Patients and their families can request a rapid second opinion from April if they are worried about a condition getting worse, as the NHS rolls out Martha’s Rule in England.
The escalation process will instigate an urgent review by a different critical care team in the hospital and will be available 24/7.
It can be used if a patient’s condition is rapidly worsening and they or their family feels they are not getting the care needed.
The new process follows the death of 13-year-old Martha Mills in 2021, who developed sepsis under the care of King’s College Hospital NHS Foundation Trust in London.
Her parents – who campaigned for the change – said they want it “in place as quickly and widely as possible”, with at least 100 NHS trusts expected to bring in the rule initially.
“We believe Martha’s Rule will save lives,” Merope Mills and her husband Paul Laity said in a statement.
“In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t; their knowledge should be recognised as a resource.
“We also look to Martha’s Rule to alter medical culture: to give patients a little more power, to encourage listening on the part of medical professionals, and to normalise the idea that even the grandest of doctors should welcome being challenged.”
Martha was being treated after suffering a pancreatic injury in a fall from her bike during a holiday in Wales.
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An inquest heard there were several missed opportunities to refer her to intensive care, and that she probably would have survived if doctors had identified sooner that she was rapidly getting worse.
At one point, Martha began to bleed heavily through a tube inserted into her arm and through a drainage tube, and she also developed a rash.
Her mother voiced concerns to staff that her daughter would go into septic shock over the bank holiday weekend.
One of the trust’s own intensive care doctors told the inquest he would “100%” have admitted her if he had seen her.
The trust – a specialist referral centre for children with pancreatic problems – has apologised.
The plan is to extend Martha’s Rule to all acute hospitals, subject to government funding, with the programme evaluated throughout this year and next.
NHS chief executive Amanda Pritchard said it had the potential to “save many lives in the future”, while Health Secretary Victoria Atkins said it would “provide a major boost to patient safety”.
“The introduction of Martha’s Rule from April will put families at the heart of the patient’s own care, recognising the critical role they have in the treatment of loved ones,” said Ms Atkins.
Martha’s parents said their daughter’s death was “a preventable death but Martha’s Rule will mean that she didn’t die completely in vain”.
Marnie’s first serious relationship came when she was 16-years-old.
Warning: This article contains references to strangulation, coercive control and domestic abuse.
She was naturally excited when a former friend became her first boyfriend.
But after a whirlwind few months, everything changed with a slow, determined peeling away of her personality.
“There was isolation, then it was the phone checking,” says Marnie.
As a survivor of abuse, we are not using her real name.
“When I would go out with my friends or do something, I’d get constant phone calls and messages,” she says.
“I wouldn’t be left alone to sort of enjoy my time with my friends. Sometimes he might turn up there, because I just wasn’t trusted to just go and even do something minor like get my nails done.”
Image: The internet is said to be helping to fuel a rise in domestic abuse among teens. Pic: iStock
He eventually stopped her from seeing friends, shouted at her unnecessarily, and accused her of looking at other men when they would go out.
If she ever had any alone time, he would bombard her with calls and texts; she wasn’t allowed to do anything without him knowing where she was.
He monitored her phone constantly.
“Sometimes I didn’t even know someone had messaged me.
“My mum maybe messaged to ask me where I was. He would delete the message and put my phone away, so then I wouldn’t even have a clue my mum had tried to reach me.”
The toll of what Marnie experienced was only realised 10 years later when she sought help for frequent panic attacks.
She struggled to comprehend the damage her abuser had inflicted when she was diagnosed with PTSD.
This is what psychological abuse and coercive control looks like.
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2:56
‘His hands were on my throat – he didn’t stop’
Young women and girls in the UK are increasingly falling victim, with incidents of domestic abuse spiralling among under-25s.
Exclusive data shared with Sky News, gathered by domestic abuse charity Refuge, reveals a disturbing rise in incidents between April 2024 and March 2025.
Psychological abuse was the most commonly reported form of harm, affecting 73% of young women and girls.
Of those experiencing this form of manipulation, 49% said their perpetrator had threatened to harm them and a further 35% said their abuser had threatened to kill them.
Among the 62% of 16-25 year olds surveyed who had reported suffering from physical violence, half of them said they had been strangled or suffocated.
Earlier this year, Sky News reported that school children were asking for advice on strangulation, but Kate Lexen, director of services at charity Tender, says children as young as nine are asking about violent pornography and displaying misogynistic behaviour.
Image: Kate Lexen, director of services at charity Tender
“What we’re doing is preventing what those misogynistic behaviours can then escalate onto,” Ms Lexen says.
Tender has been running workshops and lessons on healthy relationships in primary and secondary schools and colleges for over 20 years.
Children as young as nine ‘talking about strangulation’
Speaking to Sky News, Ms Lexen says new topics are being brought up in sessions, which practitioners and teachers are adapting to.
“We’re finding those Year 5 and Year 6 students, so ages 9, 10 and 11, are talking about strangulation, they’re talking about attitudes that they’ve read online and starting to bring in some of those attitudes from some of those misogynistic influencers.
“There are ways that they’re talking about and to their female teachers.
“We’re finding that from talking to teachers as well that they are really struggling to work out how to broach these topics with the students that they are working with and how to make that a really safe space and open space to have those conversations in an age-appropriate way, which can be very challenging.”
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Hidden domestic abuse deaths
Charities like Tender exist to prevent domestic abuse and sexual violence.
Ms Lexen says without tackling misogynistic behaviours “early on with effective prevention education” then the repercussions, as the data for under 25s proves, will be “astronomical”.
At Refuge, it is already evident. Elaha Walizadeh, senior programme manager for children and young people, says the charity has seen a rise in referrals since last year.
Image: Elaha Walizadeh, senior programme manager for children and young people at Refuge
“We have also seen the dynamics of abuse changing,” she adds. “So with psychological abuse being reported, we’ve seen a rise in that and non-fatal strangulation cases, we’ve seen a rise in as well.
“Our frontline workers are telling us that the young people are telling them usually abuse starts from smaller signs. So things like coercive control, where the perpetrators are stopping them from seeing friends and family. It then builds.”
Misogyny to violent behaviour might seem like a leap.
But experts and survivors are testament to the fact that it is happening.
It says human rights in the UK “worsened” in 2024, with “credible reports of serious restrictions on freedom of expression”, as well as “crimes, violence, or threats of violence motivated by antisemitism” since the 7 October Hamas attack against Israel.
On free speech, while “generally provided” for, the report cites “specific areas of concern” around limits on “political speech deemed ‘hateful’ or ‘offensive'”.
Sir Keir Starmer has previously defended the UK’s record on free speech after concerns were raised by Mr Vance.
In response to the report, a UK government spokesperson said: “Free speech is vital for democracy around the world including here in the UK, and we are proud to uphold freedoms whilst keeping our citizens safe.”
Image: Keir Starmer and JD Vance have clashed in the past over free speech in the UK. Pics: PA
The US report highlights Britain’s public space protection orders, which allow councils to restrict certain activities in some public places to prevent antisocial behaviour.
It also references “safe access zones” around abortion clinics, which the Home Office says are designed to protect women from harassment or distress.
They have been criticised by Mr Vance before, notably back in February during a headline-grabbing speech at the Munich Security Conference.
Ministers have said the Online Safety Act is about protecting children, and repeatedly gone so far as to suggest people who are opposed to it are on the side of predators.
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Why do people want to repeal the Online Safety Act?
The report comes months after Sir Keir bit back at Mr Vance during a summit at the White House, cutting in when Donald Trump’s VP claimed there are “infringements on free speech” in the UK.
“We’ve had free speech for a very long time, it will last a long time, and we are very proud of that,” the PM said.
But Mr Vance again raised concerns during a meeting with Foreign Secretary David Lammy at his country estate in Kent last week, saying he didn’t want the UK to go down a “very dark path” of losing free speech.
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The Trump administration itself has been accused of trying to curtail free speech and stifle criticism, most notably by targeting universities – Harvard chief among them.