The UK government has committed to introducing a law giving patients and their families the power to request a clinical review, if they feel their concerns are being ignored – and it is likely to involve nurses at every step.

Health and social care secretary Steve Barclay told BBC Radio 4’s Today programme last week that he was “mov[ing] quickly” and was “committed” to bringing in Martha’s Rule, after hinting at it in the House of Commons earlier this month.

“A key part of this measure is that patients feel heard and get a second opinion”

Steve Barclay

Martha’s Rule would empower patients to formally request a review of their, or their family members’, case by a senior nurse or doctor, if the patient was deteriorating and they felt their concerns were not being listened to.

The rule is named after 13-year-old Martha Mills, who died of sepsis after falling off her bicycle while on holiday with her family in 2021.

Martha was admitted to hospital following the fall onto her bicycle’s handlebars, which caused a pancreatic laceration.

Merope Mills, Martha’s mother, wrote an account of how her daughter was transferred to King’s College Hospital NHS Foundation Trust.

There, Martha’s her condition deteriorated quickly and signs of sepsis were not acted upon by doctors quickly enough.

Ms Mills raised the alarm about sepsis to clinicians and asked for more urgent action to be taken, but was instead reassured by medical and nursing staff that her daughter’s condition would improve.

It did not, and the 13-year-old died after subsequently being transferred, far too late, to paediatric intensive care.

Ms Mills has spent the time since her daughter’s death campaigning for the introduction of Martha’s Rule, which would work similarly to Ryan’s Rule, introduced in Queensland, Australia, after a similar case to Martha’s.

It also bears resemblence to Call 4 Concern, a system which has already been adopted by some UK hospitals. Call 4 Concern gives patients a direct line to ask a clinical team, separate from the one already in charge of the patient, to review or give a second opinion on the case.

Recommendations from the Martha’s Rule campaign, led by Merope Mills: 

“In the models we have evaluated we have identified clear elements that improve effectiveness:

  • The referral point must be independent of the treating team
  • The referral point must be reliable
  • The system must be communicated effectively, for example via posters in high traffic areas
  • In best practice more junior staff members are also encouraged to use it along with patients and their families

“NHS England should develop best practice guidance to allow hospitals to adopt this system as soon as possible.

“Hospitals should adopt Martha’s Rule as a matter of urgency and communicate it clearly to patients.

“The Care Quality Commission, that inspects hospitals, should consider Martha’s Rule standard practice in inspections and include their implementation in inspections.”

The problems at the heart of the Martha Mills case, according to an inquest, lay among medical staff.

However, if the new law is brought in, it is likely to heavily involve nursing staff, and a Martha’s Law proposal document led by Ms Mills pointed out that in her daughter’s case, junior doctors and nurses often felt unable to challenge the decisions of consultants – and it called for better communication between nursing and medical staff.

Steve Barclay, in a speech to the Commons on 4 September, said he was “exploring” the introduction of Martha’s Rule to the UK.

Mr Barclay said: “Martha’s Rule would be similar to Queensland’s system, called Ryan’s Rule.

“It’s a three-step process that allows patients or their families to request a clinical review of their case from a doctor or nurse if their condition is deteriorating or not improving as expected. 

“Ryan’s Rule has saved lives in Queensland, and I’ve asked my department and the NHS to look into whether similar measures could improve patient safety here in the UK.”

Mr Barclay’s hints at emulating Ryan’s Rule suggests the clinical review that a patient, or family member, can request could go to a nurse in the first instance, not necessarily a doctor.

Ryan’s Rule

Clinical Excellence Queensland lays out the Ryan’s Rule escalation process as:

Step 1: Talk to a nurse or doctor about your concerns. If you are not satisfied with the response, go to the next step.

Step 2: Talk to the nurse in charge of the shift. If you are not satisfied with the response, go to the next step.

Step 3: Phone 13 HEALTH (13 43 25 84) or ask a nurse to phone for you, and request a Ryan’s Rule Clinical Review. You will need to provide the hospital name, patient’s name, ward and bed number (if known), and your contact number

Once the rule is enacted, a nurse or doctor will undertake a Ryan’s Rule clinical review of the patient and the treatment they are receiving.

Mr Barclay said the next steps for introducing Martha’s Rule would be speaking with NHS trusts to figure out how the law would work differently across different wards and medical specialisms.

“I think the case Merope has set out is compelling,” he said. “It is for everyone who heard it, an absolutely heartbreaking case and I’m determined we learn the lessons from it.

 “I particularly want to give more credence to the voice of patients, and a key part of this measure is that patients feel heard and get a second opinion,” he said.

Ms Mills said: “Having met with the Secretary of State for Health, NHS England and the Patient Safety Commissioner, I understand that Martha’s Rule will be implemented across NHS England hospitals, and sooner rather than later.

“We are grateful for the surge of support for Martha’s Rule within the NHS and among individual clinicians.

“The rule will be a standardised and recognisable right that will become part of patients’ experience on hospital wards. I’m looking forward to working with hospitals and staff to make its implementation as effective as possible. Our incredible daughter Martha lost her life needlessly, far too young.

“We believe this new rule will put some power back into the hands of patients, do something to change the culture within hospitals and prevent unnecessary deaths.”

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