BMA responds to independent review of gross negligence manslaughter and culpable homicide

By agency reporter
June 7, 2019

Responding to the independent review of gross negligence manslaughter and culpable homicide, commissioned by the General Medical Council (GMC) and chaired by Leslie Hamilton, Dr Chaand Nagpaul, BMA council chair, said: “When an error is made in a medical environment that is so serious that a patient loses their life, though incredibly rare, it is a tragedy, causing unspeakable distress to the person’s family and loved ones, as well as to the health professionals involved.

“We therefore welcome this review, which takes on board many of the points the BMA raised in its own submission – not least on the need for a just culture based on learning rather than blame – and builds on the important work from Professor Sir Norman Williams last year.

“This culture shift is vital to help avert such tragedies, and give the public confidence in the health service, while reassuring doctors and other staff that they will not be unfairly blamed when things went wrong.

“We welcome the recommendation that all healthcare providers should be consistent when conducting local investigations and in line with the relevant national frameworks. This, in our opinion, would alleviate issues of too much variation in who carries out investigations into serious clinical incidents. While that variability is of some concern, our greater worry lies in the lack of training provided to those involved. The BMA firmly believes that standardising local processes could lead to fewer cases being escalated to the criminal justice system.

“We also welcome the recommendation that, in England and Wales, any gross negligence manslaughter cases in healthcare are referred on only after consultation with the Chief Coroner. This should ensure that only the cases that warrant further investigation are referred to the police, and is also vital as some medically qualified coroners may have a different threshold from a legally qualified coroner and there may be unintended bias.

“However, when cases do become subject to criminal proceedings, it is important for investigators to seek good quality and objective expert medical opinion, something we are glad this report recognises.

“As the trade union and professional body representing doctors from across the UK, the BMA also knows too well the damage that recent high-profile cases have done to the profession’s confidence in the GMC. There is an urgent need for the Regulator to repair its relationship with doctors so that they feel better supported to deliver a high standard of care for their patients.

“Specifically, we are glad that this review has backed both Professor Sir Norman Williams’ and the BMA’s position that the GMC should lose its right to appeal fitness-to-practise decisions made by its own tribunal service, and we similarly urge the Government now to introduce the legislative changes to allow this to happen as soon as possible. We also fully support the review’s call for doctors recorded reflections to be legally privileged.

“It is also imperative to recognise, as this report does, that mistakes rarely happen in isolation from wider system pressures, and these must be considered as part of any investigation. It is simply not fair that one person should carry the blame for a mistake, no matter how grave, that is the product of a series of failings across the workplace. This review’s recommendation for the appropriate authority to scrutinise the environments that doctors find themselves working in is a positive one, and this area’s particular focus on trainees, who often work under difficult conditions without appropriate support, is important.

“The BMA has repeatedly called for systemic pressures to be explored and recognised when errors occur, and has worked closely with other stakeholders, including the royal colleges, to help ensure workplace concerns can be raised quickly and safely. Through the work of the BMA – including that of our junior doctors committee and medico-legal committee – we hope that we can avoid seeing cases where medical error is inappropriately criminalised.

“Meanwhile, doctors from overseas backgrounds bring incredible knowledge and a wealth of insights through experiences in their home nations, which, as described in this report, often remains untapped due to lack of support and pastoral care when they arrive to practise in the UK. The BMA is happy to build on the resources we have already developed for international medical graduates and those that employ and develop them, and to work alongside the GMC’s commitments to supporting overseas doctors to work and thrive in UK practice.

“That doctors from black and ethnic minority communities are more vulnerable to complaints and investigation, and are disproportionately represented in fitness-to-practise proceedings, is another concern that the BMA has long been raising, and we welcome this review’s work and recommendations in this area. A call for all healthcare systems to ensure an inclusive culture within workplace, education and training environments, is core to the BMA’s values and its vision for the NHS.

“While it is essential that the GMC and other stakeholders have committed to addressing issues in workplace cultures in the NHS, this must be tied to action to tackle other issues, such as improving training on equality and inclusion, embedding human factors in everyday practice, displaying compassionate leadership throughout health organisations and structures, and alleviating system pressures.

“Of course, this review is just a starting point, and we would urge the Government, the GMC, healthcare providers and other relevant bodies to urgently monitor, evaluate and regularly report on the implementation of the recommendations, and the BMA looks forward to working alongside these stakeholders to ensure the best for both doctors and the patients they go above and beyond to provide care to every day.”

* Read The independent review of gross negligence manslaughter and culpable homicide here

* British Medical Association https://www.bma.org.uk/

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