Patient safety
in terms of listening to the patient’s voice and their loved ones, in relation to concerns around deterioration, but also in terms of the general co-production of services. It is also critical to think about underrepresented voices within patient communities.
Leadership accountability is also key, he continued: “We work in a really complex multi- layered health and care system. However, I see the primary leadership accountability is to create a positive safety culture that advocates for raising concerns, learning from what has gone well and less well, and listening to the voice of colleagues and service users and their loved ones. “As a Chief Exec, my role is not to sub-contract
clinical safety to the Chief Medical Officer or the Chief Nursing Officer, but to use the privileged platform that comes with a senior leadership position to advocate for the behaviours that are implicit in a safety culture - listening, learning and improving,” he concluded. “Ultimately, Martha’s Rule cannot be a sticking plaster for organisations, where the fundamental culture of safety is lacking.”
Benefits and challenges Joining the discussion was Dr. Dita Wickins- Drazilova, Associate Professor in Biomedical Ethics and Law, Birmingham Medical School, University of Birmingham. She explained that she is responsible for leading the teaching of ethics and law to over 2,000 medical students at Birmingham Medical School.
“While I have never worked for the NHS, in
a clinical setting, I have worked with lots of doctors over a period of 20 years. I’m also a patient and I have experience of being a parent of a patient in intensive care, which influences my perspective on this. “When I first heard about Martha’s Rule, my first thought was that ‘the right for a second opinion’ is already part of the GMC guidance (specifically on Consent), and I looked it up – it can be found in paragraph 49.2
The problem
is how many people actually know about this? I haven’t seen any polls, but I wouldn’t be surprised if lots of doctors were unaware. However, lots of lay people will definitely not know about this,” she commented. She pointed out that the issue is that the
GMC guidance says you ‘should’ provide a second opinion - not that you ‘must’ and this could change in future guidance. However, the main difference between Martha’s Rule and the current GMC guidance is that the latter does not specify how it should happen. This means it may be undertaken differently across different settings and it may take days or weeks before the second opinion is provided. “Another big difference is that Martha’s Rule
streamlines this to make it easier for patients and relatives to request a second opinion, as well as making it quicker,” Dr. Wickins-Drazilova. She pointed out that Martha’s Rule states that ‘patients, families, carers and staff will have round-the-clock access to a rapid review from a separate care team, if they are worried about
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a person’s condition’.3
“A ‘rapid’ review is an
important word,” she commented. She observed that there are “many benefits of implementing Martha’s Rule”, including: l Improving patient safety and outcomes, restoring trust in the NHS, and moving towards better patient-centred care.
l Giving more power and control to patients, parents and carers of patients, and tackling the power imbalance and hierarchy in the NHS.
l Doctors could often do with more humility and patients and families with more confidence.
“In my experience of medical school teaching, the biggest difference I see between a year one student and a year five student is they build a lot of confidence…Part of what we are teaching them is to be incredibly confident, but what I think we also need to teach, during the training years, is humility – and we also need to give more power and confidence to patients and families to raise concerns,” Dr. Wickins-Drazilova commented. However, she added that there may be some
challenges around implementing Martha’s Rule that will need to be addressed. She warned that we need to avoid it becoming just ‘a piece of paper’; it must not be ‘unrealistic to implement’, especially in Trusts or hospitals where there is already a poor culture and poor patient safety. “One of the challenges I see is funding and
resources. I work with doctors; I know they are incredibly stretched to their limits. The
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