Making it easier to speak up

When you're worried about yourself or someone you love in hospital, you know what's normal for them.

Martha's Rule gives patients, families and carers a clear way to ask for help if they feel a condition is getting worse and their concerns are not being heard.

Perhaps a parent notices their child is quieter than usual. A partner spots a change that seems small but does not feel right. Or a patient senses something has changed, even if they cannot explain exactly why.

Those instincts can matter.

For Dr Ronny Cheung, consultant paediatrician at Evelina London, listening to patients and families is an essential part of good care.

"Patients and family members understand what is normal for them," he says. "That might be especially true for people with complex conditions, where what looks normal in a textbook is not always what is normal for that person."

You are the expert in yourself, your child or your loved one.

When speaking up feels difficult

Even when people are worried, raising concerns can be hard.

Families might feel uncomfortable questioning doctors and nurses. Some worry about making a fuss. Others may struggle to find the right words to explain what they are seeing or feeling.

"There is a natural hierarchy in healthcare," Ronny says. "People can feel worried about challenging expertise. Health literacy, cultural differences and other barriers can make it harder for some people to be heard. But everyone can find it difficult."

Ronny knows that feeling personally. Nearly 18 years ago, when his first child became unwell shortly after birth, he found himself trying to convince others that something was wrong.

Despite his medical training, he struggled to get his concerns taken seriously.

"In the end, I went directly to the surgical team," he says. "My son did have a life-threatening problem and needed surgery. If you, as someone who understands the condition, cannot get your voice heard, what chance does anyone else have?"

A safety net when concerns remain

Martha's Rule was introduced across NHS hospitals to strengthen the way concerns about deterioration are listened to and acted on.

It's named after Martha Mills, who died in 2021 after developing sepsis in hospital. Her family repeatedly raised concerns about her worsening condition. Martha's Rule was recommended nationally to help make sure patients, families, carers and staff have a clear route to ask for an urgent review if they believe someone's condition is getting worse. 

The rule does not replace conversations with the clinical team caring for a patient. Instead, it provides another route if concerns continue.

"We don't want patients or families second-guessing whether their concern is important enough, that's our job." Ronny says.

"If you're still worried that things are getting worse and you feel you're not being heard, speak up."

Changing conversations

One of the biggest changes is not just what happens when someone makes a call, but the conversations happening before that point.

Martha's Rule is helping to strengthen a culture where listening is a routine part of care. By encouraging staff to regularly ask patients and families whether they feel a condition is getting worse, it creates more opportunities for concerns to be shared, discussed and acted on. The result is not just safer care, but stronger partnerships between patients, families and the teams looking after them.

"It allows it to become part of the norm," Ronny says. "Patients don't feel like they're bothering us because we're actively asking them. We're giving them permission to tell us when something isn't right."

Sometimes a call leads to a change in treatment or a higher level of care. At other times, it highlights something equally important: the need for clearer communication.

Ronny remembers one family who requested a review while a clinical escalation was already under way.

"The clinical plan was already happening," he says. "What we realised was that we hadn't communicated that clearly enough. They were worried about their child and wanted to know everything possible was being done."

For him, that reinforces an important lesson.

"Even when it doesn't change the clinical care, it can uncover something really important about how we communicate. That's just as much a part of good care as the medicine itself."

Trust what you know

Ronny's message to patients and families is simple. "You are the expert in yourself, your child or your loved one," he says.

"We are clinical experts, but we need to bring those two kinds of expertise together. If you're worried and feel your concerns are not being heard, there isn't a threshold. Don't spend time wondering whether it's important enough. Your expertise counts too." 

For Ronny, that is what Martha's Rule is really about: making sure everyone has the same opportunity to speak up. "It levels the playing field," he says.

"Everyone should have the opportunity to advocate for themselves or someone they love if they think something is wrong." 

About Martha's Rule

Martha's Rule gives patients, families, carers and staff a way to request an urgent review if they are worried that a patient's condition is getting worse and they feel their concerns are not being heard.

At Guy's and St Thomas', patients and families should first speak with the team caring for them wherever possible. If concerns remain, Martha's Rule provides another route to seek help.

Find out more about Martha's Rule at our hospital and community sites.