A legal right to request a second opinion will be open to inpatients at the Princess Elizabeth Hospital by March next year.
Health and Social Care has also confirmed that the right, known as ‘Martha’s Rule’, will be extended to patients being treated at the Emergency Department by March 2028.
The move has been welcomed by Deputy Gavin St Pier, who questioned the HSC President in the States this week.
“I’m encouraged that HSC have accepted the evidence from elsewhere that Martha’s Rule is benefiting patients and resulting in changes in the management of cases,” he told Express.
What is Martha’s Rule?
Martha’s Rule, also known as Martha’s Law, is a patient safety initiative adopted by the UK’s National Health Service, following a campaign by the parents of Martha Mills.
13-year-old Martha died of sepsis in 2021 after her pancreas was injured in a bike accident.
Her parents raised concerns as her condition worsened but Martha died while in hospital. A coroner later ruled that her death was avoidable.
Merope Mills’ and Paul Laity’s campaign for a method to escalate medical concerns led to Martha’s Law being introduced across the UK giving patients, their families, carers, and staff the legal and procedural right to request an urgent, independent second medical opinion if a patient’s condition is deteriorating and concerns are not being addressed by the current care team.
HSC President, Deputy George Oswald told the States that “evidence from the pilot studies in the UK shows that Martha’s Rule is benefiting patients and resulting in changes to the management of cases”.
He explained that HSC already “strongly supports patients, family, and staff being able to raise concerns about a patient’s condition, seek escalation where they remain concerned and have access to an independent clinical review”.
“Many of the principles underpinning Martha’s Rule are already reflected in practice in Guernsey,” he added.
“HSC is now working to formalise these arrangements in line with the recommendations for Martha’s Rule and intends to align with the UK position and formally implement the changes in accordance with the NHS timetable.”
Deputy St Pier welcomed this commitment, telling Express: “Whilst the principles underpinning Martha’s Rule enabling patients to raise concerns, seek escalation or obtain an independent clinical review may be reflected in local practice, I’m encouraged that HSC have accepted the evidence from elsewhere that Martha’s Rule is benefiting patients and resulting in changes in the management of cases.
“Patients and their families are vulnerable and often scared when attending the Emergency Department or in hospital for acute inpatient care, whether planned or unplanned, so it’s important that the principles are formalised so there is clarity and certainty for both patients and clinicians,” he added.
“I was also pleased that the Committee gave undertakings in the States that these arrangements will be put in place on the same timeframe as in NHS England – so by March 2027 for inpatient services and by March 2028 for the Emergency Department.”
Deputy Oswald highlighted issues with extending Martha’s Rule to some services, including maternity and neonatal services, ENT, or psychiatry in Guernsey – with “workarounds” being explored.
This could involve off island consultations with experts elsewhere, he explained.
Responding to a query from Deputy John Gollop about the availability of on-island expertise, Deputy Oswald reassured him that there is “adequate provision” in local health services.
“I think we have to be clear about what Martha’s Rule actually means,” he said.
“It is not a route to a second opinion about an underlying diagnosis. It’s a route for the escalation of care, where patients, or relatives, or staff, are concerned that a deteriorating situation has not been observed and is not being acted upon.
“As such, currently there is adequate provision for that 24-hours-a-day, seven-days-a-week, in hospital with the outreach team from the intensive care unit in particular playing an important role in this, and they could of course outreach to any area where a patient is deteriorating.
“As I mentioned to Deputy St Pier, it is more difficult in areas where the breadth of experience or availability of staff locally matches the size of our hospital and our community.
“In those circumstances, we are looking at workarounds to exactly satisfy those issues.
“But I can assure you that in the case of any patient deteriorating suddenly and unexpectedly in hospital, help is at hand all hours of the day.”
Clarifying why Martha’s Rule needs to be formally introduced when its principles are already followed here, in response to a question from Deputy Haley Camp, Deputy Oswald offered some insight into what it is like for a clinician who intervenes in a patient’s care.
“As I pointed out in my response, the actual principles behind the establishment of Martha’s Rule are already firmly established and practiced locally,” he said.
“Certainly in my clinical days, I was an active proponent, and indeed intervened on a number of occasions, much to the ire of the medical community in years gone past.
“And indeed, my appointment to the hospital committee here was delayed by a year because I upset somebody in exactly those circumstances.
“So this is a long-standing principle that I hope all of my colleagues will understand and appreciate.
“I think it’s appropriate to formally align with the UK NHS position, so I’ve got no issues about that.”
