What is Martha’s rule?
Martha’s rule would give patients the right to a second medical opinion or assessment where they feel their concerns are being dismissed.
This rule stems from a campaign bought by the parents of a 13-year-old child called Martha Mills who sadly died in 2021 in a London hospital from sepsis after sustaining a pancreatic injury from a bicycle accident. There was a failure to identify a deterioration in Martha’s symptoms and a failure to admit her to intensive care leading to her avoidable death. The coroner ruled that she would most likely have survived had she been transferred to intensive care earlier.
What’s the Government position on Martha’s rule?
The Health Secretary confirmed this week that the case for introducing the rule is compelling and that he would be looking to implement Martha’s rule across the NHS but particularly in paediatrics.
What’s the current situation for patients?
The current position is that patients can ask for a second opinion but that is not a statutory right. There are global examples where a similar rule exists such as Ryan’s rule in Australia. There are also examples of individual NHS Trust patient safety led initiatives in the UK such as Call 4 Concern which is an outreach service that patients can access if they have concerns about the deterioration of a loved one.
Another recent example of strengthening patients’ voices is the legal decision in the case of ‘Montgomery’ in 2015 which, in effect, increased the standard a doctor must meet when discussing treatment options and obtaining consent.
Prior to that, in 2014 a statutory Duty of Candour was introduced which obliges all health service bodies to tell patients when things have gone wrong, explain what has happened and apologise. Sunday 17 September was also World Patient Safety Day.
How will Martha’s rule work in reality? My opinion…
Sadly, this is not a new dilemma. We see examples of patients seeking medical help, trying to speak up for themselves or a loved one, questioning a decision to ‘wait and see’, being sent home when they should have been admitted and not listened to in many of the cases we deal with. Nobody doubts that the NHS is staffed with amazing people all trying to do their best, but the reality is that this is a body that is overworked, understaffed and under resourced.
In this context, it is hard to see how such a rule can be meaningfully implemented rather than become another lip service initiative. Whilst undoubtedly there is a need for patients to be listened to and have access, in certain critical circumstances, to a second opinion/assessment, and why the sentiment of Martha’s rule is to be welcomed, but how it is to be rolled out will be the key to its success.
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