The national rollout of Martha’s Rule across NHS hospitals has established a crucial safety net, giving patients, families and carers a guaranteed right to request an urgent, independent clinical review when they observe signs of deterioration. However, a patient safety initiative is only as effective as its accessibility. If the channels to request a rapid review rely exclusively on phone calls or spoken conversations at the bedside, vulnerable patient groups risk being excluded from life-saving interventions.
As reported by The Bolton News, a pioneering partnership between Bolton NHS Foundation Trust and Bolton Deaf Society has been named a finalist for the Patient Involvement in Safety Award at the HSJ Patient Safety Awards 2026. Their collaborative project ‘Martha’s Rule – Equitable Access for Members of the Deaf Community’ provides a vital template for making patient escalation pathways genuinely inclusive.
Breaking the Barrier: Spoken Communication vs. Equitable Access
In acute hospital settings, clinical deterioration can happen rapidly. When a patient or family member senses that something is wrong, the standard escalation process typically involves speaking directly with ward nurses, doctors or calling a hospital helpline.
Bolton NHS Foundation Trust recognised a critical systemic flaw: relying solely on verbal communication creates severe barriers for deaf patients. Without tailored escalation mechanisms, deaf patients face diagnostic delays, misunderstood symptoms and an inability to independently raise the alarm when their condition worsens.
To solve this, representatives from the deaf community collaborated directly with clinical teams to identify operational hurdles and co-design accessible solutions:
Non-Verbal Escalation Pathways: Developing formal pathways that allow patients to trigger a Martha’s Rule rapid review without relying on spoken phone calls or verbal handoffs.
British Sign Language (BSL) Resources: Producing clear BSL instructional video materials explaining how, when and why to activate Martha’s Rule.
Independent Communication Tools: Implementing accessible tools and digital processes at the bedside so deaf patients can report worsening symptoms independently and with confidence.
Health Equity as a Core Component of the Standard of Care
Under medical negligence law and clinical governance frameworks, healthcare providers owe an equal duty of care to all patients, regardless of their communication needs or background.
Communication breakdowns are among the leading root causes of preventable adverse events in hospitals. When a health system fails to provide accessible communication channels, a patient’s warning signs are easily missed. Ensuring that escalation protocols are accessible to all patients is a fundamental requirement of safe, non-negligent clinical care.
Lessons for Irish Healthcare Reform
The work carried out by Bolton NHS Trust and Bolton Deaf Society demonstrates that patient agency must be built with equity at its core. As Ireland continues to develop and reform its patient safety frameworks under the Patient Safety Act 2023, the lessons from Bolton are directly applicable to Irish acute and maternity services.
Has your family experienced an unaddressed clinical deterioration or a failure in hospital communication? Contact Whelan Law today to discuss your experience with our medical negligence team and ensure your rights are reviewed against the highest international standards of patient safety and governance.