Anna’s Blog – Jess’s and Martha’s Rules
When we’re worried about our health, we visit the GP and expect them to take our symptoms seriously, and most of the time they do. Yet, this sadly wasn’t the case for 27-year-old Jessica Brady who tragically passed away from cancer in 2020. Alarmingly, she had visited her GP 20 times before she was officially diagnosed after one self-funded appointment at a private hospital.
After her official diagnosis, Jessica dedicated the rest of her life to raising awareness about the poor practice she had experienced. Andrea Brady (Jessica’s mum) stated: “In the bleak weeks following the loss of Jess, I realised it was my duty to continue what she had started”, and four years on, her family have kept that promise. Finally, in September of this year, the Department of Health & NHS England launched a new initiative in her memory called ‘Jess’ Rule.’
Under the new rule, GPs are now strongly advised to follow a ‘Three Strikes and we Rethink’ strategy (promoted as Reflect, Review and Rethink). It aims to prevent misdiagnosis or delayed treatment by getting GPs to take more responsibility when a patient has visited at least three times with ongoing or worsening symptoms. Essentially, this means that doctors will either seek a second medical opinion, review and adapt treatment plans, or redirect patients to a specialist.
Research suggests this strategy is already reducing diagnostic delays and misdiagnoses at crucial stages of primary care. The rule also supports younger people and people from Black, South Asian and minority ethnic backgrounds, who are most at risk of having several appointments with doctors before being diagnosed with a serious condition.
This rule comes alongside another initiative called ‘Martha’s Rule’. This was introduced in 2023 in response to yet another case of malpractice. Martha Hills was a 13-year-old girl who lost her life in 2021 after getting sepsis whilst in hospital following a bike accident. Martha’s parents described it as “a difficult, tricky injury, but it did not have to be a fatal one.” The problem arose because the consultant responsible for Martha’s care did not send her to intensive care when she was becoming increasingly unwell from an infection. Sadly, her health deteriorated over something that otherwise would have been treatable had it been acted on when her parents first raised their concerns.
After years of hard-fought campaigning from Martha’s parents, the NHS rolled out a 24/7 telephone helpline across hospitals in April 2024. It allows patients, families, and carers to request urgent review from a critical-care outreach team if they suspect health is deteriorating whilst in hospital.
Interestingly, the most recent statistics from September 2024-2025 revealed that 7,257 escalation calls have been received through the ‘Martha Rule’ phone lines. The highest percentage of those calls (72%) came from family or carers requesting an escalation process. A high number of calls (1,029 calls, 14%) required a change in treatment (such as a new medication or antibiotics to treat infection) and 339 calls (5%) resulted in loved ones being transferred to the Intensive Care Unit, or to a specialist ward.
Health Secretary, Wes Streeting has said “patient safety must be the bedrock of the NHS” but without putting standard procedures in place, proper regulation and robust governmental oversight, then avoidable deaths such as Martha’s and Jess’s will continue.
Initiatives like these do make a meaningful impact and help challenge some common problems which exist in the NHS and the Health and Social Care sector as a whole. Indeed, both Jess’s and Martha’s rules actively help to reduce unconscious bias and poor judgement getting in the way of people accessing urgent care. Yet we must remind ourselves that it is only when devastating cases like these, which make the news and have compassionate campaigning on their side, result in such initiatives being approved.
That said, these rules offer recognition that families, carers, and individuals themselves have unique knowledge that can easily be missed by medical staff. This is especially important when people with support needs require healthcare, as highlighted in ‘Oliver’s Campaign’ where Oliver McGowan received ongoing ill-treatment in hospital despite his family’s repeated attempts to have him effectively supported and listened to.
Whilst these rules are not legal obligations, knowing about them can be potentially life-saving. It’s therefore really important that the people we support are aware of these rules so here’s a few key things to remember:
- Doctors are the professionals but we know our own bodies and what feels normal. If symptoms change or something doesn’t feel right (even if you already have a diagnosis) then address it.
- Tracking symptoms is an effective way to raise concerns over a health problem. Check in with the people you support and suggest logging symptoms to easily spot if symptoms change over time.
- Support people to use these rules and be clear to doctors or medical professionals if they don’t feel better or if symptoms have not improved after seeking treatment.
- Support people to maintain engagement with health professionals. Having the same GP and requesting in-person consultations can reduce key information being missed, strengthen patient-doctor relationships (which is especially important for people with additional needs) and make treatment planning more effective.
- Keep updated on changes made in Health & Social Care, share and engage in best practice, and talk about concerns as effective ways to raise awareness.
It goes without saying that these rules are testament to how much needs to change within Health and Social Care. It’s a real shame that rules like these only get implemented after tragedies occur. Lives should not be cut short in order to enable systemic changes to health care. We must therefore mark Jess’s and Martha’s lives as a legacy to making healthcare systems better for everyone and especially for people who may not be able to speak up for themselves. By using these initiatives, people we support can be empowered, feel listened to, and get the right response as early as possible.
Here are some sample posters used across NHS healthcare services: NHS Jess and Martha posters
Additional Info:
Statistics » Martha’s Rule Programme September 2025
Martha’s Rule will ‘significantly improve outcomes’ for people with a learning disability
Jessica Brady’s legacy inspires new life-saving GP safety rule – GOV.UK
Jess’s Rule | Jessica Brady CEDAR Trust
NHS England » Jess’s Rule: Three strikes and we rethink
Government pledges further action to strengthen patient safety – GOV.UK