Patient safety
condition, noticed by the people who know the patient best, are considered by staff.
“The ‘standardised approach’ is going to be really important in terms of how it is then considered from a legal perspective and we’ve talked earlier about how families need to know about this rule. But they also need to be feel confident, to effectively seek a second opinion,” Kashmir continued. “In a lot of the cases that we deal with, the families or the injured person say, ‘nobody listened to me...’ “Often, when we ask, ‘what do you want
to achieve from contacting a solicitor?’, they answer that they just want an explanation – an apology. If this rule can assist in patients feeling empowered and they feel listened to, it may well stop litigation.” She added that when there is a fresh pair
of eyes, the reviewing clinical team may find something different. She explained that she had seen cases where there has been “a sticky diagnosis” – in other words, once a diagnosis has been made, nobody has sought to question it. In one instance, failure to question the initial diagnosis led to major complications for a patient. She further explained that, to establish
a claim, there must be a breach of duty of care, and the Bolam test is applied in such instances. The Bolam test considers, ‘what would a reasonable doctor have done in those circumstances?’ In addition, there must be proof of ‘causation’, i.e. the breach of duty caused harm. Finally, to compensate the
claimant for harm, there is a requirement to prove a ‘loss’. With regards to obtaining a second opinion (i.e. elements 1 and 2), Kashmir pointed out that patients do not have a legal or automatic ‘right’ to a second opinion. While there is no obligation for the NHS to accept a patient’s request, they should consider the request, and most services will allow a second opinion. She also pointed out that Martha’s Rule forms part of a Patient Safety Initiative – it does not change the law. However, it does change how second opinions are sought by families in emergency situations by providing patients with the ability to rapidly access a second clinical opinion in urgent or contested cases. It is important to note that it does not apply to routine or outpatient services. Furthermore, to access it, patients and their families need to: l Know it exists l Take the step to access it
With regards to recording daily insights about the patient from families, and ensuring concerns are considered by staff (i.e. element 3), Kashmir pointed out the following legal considerations will be pertinent: l Good Medical Practice (GMP) by the GMC sets the standards of care and behaviour expected of all medical professionals. The latest edition came into effect 30 January 2024.
l It already requires healthcare providers to take a patient’s concerns into account.
l If daily insights are recorded, this will provide an insight into any deterioration
Unconscious bias and discrimination
During the conference, Dr. Daniels also shared the story of Yousef, who tragically died of sepsis on 5th February 2023, just after his first birthday. His parents, Mohammed Elsiddig and Duaa Siyed Ahmed were both doctors. Despite asking multiple times ‘could this be sepsis?’ – and both parents being qualified doctors – they were not listened to. “When I asked them why they thought this
was, they said they believed it was because they ‘looked and sounded different’ to the doctors who were dealing with them. They felt that they were not listened to because English was not their first language, despite being trained medics who asked all the right questions,” explained Dr. Daniels. “Yousef didn’t even have a blood test, and yet he presented at A&E on four separate occasions. So, how do we ensure that people such as Mohammed, Duaa and Yousef do not fall through the cracks?”
In a statement shared on the UK Sepsis Trust’s
website, Mohammed said: “I think the fact that we were not listened to, and our concerns were persistently dismissed, was partly due to the fact that we come from different ethnic backgrounds. I strongly believe that we were stereotyped and treated as being dramatic or exaggerating, so we were not taken seriously at all. “I want health professionals to acknowledge
the presence of unconscious bias and stereotyping in healthcare; to pay attention to it and to actively manage it to prevent discrimination in delivering healthcare. Perhaps with education, training and monitoring, everyone from different cultural backgrounds can get the same level of treatment and care without discrimination.” Yousef’s story can be found on the UK Sepsis
Trust’s website at:
https://sepsistrust.org/ about/about-sepsis/patient-stories/yousef/
34
www.clinicalservicesjournal.com I September 2024
and, if no action is taken by staff, this can be investigated further. This may assist in making a claim, if breaches of duty can be identified.
In her concluding remarks, Kashmir emphasised once again that a lot of the complaints she has seen are about failures in communication, resulting in lawyers being instructed. Martha’s Rule could be a positive move in
improving patient safety, but it could also offer the benefit of helping to prevent cases from ending up in litigation. To be successful, other factors will also need to be resolved, however, such as low staffing levels, training, culture, and hierarchy.
Conclusion Ultimately, NHS England states that the focused approach at the initial provider sites will inform the development of wider national policy proposals for Martha’s Rule that will be expanded in a phased way across the NHS from 2025/26. It will also identify ways to roll out an adapted Martha’s Rule model across other settings including community and mental health hospitals where the processes may not apply in the same way. The introduction of Martha’s Rule comes alongside other measures to improve the identification of deterioration, including the rollout last November of a new early warning system for staff treating children,4
built on
similar systems already in place for adult, newborn, and maternity services. To ensure that Martha’s Rule is effective, it will be implemented alongside an integrated programme to improve the management of deterioration using ‘PIER’ resources, which will aim to help systems prevent, identify, escalate and respond to physical deterioration. You can access further information on these resources at:
https://tinyurl.com/8hvc7f2h CSJ
For further details on future conferences, visit:
www.westminsterforumprojects.co.uk
References 1. RCP, Modern ward rounds, accessed at:
https://www.rcp.ac.uk/media/kc1jt4y5/ ward_round_executive_summary_0.pdf
2.
https://www.gmc-uk.org/professional- standards/professional-standards-for- doctors/decision-making-and-consent/the- dialogue-leading-to-a-decision-continued-3
3.
https://www.england.nhs.uk/patient-safety/ marthas-rule/
4.
https://www.england.nhs.uk/2023/11/new- nhs-warning-system-to-spot-deterioration-in- childrens-health-faster/
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