Speaking at an evidence session held by the House of Commons health and social care committee, Sir Robert Francis QC said senior NHS managers must have their own fitness to practise ‘held to account in the same way as their doctors and nurses’.
Sir Robert, who chairs Healthwatch England and is also a CQC board member, argued that, in cases where system failures may have lead to medical error, organisational leaders and chief executives should not be allowed to get off ‘scot-free’, but instead should be ‘in the dock’ alongside frontline practitioners.
This comes just months after Dr Hadiza Bawa-Garba - a junior doctor convicted of gross negligence manslaughter - was reinstated to the medical register after the Court of Appeal ruled that ‘systematic failures at the hospital and failures by other staff who worked there’ were partly to blame for the death of her patient, six-year-old Jack Adcock.
The health and social care committee was hearing evidence in an attempt to draw lessons from the Dr Bawa-Garba case about how cases involving gross negligence manslaughter should be dealt with by investigators, healthcare providers, law enforcement agencies and professional regulators in order to best protect patient safety.
'Nothing's touching them'
Sir Robert was responding to a question raised by Labour MP and committee member Rosie Cooper. She said that, although managers are ‘absolutely involved’ in most fitness-to-practise cases, they are allowed to remain in work while healthcare practitioners face charges, adding ‘nothing’s touching them’.
‘Everyday we can see individuals being held to account when the system is not being held to account,’ Ms Cooper said. ‘How do we develop a system that would enable that to be looked at?’
Sir Robert said: ‘I think there are two levels to your question. One is the criminal law and why is it that managers aren’t held to account under criminal law and the answer is, almost invariably, difficulty of proof of knowledge. Corporate manslaughter requires a "guilty mind" and that is always going to be difficult [to prove].
‘But, if you come down a level, I have observed, as you have, that doctors and nurses find themselves in disciplinary trouble and are sometimes erased and - unless they happen to be registered as a doctor or a nurse themselves - the chief executive and the leaders get away scot-free.
‘At some point I would suggest (and I have suggested in the past) that we need to consider the regulation of at least senior managers and leaders of these organisations in order to prove that their fitness is held to account in the same way as their doctors and nurses.’
Gross negligence manslaughter
Professor Sir Norman Williams - who was commissioned by former health secretary Jeremy Hunt to conduct a rapid review into gross negligence manslaughter earlier this year amid concern over the implications of the Bawa-Garba case - also gave evidence to the session. He said: ‘There has to be accountability but you’ve got to appreciate that when something awful happens it’s very rarely down to one or two individuals.There is a string of things… and if you’re going to get an improvement you’ve got to address that whole breakdown.’
‘I think there has been a real problem with blaming the individual and that has been historical,' Sir Norman added. 'I’d like to think things are changing and I think, slowly they are changing… But there is real fear out there still. [Doctors are] still frightened and they’re still not prepared to speak up and that is the only way to improve safety.’