Over the last week there has been an outpouring of anger and concern from the medical profession following a High Court ruling in the case of Dr Hadiza Bawa-Garba.
In 2015, Dr Bawa-Garba was convicted of manslaughter by gross negligence following the tragic death in 2011 of Jack Adcock, a six-year old boy with Down’s Syndrome and a heart condition. She was given a suspended sentence and was later also suspended from the medical register by the Medical Practitioners Tribunal Service for a year. The General Medical Council – the doctors’ regulator – appealed this decision. It wanted Dr Bawa-Garba to be struck off the medical register and the High Court last week ruled in its favour.
Firstly, and most importantly, I want to express my deepest sympathy to the family involved. They lost a child under the most terrible of circumstances. As doctors, we want to provide the best possible care for every patient, and a case with such an awful outcome is every doctor’s worst nightmare.
On the day in question Dr Bawa-Garba, a trainee paediatrician, had only recently returned from maternity leave. She was dealing with a large number of patients, in a unit that was understaffed. There were several delays and errors in receiving and assessing important test results, and confusion about whether to perform CPR on the patient.
That serious mistakes were made in this case is not in question. But what has sparked so much debate and concern is the context and systemic pressures in which doctors work, and mistakes are made.
The private fear and vulnerability that many doctors feel daily, working in an understaffed, under-funded health service, has spilled into public debate since last week’s ruling. There is an overriding and uncomfortable sense amongst doctors that “this could have easily been me”. In recent weeks, we’ve seen a slew of media reports about overcrowded accident and emergency departments, patients waiting in ambulances or backing up on trolleys in hospital corridors, and GPs seeing up to 60 patients a day.
These are not just headlines. Such scenes form the backdrop to the daily working lives of frontline NHS staff, who are dealing with rising numbers of patients waiting longer, often in pain or distress, for the care they need. The physical, emotional and professional burnout that comes from working day after day, year after year in this environment causes many to leave the NHS or quit medicine altogether.
Mistakes are inevitable in medicine, as they are in life. What is important is that there are systems and processes in place that minimise the chance of mistakes being made, and maximise the chance they will be picked up when they do. In the case of Dr Bawa-Garba, the NHS trust in question acknowledged there were systemic failures and pressures which contributed to the events that day.
Frontline staff know that the greatest systemic risk to high-quality care and patient safety is an under-resourced, understaffed NHS. Each year, the UK spends less as a proportion of GDP on health than other comparable EU countries. Around £10bn a year less in fact. We have fewer beds and doctors than countries like France and Germany. At the same time demand on the NHS is rising year on year. We cannot deliver a world class health service on second class funding. Whilst attention is rightly focused on the case, we must also look to government, NHS employers and managers to take responsibly for wider issues around staffing, resources and poor IT systems. Staff who want to raise concerns also need to feel confidence that the right mechanisms are in place for them to do so.
Many doctors believe that in the case of Dr Bawa-Garba, the systemic failings which contributed to the death of a patient in this case were not adequately considered in the original criminal trial. They have concerns about a growing number of doctors being prosecuted for the offence of manslaughter by gross negligence.
They are also worried about the future of personal reflective learning material. During training, doctors are encouraged to write personal reflections, in order to encourage openness and improvement through learning. Now, despite assurances to the contrary, many doctors fear this material could be used against them.
Although the Medical Protection Society has confirmed reflections did not form part of the evidence in Dr Bawa Garba’s criminal trial, if doctors feel this way, there is a risk they will practice medicine more defensively. They will fail to fully reflect on mistakes and thereby learn from them. Following a meeting this week, we’ve received guarantees from the GMC that it does not ask a doctor to provide their reflective statements when investigating a concern about them. Still, more work is needed to ensure doctors have full confidence in this process.
This is a tragic case, in which a young child died and a doctor’s career was ended. In highlighting these issues and the pressure NHS staff are working under, doctors are not seeking to minimise or make excuses for the avoidable death of a young child. Rather they are speaking out on the systemic shortcomings this case has brought into sharp focus. We need government, employers, managers and regulators to come together to address system-wide pressures and put an end to the blame culture in our NHS. In doing so, the hope is that doctors can work in an NHS where they have the support, resource and confidence they need to provide the high-quality care patients deserve.
Dr Jeeves Wijesuriya is the junior doctors committee chair for the British Medical Association.