hospital in the event of a suspected deterioration or serious concern.
Patients are given access to a critical care team of doctors and nurses from elsewhere in the building, who specialise in the care of patients who are deteriorating, and who will assess the situation.
It means that in cases where relatives are not convinced by the care or have a gut feeling there is something wrong, they can officially ask – and must be given – a second opinion by another group of experts not directly involved in the current care of the patient.
Who is Martha’s rule inspired by?
The rule came into force from April thanks to a campaign by two grieving parents, who lost their daughter in tragic circumstances.
Mother Merope Mills, a senior editor at the Guardian, and her husband, Paul Laity, campaigned for the change after their daughter, 13-year-old Martha, died of sepsis at King’s College hospital in London in 2021.
Martha had fallen from her bike while playing and sustained an injury to her pancreas.
She was taken to hospital but doctors did not listen to her parents’ concerns, including the possibility Martha could have had sepsis, a major cause of avoidable death that kills an estimated 40,000 people a year in the UK.
They later found out some of the doctors knew Martha had sepsis days before she died, but did not tell her parents and failed to send Martha to intensive care.
An inquest heard that Martha would probably have survived if she had been moved to intensive care sooner, which her parents had asked doctors to do.
Mills and Laity 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 treated 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.
“Our incredible daughter, Martha, lost her life needlessly, far too young. We hope this new rule will put some power back into the hands of patients and prevent unnecessary deaths.”
Are there similar rules in other countries?
Yes, in Australia there is already legislation in place which is a three-step process, called Ryan’s rule.
Ryan’s rule was developed in response to the tragic death of Ryan Saunders, who died in 2007 from an undiagnosed streptococcal infection, which led to toxic shock syndrome. After Ryan’s parents had begun to worry he was getting worse, they did not feel their concerns were acted on in time. In light of his death, the Australian department of health made a commitment to introduce a patient, family and carer escalation process (Ryan’s rule) to minimise the possibility of a similar tragedy occurring.
People with concerns can use Ryan’s rule to ask a nurse or doctor in the first step, escalate to a nurse in charge if still not happy and finally phone a specialist phone line that has been set up to request a Ryan’s rule clinical review.
Germany has a similar system in place.
