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Rapid review ordered into medical manslaughter laws

Jeremy Hunt says report will bring greater clarity

Jo Carlowe

Wednesday, 07 February 2018

Health and social care secretary Jeremy Hunt has ordered an urgent medical review into whether gross negligence manslaughter (GNM) laws are fit for purpose.

The decision came in light of the manslaughter case involving paediatrician, Dr Hadiza Bawa-Garba, who was struck off the medical register after making a ‘catalogue’ of errors that led to the death of a six-year-old boy. The patient, Jack Adcock, died of sepsis at Leicester Royal Infirmary in 2011, hours after being admitted with sickness and vomiting.

The review is intended to bring about greater transparency and help set out where the line should be drawn between the charge of manslaughter by gross negligence, and human error.

Dr Bawa-Garba, who was sentenced to two years in prison, suspended for two years, was originally suspended from the medical register for 12 months, but a High Court ruling deemed she should be struck off. Mr Hunt criticised the GMC, which brought the appeal against its own tribunal service’s ruling.

Mr Hunt has said clarity is needed about drawing the line between gross negligence and ordinary errors.

“The only way we can reduce mistakes in the NHS is to learn from every single one and the tragic case of Dr Bawa-Garba raises many important questions about how the health system supports staff to be open and transparent when things go wrong,” he said.

The government’s rapid review, will explore the following:

  • Lessons that need to be learned by the General Medical Council and other professional regulators
  • How learning, openness and transparency can be protected so that mistakes are learned from and not covered up
  • Providing clarity to doctors about where they stand with respect to criminal liability and professional misconduct.
The British Medical Association welcomes the rapid review, but warns that a growing number of prosecutions against doctors could lead to more defensive medicine.

Dr Chaand Nagpaul, BMA council chair, said: “We welcome this review which must provide greater clarity on the role of reflective learning and the application of gross negligence manslaughter in healthcare.

“It’s vitally important that doctors’ personal reflections – which encourage openness and improvement through reflection and learning – are protected. While the BMA has received important assurances from the GMC in relation to the use of reflective learning, further clarity around how reflections can be protected will be welcomed by doctors. We also need greater clarity on the line between gross negligence manslaughter and human error in medicine. There is concern that a growing number of prosecutions of doctors for gross negligence manslaughter results in doctors becoming more cautious. This makes it more likely that they will practise defensive medicine, which is not in the interests of patients.

“While this review is important, especially in examining lessons learnt by the GMC, it’s equally important that the government acknowledges and addresses the system-wide pressures NHS staff work under and which compromise the delivery of high-quality, safe patient care. Doctors want to provide the best possible care for each patient and many believe the greatest system risk to patient safety is an under-resourced and understaffed NHS, in which services and staff are stretched too thinly.”

The rapid review is to be led by professor Norman Williams, former president of the Royal College of Surgeons, who will report back by the end of April 2018.

The GMC also welcomed the secretary of state’s announcement.

Charlie Massey, its chief executive, said: “The issues around GNM within healthcare have been present for a number of years, and we have been engaged in constructive discussions with medical leaders on this issue.

“As an independent UK-wide medical regulator we have committed to bringing together health professional leaders, defence bodies, patient, legal and criminal justice experts from all four countries to explore how gross negligence manslaughter or its equivalent in the devolved nations is applied to medical practice, in situations where the risk of death is a constant and in the context of systemic pressure. That work will include a renewed focus on reflection and provision of support for doctors in raising concerns.

“Doctors are working in extremely challenging conditions, and we recognise that any doctor can make a mistake, particularly when working under pressure. We know that we cannot immediately resolve all of the profession’s concerns, but we are determined to do everything possible to bring positive improvements out of this issue.

“We look forward to participating in the government’s review and will ensure that the outputs from Sir Norman Williams’ work feed into our own wider four-country review."

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