A MAJOR rule change to allow patients a right to second medical opinion to be tested and rolled out in 143 hospitals.
Named after teenage Martha Mills, who died of sepsis despite her parents’ pleas that she wasn’t receiving the necessary care, the rule will see give patients and their families access to a rapid review if they are worried about their condition.
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NHS England pledged to introduce ‘Martha’s Rule’ to at least 100 hospitals in February.
But it announced today that 143 sites will roll out the rule change by March 2025 – surpassing the initial target – following “significant interest” from hospitals across the country.
The purpose of Martha’s Rule is to provide “a consistent and understandable way for patients and families to seek an urgent review if their or their loved one’s condition deteriorates and they are concerned this is not being responded to”, NHSE said.
It’s now working with Martha’s parents to develop materials to advertise and explain the initiative in hospitals across the country, so patients, their families and staff know when to call for a second opinion.
Read more on Martha’s Rule
Martha Mills, 13 , died from sepsis in 2021 after medics at King’s College Hospital, London, failed to boost her intensive care despite her parents raising concerns about her rapidly deteriorating condition.
Her parents Merope Mills and Paul Laity said: “We are pleased that the roll-out of Martha’s Rule is off to a flying start and that the need for it has been so widely recognised.
“It will save lives and encourage better, more open, communication on hospital wards, so that patients feel they are listened to, and partners in their healthcare.”
HOW WILL THE ‘3-STEP SAFETY NET’ WORK?
NHSE was initially aiming to implement the rule change in at least 100 hospitals.
But “significant interest from frontline clinicians” had lead to the first phase of the programme being expanded.
By March 2025, patients and their families will be able to request an urgent review into their or their loved one’s care in 143 locations across the country.
Each hospital will evaluate whether the system works over the course of this year.
Martha’s Rule could then be further expanded across all acute hospitals in England, subject to future government funding.
The rule will be made up of three components so that concerns about deterioration can be swiftly responded to.
Firstly, an escalation process will be available 24/7 at all the 143 sites.
This will be advertised throughout the hospitals on posters and leaflets, enabling patients and families to contact a critical care outreach team that can swiftly assess a case and escalate care if necessary.
Secondly, NHS staff will also have access to this same process if they have concerns about a patient’s condition.
Finally, clinicians at participating hospitals will also be obligated to formally record insights and information about a patient’s health provided by their families daily.
This will ensure that any concerning changes in behaviour or condition noticed by the people who know the patient best are considered by staff, NHSE said.
‘MOST IMPORTANT CHANGE TO PATIENT CARE IN YEARS’
Martha’s parents Merope and Paul campaigned extensively for a single system that allows patients or their families to trigger an urgent clinical review from a different team in the hospital if the patient’s condition is rapidly worsening and they feel they are not getting the care they need.
They were supported by the cross-party think tank Demos.
Their campaigning saw widespread support from hospitals and clinicians.
Professor Sir Stephen Powis, NHS national medical director, said: “Rolling out Martha’s Rule to over 143 NHS sites in this first phase will represent one of the most important changes to patient care in recent years, and we are pleased to have seen such interest from hospitals right across the country, all thanks to the moving and dedicated campaigning by Martha’ parents, Merope and Paul.
“That is why today is such an important milestone, with the NHS outlining the 143 sites where this major patient safety initiative will be rolled out later this year, allowing staff, patients and families to immediately raise concerns and bring about an escalation in care in an easily recognisable and fast way.
“The inclusion of daily insights from families about their loved ones’ condition within patient records is also a really significant step and will help staff identify changes and deterioration using insights from those who know the patient best.
“While thankfully the need for escalation of care will hopefully only be needed in a limited number of cases, this three-step safety net has the opportunity to truly transform patient care and safety.”
What are the symptoms of sepsis?
SEPSIS is a life-threatening reaction to an infection that happens when your immune system overreacts and starts to damage your body’s own tissues and organs.
Symptoms of sepsis in an adult include:
- Acting confused, slurred speech or not making sense
- Blue, grey, pale or blotchy skin, lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
- A rash that does not fade when you roll a glass over it, the same as meningitis
- Difficulty breathing, breathlessness or breathing very fast
Symptoms in a child include:
- Blue, grey, pale or blotchy skin, lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
- A rash that does not fade when you roll a glass over it, the same as meningitis
- Difficulty breathing (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
- A weak, high-pitched cry that’s not like their normal cry
- Not responding like they normally do, or not interested in feeding or normal activities
- Being sleepier than normal or having difficulty waking
They may not have all these symptoms.
If you think you or someone else has symptoms of sepsis, call 999 or go to A&E.
Source: NHS
NHS national patient safety director and senior responsible officer for Martha’s Rule, Dr Aidan Fowler, added: “Working closely with Martha’s parents and colleagues across the NHS over the last few months on this rollout, I am in no doubt this programme will deliver clear change.
“It has been so encouraging to see how many hospitals have shown interest in being part of delivering these all-important patient safety measures this year.
He said the new processes brought about by Martha’s rule “can help us better identify and manage deterioration as part of wider work, which is a key priority for us and will no doubt lead to improvements in the care patients receive”.
The parents of young rugby star Maddy Lawrence recently expressed their support of Martha’s Rule, after their 20-year-old daughter died in hospital from sepsis.
Maddy’s “screams of pain” weren’t listened to by medics until it was too late and she was branded a “difficult patient”.
WHICH HOSPITALS ARE ROLLING OUT MARTHA’S RULE?
NHS provided the full list of hospitals rolling out the rule change:
- Addenbrooke’s Hospital
- Watford General Hospital
- Princess Alexandra Hospital
- Colchester Hospital
- Bedford Hospital
- Southend Hospital
- Basildon Hospital
- Broomfield Hospital
- Peterborough City Hospital
- Lister Hospital
- West Suffolk Hospital
- Luton and Dunstable University Hospital.
- James Paget University Hospital
- The Queen Elizabeth Hospital
- Norwich University Hospital
- Ipswich Hospital
- University Hospital Lewisham
- The Royal Marsden Hospital , Chelsea
- The Royal Marsden Hospital, Sutton
- Croydon University Hospital
- St Georges Hospital
- Barnet Hospital
- Royal Free Hospital
- Great Ormond Street Hospital for Children
- North Middlesex University Hospital
- University College Hospital
- Kingston Hospital
- Kings College Hospital (Denmark Hill Site)
- Queen Elizabeth Hospital
- Princess Royal University Hospital
- Chelsea and Westminster Hospital
- West Middlesex University Hospital
- Northwick Park Hospital
- Charing Cross Hospital
- Hillingdon Hospital
- St. Mary’s Hospital
- Hammersmith Hospital
- Newham University Hospital
- Homerton University Hospital
- St Bartholomew’s Hospital
- Whipps Cross Hospital
- Royal London Hospital
- The Whittington Hospital
- Ealing Hospital
- Northampton General Hospital
- Kettering General Hospital
- Royal Stoke University Hospital
- New Cross Hospital
- Manor Hospital
- Pilgrim Hospital Boston
- Birmingham Heartlands Hospital
- Good Hope Hospital
- Queen Elizabeth Hospital
- Solihull Hospital
- Birmingham Children’s Hospital
- Russell’s Hall Hospital
- Sandwell General Hospital and City Hospital (two sites)
- Glenfield Hospital
- Kings Mill Hospital
- Kettering General Hospital
- University Hospital Coventry
- Lincoln County Hospital
- Leicester Royal Infirmary
- Leicester General Hospital
- Robert Jones and Agnes Hunt Orthopaedic Hospital
- Sheffield Childrens Hospital
- Barnsley Hospital
- Queen Elizabeth Hospital
- Site: Sunderland Royal Hospital
- Site: South Tyneside District General Hospital
- Huddersfield Royal Infirmary
- York Hospital
- Cumberland Infirmary
- University Hospital of North Durham
- Bishop Auckland Hospital
- Royal Victoria Infirmary, Newcastle
- Freeman Hospital
- James Cook University Hospital
- Darlington Memorial Hospital
- West Cumberland Hospital
- Pinderfields Hospital
- Calderdale Royal Hospital
- Leeds General Infirmary
- Bradford Royal Infirmary
- Airedale General Hospital
- St James’s Hospital
- Countess of Chester Hospital
- Wirral University Teaching Hospital
- Royal Liverpool University
- Southport District General Hospital
- Blackpool Victoria Hospital
- Royal Blackburn Hospital
- Burnley General Hospital
- Royal Bolton Hospital
- Royal Manchester Children’s Hospital
- Alder Hey Childrens Hospital
- The Walton Centre
- Leighton Hospital
- Warrington Hospital
- Preston and Chorley Hospitals
- Royal Blackburn Hospital
- Tameside General Hospital
- The Christie
- Royal Oldham Hospital
- Royal Albert Edward Infirmary, Wigan
- St Mary’s Hospital
- Frimley Park Hospital
- Wexham Park hospital site
- Darent Valley Hospital
- The Tunbridge Wells Hospital
- Maidstone Hospital
- Southampton Children’s Hospital
- Royal Berkshire Hospital
- Stoke Mandeville Hospital
- Conquest Hospital
- Eastbourne District General Hospital
- Royal Sussex County Hospital
- Princess Royal Hospital
- Medway Maritime Hospital
- William Harvey Hospital, Ashford
- QEQM Hospital, Margate
- Queen Alexandra Hospital
- Basingstoke North Hampshire Hospital
- East Surrey Hospital
- Southampton General Hospital
- Bristol Royal Infirmary
- Great Western Hospital
- Salisbury District Hospital
- Cheltenham General Hospital
- Gloucestershire Royal Hospital
- Dorset County Hospital
- Royal Bournemouth Hospital
- Poole Hospital
- Torbay Hospital
- Derriford Hospital
- Musgrove Park Hospital
- Yeovil District Hospital
- Weston General Hospital
- Southmead Hospital
- Bristol Royal Hospital for Children
- Royal United Hospital, Bath
- Treliske Site – Royal Cornwall Hospital