Patient safety
the implementation of Martha’s Rule, and, hours later, there was a commitment to write it into the NHS Constitution. “It was an incredibly fast impact, but there
was a lot of work behind the scenes that meant that moment could happen. The journey that the policy and the health system has been on since has been extraordinary,” Polly commented. She explained that it was already on NHS
England’s radar, as part of their deterioration strategy, and had been trialled in hospitals, such as The Royal Berkshire NHS Foundation Trust. This meant that there was already evidence available to support it. Henrietta Hughes, the Patient Safety Commissioner, saw the potential for Martha’s Rule to be “a game changer” and put the weight of her office and her influence behind it. What happened next was unusual in policy circles; the Health Secretary asked Henrietta Hughes to chair a ‘policy sprint’, which happened over the course of five days, in autumn 2023. Polly explained that a group of around 20 leading people, from across the NHS, came together to develop the principles for Martha’s Rule: “A ‘sprint’ is a process that was first developed out of Silicon Valley to develop tech products. You bring together the right expertise and develop a plan in rapid time, which can then be tested and iterated. It gives you something powerful to work with; and that sprint resulted in a set of recommendations for principles for Martha’s Rule, at the end of last year,” she continued. At the same time that there was a political momentum for Martha’s Rule, there was also a growing movement within the system to make it happen. Just seven months after Martha’s Rule was first proposed, 143 hospitals came forward to pilot the rule. “It was an extraordinary outcome. I think the original target was to get the first 100 hospitals on board, this year, but there has been a real desire from the system to get involved – it’s seen as a brilliant thing to be involved in,” Polly commented. She went on to share some lessons learned. To successfully deliver rapid change, you need the following: l Stories to move people and to get action – the political momentum for Martha’s Rule
came from one story.
l Being actionable is key to successful policy implementation.
l Both carrots and sticks are important – but you can achieve true momentum by encouraging people to voluntarily get involved.
While Martha’s story was not an isolated incident, Polly also warned that clinicians should be concerned about the stories that they do not hear about. “Merope and Paul have been incredible and
dedicated campaigners. They have a lot of skills; they are journalists and have connections. One of the reasons they were so committed to this was that they didn’t want this to happen again. They know that despite all the influencing skills they have, they couldn’t get the help they needed – so what hope is there for people who are less articulate, and who have English as a second language? “Merope and Paul love the NHS and understand the pressures, but the ward that Martha died on was not particularly underfunded. It wasn’t about the wider systemic issues that are facing the NHS. This is about
This is about a particular cultural problem and a hostility between medics and patients and their families, which hinders patient care. If that relationship isn’t working, you
cannot do the best by your patients. Polly Curtis, Chief Executive, Demos
30
www.clinicalservicesjournal.com I September 2024
a particular cultural problem and a hostility between medics and patients and their families, which hinders patient care. If that relationship isn’t working, you cannot do the best by your patients,” she concluded.
Assessing the delivery of Martha’s Rule Dr. John Dean, Clinical Vice President, Care Quality Improvement Directorate, Royal College of Physicians, emphasised the importance of Martha’s Rule in supporting patients who may be deteriorating. How this is articulated will be vital as, until recently, there has been some misinterpretation of what is meant by ‘a second opinion’, he asserted. He described the rule as “a safety net” when normal practice fails to pick up deterioration. What the rule has emphasised is “the need for cultural change”, as well as “structural change to support that cultural change”, he continued. “Sadly, we are in a situation where we have hierarchies between professionals and members of the care team, and patients and families. That’s what we need to break down – that’s the diagnosis of what the problem is here; the need for a safety net is the symptom,” he commented. So, how do we flatten hierarchies, in order
to ensure care providers listen to patients and families, so that they respect their concerns and bring them into clinical assessment? He identified the need to ensure that the hierarchy is such that a person “giving the patient a cup of tea” can say to a member of the clinical team, “I don’t think that patient is looking so well today”. Anyone in the team, whatever their professional background, must be able to speak up, so that
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