This week the health secretary, Steve Barclay, announced that the government would introduce Martha’s rule in England, giving patients and their families the power to obtain a second opinion from senior medics in the same hospital if they are deteriorating rapidly and feel their concerns are being dismissed. It follows the campaign by the parents of Martha Mills, who died in 2021 after hospital doctors failed to admit her to intensive care. Martha, 13, died after developing sepsis at King’s College hospital in south London. Claudia Paoloni, consultant anaesthetist at University Hospitals Bristol and Weston NHS trust Martha’s rule should only be used as a last resort, because other patient safety systems already in place should be working. Otherwise, there is a risk that this becomes another kneejerk reaction by ministers to an individual incident that actually reflects wider issues within the NHS. It shouldn’t actually be needed. There are a whole load of safety processes that every trust should be doing when patients deteriorate. Everyone who turns up in hospital should be assessed and marked on a risk level for their status and then, by having regular observations done, a deteriorating patient will be very quickly seen. It’s a very simple visual score that shows you if someone’s pulse is going up, their temperature is going up, their blood pressure is going down, their breathing rate is going up, they start going into a red zone. As soon as they go to red, that should trigger a response. A more senior member of staff has to be called and if vital trends keep going down, then automatically high levels of care should be involved. It might be an outreach team from intensive care or a move to intensive care depending on the size of the hospital, but there will be a pathway to manage a deteriorating patient and that should be within a policy. But Martha’s rule could be an additional safety mechanism, when other patient safety systems don’t be seem to be working. All trusts should have adequate emergency warning systems and a deteriorating patient policy. If patients have concerns, is it because these policies aren’t being followed properly? So often when problems arise in these sorts of circumstances, it’s either because of lack of staffing, inadequate handovers, multiple teams are involved making it hard to coordinate continuous care, or there are communications failings. If all of the systems have failed for all of these reasons, then a patient or patient’s relative should have an ability to raise concerns themselves. But I wouldn’t want to advocate it or say it is the answer, because it isn’t the answer. Because if you’re getting to that point, what you’re saying is the other systems aren’t working.