Bawa-Garba case 'small step towards more just NHS culture'

The case of Dr Bawa-Garba represents a 'small step' towards a more just NHS culture, a campaigning doctors' group has said.

NHS can move to learning culture (Photo: iStock)
NHS can move to learning culture (Photo: iStock)

Dr Hadiza Bawa-Garba’s successful appeal against the GMC’s decision to strike her off the medical register has the potential to drive change within the NHS, leading to a more ‘open and transparent’ culture of ‘learn not blame’ for health professionals, patients and their families, the Doctors’ Association UK (DAUK) has said.

Dr Cicely Cunningham - a clinical oncology trainee and lead for the DAUK's 'Learn not Blame' campaign, was present at the Court of Appeal to hear the final ruling on the Bawa-Garba case on Monday.

She told GPonline: ‘I don’t think this is a victory for anyone, but this is a very small step towards a more just NHS where doctors can practise without the fear that the mistakes that they make under pressure are going to put their personal reputation and their professional life on the line.'

Dr Bawa-Garba was erased from the medical register in January after the GMC appealed against a Medical Practitioners Tribunal Service (MPTS) decision that she should be suspended for 12 months. The GMC argued that Dr Bawa-Garba should be struck off because the tribunal decision showed it had taken a less severe view of her actions than an earlier court that convicted her of gross negligence manslaughter (GNM) following the death of six-year-old patient Jack Adcock in 2011.

However, the appeal court rejected this view and the GMC has now confirmed it will not seek to pursue the case further.

'Learn not blame'

Dr Cunningham described the courtroom as ‘packed’ with doctors and campaigners who had taken the day off to show their support for Dr Bawa-Garba, and said the verdict was met with 'no celebration, no joy, just relief'.

The Learn not Blame campaign launched by DAUK in response to the Bawa-Garba case aims to change the way medical error is approached in the UK.

On the day Jack Adcock died, Dr Bawa-Garba, a specialist registrar in year six of her postgraduate training (ST6) who had recently returned from maternity leave, had sole responsibility for the whole children’s assessment unit (CAU) at Leicester Royal Infirmary. There was also an IT failure that led to delays in obtaining test results and staffing problems.

In a submission to the GMC’s independent review into GNM last week, DAUK wrote: ‘It is imperative that the judicial system recognises that mistakes and human error are often the result of multiple factors... It must be recognised that individuals working in a system which is failing should not be held responsible for the death of a patient, especially where the removal of systemic failures may have contributed to a better outcome. A supportive culture of learning and not apportioning blame or punishing individuals is required so that clinicians have faith in reporting their mistakes or system failings.'

NHS culture

Speaking on the first day of an appeal hearing on 25 and 26 July, Dr Bawa-Garba’s counsel James Laddie QC described how, in the 70th anniversary year of the NHS, the case had become ‘something of a lightning rod for the dissatisfaction of doctors and medical staff in this country'.

Dr Cunningham said: ‘I think what happened in this case was the silent majority of doctors woke up, in a way, to the injustices within the NHS. What we want to do through the Learn not Blame campaign is allow that silent majority to feel that they can have a voice, that they can advocate a just culture in the NHS and that they can drive change and that they can be the change. We want people to feel that they can be part of a movement to change the NHS.'

The blame culture within the NHS is not just something that just affect doctors, Dr Cunningham added, but it also negatively impacts patients and families.

'A grieving family trying to get answers often finds an NHS that slams the door in their face. We need a culture that is open and that is transparent both for health professionals and for patients and families so that people can get the answers they need, understand how care decisions are made (and be part of those decisions) and so that - when things go wrong - there can be open discussion of what happened and why it happened. Instead of looking to blame one individual, it would be better if we could look for what learning could come out of it.

Dr Cunningham added: 'Our thoughts are with the Adcocks - they are topmost in our minds.'

The DAUK described the GMC’s GNM review, the results for which are due to be made public early next year, as ‘an opportunity where the GMC can start to rebuild the trust that was lost over the last few years and as a result of the Bawa-Garba case'.

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