I am the chief executive of Demos, a cross-party think tank that works to put people at the heart of policy making to improve how policy is developed as well as trust in politics. Think tanks sit outside government and are hives of ideas of how to improve the country, so it is very rare that we end up as part of an oversight group on a policy being piloted at more than 143 hospital sites across the NHS.
Demos began working with Martha Mills’ parents Merope and Paul in September 2022. Merope had written a powerful piece about Martha’s death in the Guardian that was very widely read, particularly by NHS workers who recognised the issues it raised. Merope and Paul had read about Ryan’s Rule in Australia and were thinking about how to make change happen in the NHS so that no one else had to go through what they had experienced.
We convened a private meeting with senior people from across the NHS in which Merope and Paul outlined their experience. We heard the experts’ views and discussed what could be done. We examined the problem of weekend working, when staffing numbers are lower and patient safety incidents increase – Martha died after a bank holiday weekend, a particular danger point. But we kept coming back to the cultural problems of hierarchy and the failure of staff to truly listen to patients and their families. We heard that there have been many cultural initiatives in the NHS but perhaps different training for medics was the answer.
Then one senior hospital leader made an important intervention: ‘Ask for something that is actionable.’ People in the room agreed that Martha’s Rule would be hard to introduce but that it made sense.
Over the following months we worked on a short paper setting out how Martha’s Rule would work and assessing the precedents of such schemes elsewhere. We held meetings with senior people in the NHS to assess appetite.
In September 2023 Merope was interviewed on the Today programme telling her story and making the case for Martha’s Rule. We simultaneously published a paper to set out the evidence. Hearing Merope so painfully describe her frustrated efforts to get help for Martha in hospital and the powerful case for Martha’s Rule to prevent future deaths galvanised politicians into action. That afternoon the former health secretary Steven Barclay stood up in the House of Commons and committed to examining the plans. Wes Streeting, then in opposition, said he would write Martha’s Rule into the NHS Constitution.
The roll-out of the pilot of Martha’s Rule is quite unlike any other policy process I have ever known: a mixture of strong political will, collaboration across the sector and system leadership from the PSC Henrietta Hughes to create and maintain momentum.
The oversight group – a team of highly experienced professionals from across the NHS – meets monthly to examine the progress of the pilot. We receive updates from DHSC, from hospitals that are taking part in the pilot, and we have heard from specialist areas of paediatrics and on important issues such as how we overcome any potential barriers to the implementation of Martha’s Rule. We troubleshoot problems, share information and consider how to maintain momentum.
It has not always been a straight path. I have learnt how complex it can be to roll out a national scheme to hospitals and how few levers there are to make meaningful change. I have learned that to make things happen, you have to work hard to build on existing influence and local leadership. But the fact that there are now 143 hospital sites in the first phase of the pilot, only one year after Martha’s Rule was first suggested, is an awesome achievement. It is also a credit to the thousands of people across the system who are making it happen. And most importantly, it is the first step towards ensuring that lessons are learnt from Martha’s avoidable death.