How to push for a ‘critical review’ if you think your hospital has got it wrong

Martha’s Rule makes sure family members and loved ones are listened to if a patient deteriorates in hospital. This is how it will work

Trust in the system? It’s not always a given. And when a loved one’s life is at stake, having vital support takes precedence. Sadly, hospitals do make mistakes, doctors don’t always listen and the fears of terrified families are ignored. But the arrival of a new incentive to influence potential shortcomings of professionals, aims to help eliminate future pain and loss. The head of the NHS has announced the roll out of ‘Martha’s Rule’ in 100 hospitals across England from April, enabling patients and families to seek an urgent review if their condition deteriorates.
The policy is a result of nearly three years of campaigning by her parents, Merope Mills and Paul Laity, after Martha died in the summer of 2021, a few weeks before her 14th birthday. Martha had endured a bike accident during the family holiday in Snowdonia, resulting in a ruptured pancreas. Helicoptered to King’s College Hospital in London, the couple believed she would be receiving the best specialist care, but she developed an infection and her condition rapidly spiralled downward. Merope and Paul suspected sepsis, especially when Martha developed a rash, a typical sign of blood poisoning. Their fears were pushed aside as the doctors claimed the rash was an allergic reaction. The family later said they didn’t have the language or the opportunity to insist their daughter be taken into the ICU earlier.
Today, in the year that Martha would have turned 17, Merope remembers, “I watched Martha getting worse for longer than a week. By her bedside, I could see the dangerous trend – I knew her so well – but the different consultants each day failed to respond to it and told me she just had ‘a normal infection’. On the day of Martha’s most rapid, fatal deterioration I raised serious concerns but was ignored. I had nowhere else to turn. Now, with Martha’s Rule, there is somewhere else to turn in such a horrific situation. It won’t be needed very often, but as many doctors have told us, it should be introduced as widely as possible and it will help save lives.”
With the support of the think tank Demos throughout the campaign, the aim has always been to improve the system rather than wag a finger at it. Everyone involved wants Martha’s Rule to be as accessible as possible; a way for the patient or the patient’s family to feel more confident in challenging the care they are being given. There will be distinctive posters and leaflets placed in all wards in the selected hospitals – Merope remembers studying the various posters during the long hours of waiting throughout Martha’s illness. These posters, leaflets and screen displays will give details and phone numbers of the critical care outreach teams, who are on call 24/7, with advice on when and how to contact them.  
Polly Curtis, the CEO of Demos, says: “Let’s be clear here. It’s not about getting a generic second opinion. Patients and families are already entitled to escalate concerns and can ask for a second clinical opinion if they need one. Martha’s Rule is about round-the-clock access to a critical care team and the option of a rapid review if they are worried about their loved one’s condition. These teams are highly skilled and experienced and they can independently assess what is going on. Having the contact details for the team means a person can take control by calling the number themselves if they feel there is a significant change or deterioration, and their concerns are not being addressed.
“And while the specialists are experts on conditions and illnesses, they might not always know what is normal for a particular patient. A parent, a loved one or yourself will know when something isn’t right. This rule gives that extra line of defence and actually involves patients and families in the treatment much more closely.”
There has been some scepticism from medics who fear patients may overuse this policy, thus adding more strain to an already overstretched NHS. Merope replies: “Similar initiatives are in place in hospitals around the world and the evidence shows that they are used sparingly and have resulted in life-saving escalations. They are not abused by patients; families do not trigger them for non-serious reasons; they have not resulted in poorer care for other patients. I understand that the NHS is in crisis – there aren’t enough clinicians, and healthcare professionals are under great pressure. But as many doctors have told us, this is exactly the time when Martha’s Rule is most needed.”
Ultimately, the hope is that Martha’s Rule triggers a culture change in hospitals where the doctors and nurses start really listening to the families and patients. “This is a backstop because the general system can fail, but what we would really love is for Martha’s Rule not to be used because doctors and nurses are listening more,” adds Curtis.
When Martha was critically ill, she lay in her bed and quietly told her mother: “It feels like it’s unfixable.” The sense that an unheard voice means hope is fast disappearing must be excruciating. For Merope, there is small comfort in a better future for others. 
“We expect clinicians to have faith in their patients and their loved ones to use Martha’s Rule appropriately, and to recognise that listening to patients and those at their bedside – who can spot trends missed by the best systems – is the basis of safe treatment,” she says. “There are far too many preventable deaths in the NHS. Often poor communication is at the heart of them, with incomplete handovers and a lack of consistent care. Martha’s Rule will, in some situations, prevent these problems from becoming fatal.”
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