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Martha’s Rule will force doctors to take note of parents’ ‘instincts’

Martha Mills
Martha's Rule is named for Martha Mills, who died aged 13 after doctors failed to heed her parents' concerns

Doctors will be forced to take notes of parents’ instincts about how their children are faring in hospital under Martha’s Rule, NHS leaders will announce today.

Under the measures, medics will also be obliged to accept any request for a second opinion if relatives believe a patient’s condition is worsening.

Clinical staff will be told to formally record daily insights and information about a patient’s health given by parents and families.

Medics will be told they must take account of changes in behaviour or condition as noted by those who know the patient best.

The new guidance, which is being introduced to more than 100 NHS sites across the country from April,  also gives families the right to a second opinion from an independent team of doctors in cases where a condition is deteriorating.

It is named after Martha Mills, who died in 2021, aged 13, after doctors at King’s College Hospital in London missed signs of sepsis, having failed to heed her parents’ warnings that their child’s condition was rapidly deteriorating.

‘Anyone concerned can now act’

Victoria Atkins, the Health Secretary, says the changes aim to ensure that doctors listen to families and do not miss vital warnings.

Writing for the Telegraph, she says: “No parent should have to go through what they have been through. As a mother or father, you know when something isn’t right with your child. Martha’s Rule recognises that instinct and allows anyone concerned to act.”

Ms Atkins says the NHS must not “be blind to its failings”, adding that the changes are a step towards ensuring “no family has to endure the heart-rending loss of a loved one for want of a second opinion”.

Victoria Atkins, the Health Secretary
Ms Atkins says the NHS must not be blind to its own failings - JEFF GILBERT/JEFF GILBERT

Merope Mills and Paul Laity, Martha’s parents who campaigned for the changes, said the rule would mean their child’s death was “not entirely in vain”.

They 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.”

Care team on call 24/7

Families seeking a second opinion for their loved ones’ care will have access to a critical-care team for a “rapid review” 24 hours a day. The escalation service will also be advertised throughout hospitals.

Under the move, an urgent clinical review would be carried out by a different team in the hospital if a patient’s condition was worsening rapidly and they or their family felt they were not getting the care needed.

At least 100 NHS trusts are expected to bring in the rule, with the programme evaluated throughout this year and next. The plan is to then extend Martha’s Rule to all acute hospitals, subject to Government funding.

Merope and Martha Mills
Merope Mills said the rule would mean their child’s death was “not entirely in vain”.

A coroner ruled that Martha would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier.

Martha’s parents repeatedly raised concerns about her health with medics, only to be brushed aside.

They urged all NHS staff to listen to families, saying that this meant changing the culture in parts of the health service.

They said: “We call on all NHS clinicians to back the initiative: we know that the large majority do listen, are open with patients and never complacent – but Martha’s doctors worked in a different culture, so some situations need to change.

“Our daughter was quite something: fun and determined, with a vast appetite for life and so many plans and ambitions – we’ll never know what she would have achieved with all her talents.

“Hers was a preventable death but Martha’s Rule will mean that she didn’t die completely in vain.”

Missed opportunities in Martha’s death

Martha was being looked after at King’s after suffering a pancreatic injury following a fall from her bike while on a family holiday in Wales.

An inquest heard there were several missed opportunities to refer Martha to intensive care. At one point, Martha began to bleed heavily through a tube inserted into her upper arm and through a drainage tube.

She also developed a rash and her mother voiced concerns to staff that Martha would go into septic shock over a bank holiday weekend. The trust, which is a specialist national referral centre for children with pancreatic problems, has since apologised for mistakes in Martha’s care.

One of the trust’s intensive care doctors told the inquest into Martha’s death he would “100 per cent” have admitted her if he had seen her.

Ms Atkins said: “I have read Merope’s heart-wrenching account of the poor care Martha received, how she was ignored and how the many opportunities to save Martha’s life were missed. I want to see Martha’s Rule provide patients with peace of mind.”

Amanda Pritchard, the chief executive of the NHS, said Martha’s Rule had the potential to “save many lives in the future”.

She said: “Hearing about the heartbreaking loss of Martha and the experiences of her family has had a major impact for people right across the country, with parents, patients and NHS staff welcoming her parents’ call for a simple process to escalate concerns when they can see a loved one’s condition worsening.”

Rory Deighton, the director of the NHS Confederation’s acute network, welcomed the move and said it was “right for the NHS to learn lessons from cases such as these and to take steps to try to prevent avoidable deaths”.
But he said questions remained about what resources hospitals would receive to deliver the new scheme.

“Introducing a 24/7 clinical review process will have implementation costs, and [hospital] leaders will be concerned if they are just being expected to provide the additional service without any extra resources,” he said.

The first stage of the rollout, to sites with existing critical care outreach, will be funded with £10million to support implementation.