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High Court ruling sparks concerns about health of NHS ‘no blame culture’

Hunt calls for careful consideration of ‘unintended consequences’ of striking off trainee paediatrician

Caroline White

Friday, 26 January 2018

A High Court ruling to strike off a doctor for life after she had been convicted of manslaughter following the death of a six-year old boy in her care has sparked widespread concern about the health of the ‘no blame culture’ in the NHS.

Last year a Medical Practitioners Tribunal concluded that Dr Hadiza Bawa-Garba, who was a specialist paediatric trainee at Leicester Royal Infirmary at the time of the boy’s death in 2011, did not pose a threat to patient safety and should not be struck off, but suspended for a period of 12 months.

The Tribunal cited 'multiple systemic failures,' her untarnished record before and since, and evidence from colleagues and consultants that she was an excellent doctor. She had already remediated her failings, it said, arguing that erasure from the register would be disproportionate under the circumstances.

But the professional regulator, the General Medical Council, felt the sanction was too lenient and it appealed the decision in the High Court despite a petition signed by 100 doctors urging it to desist.

Dr Gawa-Barba and a nurse were convicted of gross negligence manslaughter in November 2015 and received sentences of two years’ imprisonment, suspended for two years.

Following yesterday’s ruling, GMC chief executive, Charlie Massey, said: “This has been a tragic case; a family has lost their son in terrible circumstances and a doctor has lost her career.

“In today’s ruling the court has confirmed that the Tribunal was simply wrong to conclude that public confidence in the profession could be maintained without removing the doctor from the medical register.

“The ruling clarifies that tribunals cannot go behind the jury’s verdict when a doctor is convicted in a criminal court.”

The court found that Dr Bawa-Garba’s failures that day “were not simply honest errors or mere negligence, but were truly exceptionally bad,” he said.

He continued: “We know the strength of feeling expressed by many doctors working in a system under sustained pressure, and we are totally committed to engendering a speak-up culture in the NHS. Doctors should never hesitate to act openly and honestly if something has gone wrong.”

But speaking on BBC Radio Four’s The Today Programme, this morning, following a Tweet he sent about the case, health secretary Jeremy Hunt voiced concerns about the unintended consequences of the ruling, given that Dr Bawa-Garba had been open about her mistake.

He said it was not appropriate for a government minister to challenge a High Court ruling, but then added: “But I do think we need to consider very carefully what may be some of the unintended consequences of this ruling,” referring to the e-journals doctors keep in which they reflect on their practice.

“We know there are always going to be mistakes made, and for patients to be safe, we need doctors to be able to reflect completely openly and freely about what they’ve done to learn from their mistakes.”

Dr Neena Modi, president of the Royal College of Paediatrics said that the tragic case “had engendered anxiety, anger, and bewilderment.”

She said: “Doctors, and indeed all healthcare staff, are committed to delivering high quality, safe care and avoiding errors, but are subject to the rule of law, as is every citizen. When errors do occur, a cardinal philosophy of medical practice in the 21st century is recognition of the value of reflective practice to reduce the risk of similar occurrences happening again.

“A no-blame culture in which the focus is on learning from errors and open and frank dialogue with families affected is the route the RCPCH promotes as the best approach to caring for patients.

“However, we also wish to see recognition that healthcare staff are owed a duty of care and that in many cases where things go wrong, this is the end result of failures at multiple levels, which may include pressures within the healthcare system.”

The RCPCH has begun high level discussions with the regulator and the Crown Prosecution Service to discuss these issues in more detail, she said.

In a statement, the Academy of Medical Royal Colleges said that while it would be inappropriate for it to comment on the specifics of the case, “Nothing positive can be said to have come from this – which makes it particularly sad.”

But the case brings into sharp focus several “deeply concerning issues which must be addressed with some urgency,” it said. These are:
  • Doctors in training must be given adequate high-quality clinical supervision, even in the most stressful and pressured environments. They must be confident that they are able to make decisions with sufficient oversight from consultants in a way that protects them and their patients while allowing them to work and develop.
  • All staff must be encouraged and be able to reflect honestly, openly and safely, and without the fear of recrimination as part of the vital learning process. The threat of this being used in a potentially negative way may potentially promote a lack of candour as well as loss of learning opportunities.
  • Understanding that safe and effective care is delivered through systems – and each part of these systems must function. This, by definition includes the need to ensure safe staffing levels, functioning IT, supporting those returning to work and must be scrutinised as a whole and improved in the light of near misses, safety incidents or patients being harmed.

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