Martha’s Rule: A new policy to amplify patient voice and improve safety in hospitals

Patients and families should have a right to request a clinical review to help rebalance power in hospitals and improve patient safety, think tank recommends.

‘Martha’s Rule’ would help save lives, say parents whose daughter died after a series of catastrophic errors.

Martha Mills, who died aged 13 in 2021, Mills/Laity family photograph

• Families must be given a new route to challenge clinicians in high-stakes hospital scenarios, according to a new report from the cross-party think tank Demos

• Martha’s Rule: A New Policy to Amplify Patient Voice and Improve Safety follows the unnecessary death of Martha Mills, who died aged 13 in 2021. The inquest into her death heard that she would likely have survived the septic shock that killed her had consultants made a decision to move her into intensive care sooner – she stayed on the ward though her mother explicitly raised a concern about sepsis.

• ‘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 to easily call for a rapid review or second opinion from a senior clinician within the same hospital

• Martha’s parents, Merope Mills and Paul Laity, are backing the report. Mills, who wrote the report’s foreword, said: “The NHS ultimately belongs to patients and they should be allowed a second opinion, with no stigma attached, if things are looking bleak.”

The report calls for a rebalance of power between patients and medical professionals through the introduction of ‘Martha’s Rule’, a new method that would give patients, families and carers the opportunity to easily request a second opinion in the event of a suspected deterioration or serious concern.

Martha’s Rule: A New Policy to Amplify Patient Voice and Improve Safety , was developed after consultations with NHS experts and hospital leaders. It involved a private roundtable with Martha’s parents and high-level NHS personnel, as well as a review of existing evidence on the relationships between medics and their patients and families.

Martha’s Rule is modelled on the Call 4 Concern system that has been adopted by a number of hospitals in the UK and, to an extent, Ryan’s Rule in Australia. These schemes give patients a direct line to a separate clinical team to request a review, or a second opinion. Research in hospitals that have adopted it have found that it improves treatment in lifesaving ways and is rarely abused.

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 to easily call for a rapid review or second opinion from a senior clinician within the same hospital. Martha’s rule should be advertised to families, and staffed by an independent clinical review team, which many hospitals already have in place, the report says.

Martha, from London, died in 2021 aged 13 after sustaining a pancreatic injury from an everyday bike accident while on a family holiday in Snowdonia. Today would have been her 16th birthday.

She was eventually transferred to King’s College hospital in London, one of the three specialist centres in England that deal with pancreatic injuries in children. In her account of what happened in hospital, Mills explained how her attempts to raise concerns about sepsis and the possibility of her daughter going into septic shock were dismissed by the consultants responsible.

A subsequent inquest into her death heard that Martha would likely have survived the sepsis that killed her had consultants moved her into intensive care sooner.

In the report’s foreword, Mills wrote: “I desperately wish that I’d felt able, with no fear of being the target of ill-temper or condescension, to ask for a second opinion from outside the liver team when I became concerned about Martha’s deterioration.”

The report calls on NHS England to develop best practice guidance to allow hospitals to adopt this system as soon as possible, and for CQC to consider it standard practice in inspections. It also considers further proposals for:

• The right to access patient notes: to 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.

• The right to a named consultant: Demos argues that while this was already recommended by the Francis review, it has not been consistently adopted, and that the government should now work with the CQC to consider its implementation in its inspections. In the report’s foreword, Mills wrote: “If she had been allocated a proper named consultant, I would have, without doubt, contacted them when my doubts grew more serious about the decisions being made on the ward.”

• A review of medical training to improve non-technical skills: the report found that non-technical skills in medical training are undervalued and inconsistently delivered, and that 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.

Polly Curtis, Chief Executive of Demos and co-author of the paper, said: ‘Many clinicians listen carefully to their patients and their families, because they know they will notice vital changes in their condition that medics who don’t know them might not. But too many independent reviews have also highlighted a refusal to take families seriously with a “doctor knows best” attitude.

‘Martha’s rule would help to shift power, encouraging patients to challenge in the most difficult of circumstances and clinicians to listen to them. In other countries it has been proven to save lives.’

Martha’s Rule is part of Demos’ relational public services work. It is a programme of research that sets out a vision for a different system and culture in public services, in which we move from transactional interactions between state and individual, to a more relational way of working. It seeks to embed trust and understanding in order to improve outcomes.