Government must carefully consider the urgent review into gross negligence in the NHS
3 min read
Conservative MP and consultant paediatrician Dr Caroline Johnson writes ahead of her Adjournment debate today on Patient safety.
Doctors become doctors to help make people better. Patient safety and improving patient care is therefore at the forefront of every doctor’s practice. Indeed, when I went for my consultant interview I was asked to give a presentation on how I would demonstrate to the Trust Board that paediatric services were safe. My answer, of course, was how safe? As safe as going to a football ground? As safe as travelling on the tube? As safe as flying in an aeroplane? These activities are safe but, like patient care, nothing is ever 100% safe. What we need to do is ensure that care is as safe as it possibly can be, and that there are processes in place to learn from mistakes.
During my career there have been significant improvements in patient safety. The most important of these is probably the establishment of the Care Quality Commission, but we now also have regular revalidation of professionals, reflective practice and case reviews, as well as Child Death Overview Panels (CDOP), which review in detail all unexpected child deaths.
To err is human. We all make mistakes. The consequences of a doctor’s error are potentially huge, and could lead to a patient's death. Doctors live with that responsibility; as a doctor I always lived in fear of making a mistake because I did not wish for anyone to suffer harm. I worked with at least two colleagues who made errors where a patient died. Many lessons were learned and widely disseminated, and training was provided to stop recurrence; but neither doctor was prosecuted. Throughout my career, it has been the case that if a doctor did their best but made a genuine error, they would not face criminal charges. Gross negligence manslaughter was seen to be an appropriate sanction for the doctor who refused to see a patient for no good reason, who turned up intoxicated, or deliberately did something wrong. This facilitated a “no-blame” culture, where errors were identified and improvements made.
Following the case of Dr Bawa-Garba, this safety culture is now in jeopardy. She was convicted of gross negligence manslaughter and struck off the medical register following the tragic death of a child. Whatever the rights and wrongs of the case, very many professionals see sufficient ambiguity in the decision to shake their confidence that they know the boundary between gross negligence and a genuine mistake. It has, in the words of the Chair of the Royal College of GPs, “shaken the entire medical community”.
It is right that individuals are held accountable for their actions, but there is a balance to be struck between accountability and blame. Where this is tipped towards blame, individuals become fearful and may attempt to cover their mistakes, preventing them and others from learning; the same errors will therefore be repeated. Since the case of Dr Bawa-Garba, many doctors have become even more fearful of making a mistake. This culture of fear means that doctors are being advised to anonymise reflective practice, or to avoid uploading these onto their e-portfolio; they may escalate decisions previously undertaken themselves or refuse to do more than contracted. This cannot be good for patient safety.
The Government has commissioned an urgent review to look at the threshold for what constitutes gross negligence, reporting in April; it will be important that the Government acts swiftly on the findings of this report, and considers carefully the impact of the threshold on both the recruitment and retention of medical staff, and safety and improvements to patient care. Otherwise all of us will suffer.
Dr Caroline Johnson is the Conservative MP for Sleaford and North Hykeham
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