Martha's rule is a new patient safety initiative by NHS England. It allows patients, families, carers, advocates and NHS staff to request a rapid review from a critical care outreach team at any time if they have concerns about a patient's condition.

The rule is named after Martha Mills, who died in 2021 from sepsis after her family's concerns were not addressed. A coroner later concluded that Martha would likely have survived if she had been moved to intensive care earlier.

Martha's rule aims to ensure that patients and families can get a second opinion when they feel their concerns are not being addressed. A phased implementation is in its early stages across the NHS in England.

Patients' rights to a second opinion

Martha's rule includes three key components.

NHS staff must have 24/7 access to a rapid review from a critical care outreach team if they have concerns about a patient.
Patients, their families, carers, and advocates must also have 24/7 access to the same rapid review if they're worried about a patient's condition. Contact details for the critical care outreach team should be clearly advertised in the hospital.
The NHS must implement a structured approach to gather information directly from patients and their families at least once a day, initially covering all in-patients in acute and specialist trusts.

GMC guidance

The GMC, the Nursing and Midwifery Council (NMC) and the CQC have released a joint statement on Martha's rule, noting that it aligns with the GMC's 'Good medical practice' (2024) guidance.

The following points from 'Good medical practice' are particularly relevant.

"Good medical professionals recognise that patients are individuals with diverse needs, and don't make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them." (Domain 2)
Doctors must treat patients with kindness, courtesy and respect. This means listening to patients, recognising their knowledge and experience of their health, and acknowledging their concerns (paragraph 23).
You must recognise a patient's right to choose whether to accept your advice and respect their right to seek a second opinion (paragraph 18).
You must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information (paragraph 37).
When providing clinical care, you must consult colleagues or seek advice from your supervising clinician where appropriate (paragraph 7). Good medical professionals communicate clearly and work effectively with colleagues in the interests of patients (domain 3).

The GMC's specific guidance on 'Decision making and consent' also emphasises that all patients have the right to be involved in decisions about their care, and that serious harm can result if patients are not listened to.

Medico-legal implications

As noted in the GMC guidance, doctors must listen to and acknowledge patients and their family's concerns and respect their right to a second opinion.

While Martha's rule will establish a 24/7 critical care outreach team for second opinion for patients and their families, doctors and other healthcare staff can also contact this team when they have concerns.

Martha's rule: what it means for doctors

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