Martha's Rule: A new policy to amplify patient voice and improve safety in hospitals (September 2023)

Summary

Martha Mills died from sepsis aged 13 after sustaining a pancreatic injury from a bike accident. The inquest into her death heard that she would likely have survived had consultants made a decision to move her to intensive care sooner. Her mother, Merope, has spoken about the failures in Martha’s care, and how she trusted the clinicians against her own instincts – they didn’t listen to her concerns and instead “managed” her.

This report is a response to that call from Martha Mills’ parents to rebalance the power between patients and medics with one purpose only: to improve patient safety. It comes amidst significant evidence that shows that failing to properly listen to patients and their families contributes to safety problems in the NHS.

Content

Martha’s Rule would mean that in the event of a suspected deterioration or serious concern on the part of a patient on a hospital ward, or their family or carer, they would have the right easily to call for a rapid review or second opinion from an ICU/HDU doctor within the same hospital.

Recommendation 1 

NHS England should develop best practice guidance to allow hospitals to adopt this system as soon as possible.

Recommendation 2

Hospitals should adopt Martha’s Rule as a matter of urgency and communicate it clearly to patients.

Recommendation 3

The Care Quality Commission, that inspects hospitals, should consider Martha’s Rule standard 

practice in inspections and include their implementation in inspections.

Further recommendations

We considered three further recommendations, but have chosen to focus on Martha’s Rule as potentially the most immediately effective: 

• The right to access patient notes. This could shift the power dynamic between patients and doctors, and put the onus on the doctors to communicate in an inclusive and more relational way with patients. To implement real time open notes in acute settings it would taketesting, and training, to make it achievable in practice. 
• The right to a named consultant. This was already recommended by the Francis review but hospitals have not consistently adopted it. The government should now review the extent of the implementation in order to understand the barriers, and work with the CQC to consider its implementation in its inspections. It should be considered best practice.
• A review of medical training to improve non-technical skills. Non-technical skills in medical training are undervalued and inconsistently delivered. Training is largely on the job, delivered by people already steeped in the NHS culture that is, rather than the culture it aspires to have. In light of the safety consequences identified here, this should be reviewed.