Jeremy Hunt launches review of manslaughter in healthcare after Bawa-Garba case

Jeremy Hunt has told MPs that his senior clinical advisor will lead a review to draw a clear line between manslaughter and basic human error in healthcare following the controversial case of Dr Hadiza Bawa-Garba.

Mr Hunt told the House of Commons on Tuesday: 'On the day we mark the 100th anniversary of giving a voice to women, I want to update the House on concerns in the medical profession that we may not be giving a voice to doctors and other medical professionals who want the freedom to learn from mistakes.

'The recent Dr Bawa-Garba case has caused huge concern. Today I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons - my senior clinical advisor - to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

'Working with senior lawyers, Sir Norman will review how we ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up, how we ensure there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand in respect of criminal liability or professional misconduct, and any lessons that need to be learned by the GMC and other professional regulators.

'I will engage the devolved administrations, justice secretary and the Professional Standards Authority for Health and Social Care in this vital review which will report to me before the end of April 2018.'

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What role did reflections play in the case of Dr Hadiza Bawa-Garba?

The case of Dr Bawa-Garba has led to GPs boycotting reflective entries as part of appraisal, and campaigners have raised more than £320,000 to support a legal challenge against a recent High Court decision that allowed the GMC to strike off the junior doctor, who had previously been convicted of manslaughter following the death of a six-year-old boy.

Following the High Court ruling on Dr Bawa-Garba, Mr Hunt warned that he was hugely concerned about the 'possibly unintended implications here for learning & reflective practice'. A poll of more than 900 doctors on the doctors.net.uk website found that 92% agreed that 'the removal of Dr Hadiza Bawa-Garba from the medical register is likely to make me less open when reviewing mistakes made during my clinical practice'.

Responding to the announcement, GMC chief executive Charlie Massey said a review into whether gross negligence manslaughter laws are fit for purpose in healthcare in England was welcome.

'The issues around gross negligence manslaughter 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.

NHS pressure

'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.'

BMA chair Dr Chaand Nagpaul said protection for doctors' personal reflection was vitally important. '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.

'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.'

Dr Nagpaul warned that alongside the review, the government must 'acknowledge and address the system-wide pressures the NHS is under'.

Medical Protection Society medical director Dr Rob Hendry added: 'Gross negligence manslaughter cases are usually complex, involve systems failures, and are devastating for all concerned. A conviction should not automatically mean that a doctor who has fully remediated and demonstrated insight into their clinical failings is erased.'

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