Strengthening Patient Safety and Accountability in the NHS: Jess’s Rule and Martha’s Rule
Patient safety has become a central focus within the NHS in recent years. A number of high-profile cases involving medical negligence, delays in diagnosis, and failures to escalate patient care have highlighted how breakdowns in communication and decision-making can lead to devastating consequences for patients and their families.
The NHS has introduced a number of patient safety initiatives aimed at improving clinical escalation and to drive meaningful change across the NHS. Two of the most significant developments are Jess’s Rule and Martha’s Rule.
What is Jess’s Rule?
Jess’s Rule was introduced following the death of Jessica Brady from cancer aged 27 years. In the months before her death, she had 20 consultations with GPs, but her cancer went undiagnosed.
Jess’s Rule is a reminder to GPs to rethink a diagnosis if a patient presents three or more times with the same or escalating symptoms, especially if they remain unexplained.
Jess’s Rule encourages GP teams to Reflect, Review, and Rethink:
- Reflect – think back on what the patient has said and consider what has changed or been missed.
- Review – consider seeking a review from a colleague or review any red flag symptoms that may suggest a different diagnosis regardless or the age or demographic of the patient.
- Rethink – refer onwards for further tests or for specialist input.
What is Martha’s Rule?
Martha’s Rule was introduced following the death of 13 year old Martha Mills in 2021. Martha died in hospital after falling of her bike and developing sepsis when concerns about her worsening condition were not escalated to intensive care in time.
Martha’s Rule is now being implemented across all NHS hospitals to ensure that patients, families, and carers can request an urgent clinical review if they believe a patient’s condition is deteriorating.
Under Martha’s Rule:
- Patients will be asked, at least daily, about how they are feeling, and if they are getting better or worse, and this information will be acted upon in a structured way.
- All staff will be able, at any time, to ask for a review from a different team if they are concerned that a patient is deteriorating, and they are not being responded to.
- This escalation route will also always be available to patients themselves, their families and carers and advertised across the hospital.
This initiative empowers patients and their families to raise concerns when they believe something is wrong. It also helps prevent failures to escalate care, which is a common issue in medical negligence cases involving hospital treatment.
Why Jess’s Rule and Martha’s Rule are Important for Patient Safety
Both initiatives address problems that have historically contributed to avoidable harm within the NHS and are a positive step toward safer care.
Although both Jess’s Rule and Martha’s Rule were introduced following tragic events, they represent important progress in strengthening patient safety within the NHS.
By empowering patients, improving communication, and ensuring that concerns are taken seriously, these initiatives have the potential to prevent avoidable harm and save lives.
For patients and families, they provide reassurance that their voices matter. For healthcare professionals, they reinforce the importance of vigilance, communication, and early intervention.
Ultimately, both initiatives reinforce that patients and their families should be listened to when concerns about care arise.
Quote from author. Navdeep Kainth, Partner and Specialist Medical Negligence Solicitor from MDS, said "The implementation of Jess’s Rule and Martha’s Rule are important steps towards improving patient safety and standards of care, aiming to create positive change across GP surgeries and NHS hospitals".
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