Tell us your concerns. We will listen, and act.

We have introduced a new patient safety service at UCLH called ‘Martha’s Rule’.

Martha’s Rule is a patient safety initiative enabling patients in hospital, their families and carers to ask for a independent assessment from a critical care outreach team if they are concerned a patient is becoming more unwell and they are not being responded to. 

University College London Hospitals are committed to improving patient safety. We are implementing Martha’s Rule to ensure critical concerns of patients and those that know them best are listened to and acted on.

Please follow the steps below if you are concerned a patient’s condition may be getting worse

  • Step 1: If you are worried that you or your loved one may be getting worse in hospital, tell your named nurse or doctor. 
  • Step 2: You can also speak to the nurse in charge or ward manager if you feel your concerns have not been addressed. 

Ward teams are experts in the care of their patients and complications of illness but will refer patients to Critical Care Outreach and other services for review when needed. 

If you do not feel your concerns about a patient's health condition are being listened to or acted on you can call the Critical Care Outreach team directly and request an independent assessment.

You can call 07816 196122 to speak to someone and leave a message 24/7.

Tell them:

  • the patient’s name and location (site, name of ward, bed number)
  • your concerns
  • your name and relation to the patient
  • you contact phone number

It is essential to identify when a patient’s clinical condition is getting worse and to intervene as quickly as possible. Deterioration is usually detected through vital signs observations such as breathing and pulse rates which are routinely measured on wards.

To help monitor your health condition, ward staff will routinely ask you the patient wellness question to check how you are feeling physically.

We recognise that you, your family, or friends may notice changes in your health condition before others do. Please tell the ward staff about this, especially if things are getting worse'. 

For example, some changes you may notice before anyone else:

  • Feeling or looking different to usual
  • Behaving differently/strangely/more confused
  • ‘Not yourself’
  • Worse breathing, dizziness, or pain
  • Not recovering as expected

If you feel you or your loved one is getting worse, speak to the ward staff first or use the Martha’s Rule escalation process if you feel your concerns are not being listened to or acted on.

Martha’s Rule is intended to help patients at risk of becoming seriously unwell. 

For any concerns or complaints about other issues (e.g., communication with staff, the bed area, food, facilities, parking, visiting, transport) please talk to the ward staff or nurse in charge. They will do their best to rectify the situation. 

If you are not satisfied, you can contact the Patient Advice & Liaison Service (PALS): 020 3447 3042 or email uclh.pals@nhs.net.

Martha’s Rule gives hospital patients and their families direct access to an independent assessment if their condition is getting worse.

A second opinion is an already established process where patients and their families can ask to see a different consultant to discuss a diagnosis or treatment. This can take time to arrange. If you would like a second opinion, you can raise this with your current consultant yourself, or discuss your concerns with the ward manager.