Patient Safety

John Howell Excerpts

Wednesday 28th March 2018 Commons Chamber

[Dr Johnson]

I congratulate my hon. Friend on passing that private Member’s Bill, which has undoubtedly saved many lives.

I am proud to work in a health service that, just last year, was rated the best and safest healthcare system in the world by the independent Commonwealth Fund think-tank. To err is human: we all make mistakes. The consequences of a doctor’s error, though, are potentially catastrophic. Doctors live with that responsibility and, as a doctor, I live in fear of making a mistake because I do not wish for anyone to suffer harm.

[John Howell (Henley) (Con)]

My hon. Friend may have seen that the Medical Protection Society is asking for the bar to be lifted on criminal proceedings and for the General Medical Council to be shaken up a bit to improve its approach to dealing with this issue. Does she have any sympathy with that?

[Dr Johnson]

I will come on to that later, but I agree with my hon. Friend.

I have worked with at least two colleagues who made significant errors. Many lessons were learned and widely disseminated. Training was provided to stop recurrence, but neither doctor was prosecuted. Throughout my career it has been the case that, if a doctor does their best but makes a genuine error, they will not face criminal charges. Gross negligence manslaughter was seen to be an appropriate sanction for the doctor who refuses to see a patient, who turns up intoxicated or who deliberately does something wrong. That facilitates a no-blame or airline safety-style culture, promoted by the Secretary of State, in which errors are identified and continuous improvements are made.

Following the case of Dr Bawa-Garba, that safety culture and those improvements to patient care are now in jeopardy. Although she was newly back from maternity leave, had not received induction, was covering two people’s jobs, had inexperienced junior staff to supervise and had reduced consultant cover, a very busy unit and a broken IT results system to contend with, Dr Bawa-Garba was convicted of gross negligence manslaughter and, more recently, struck off the medical register by the GMC. Those events followed the very sad and tragic death of a little boy, which of course saddens all of us in this House and is something from which his family will never truly recover.

Whatever the rights and wrongs of this particular case, many professionals have seen sufficient ambiguity in the decision that Dr Bawa-Garba was criminally culpable that it has shaken their confidence that they understand the boundary between a genuine error of medical judgment and conduct so exceptionally bad that it amounts to criminal behaviour. It has, in the words of the chair of the Royal College of General Practitioners,

“shaken the entire medical community”.

Although the GMC is an independent organisation, the Government will be aware of concerns raised about its decision making on this case. Perhaps the most high-profile concern was raised earlier this month at the local medical committees conference, where GP leaders passed a vote of no confidence in the GMC. I would be grateful if the Minister elaborated on what the Government are doing in their work with the GMC to ensure it is executing its functions correctly and to restore medical and public confidence in it.

It is right that individuals are held accountable for their actions, but there is always a balance to be struck between accountability and blame. Where the balance 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 fearful. That culture of fear means that some doctors are being advised to anonymise reflective practice and to avoid uploading those reflective practices on to their e-portfolio. They might unnecessarily escalate decisions previously undertaken themselves or refuse to do more than contracted. That cannot be good for patient safety.