GMC Independent Review of Medical Manslaughter recommends sweeping changes to regain the profession’s trust and improve quality of investigations
Since 2011, healthcare professionals have been transfixed by the twists and turns of the investigations and hearings in relation to the trainee paediatrician, Dr Bawa-Garba and her nursing colleague Ms Amaro through their protracted criminal, coronial and regulatory processes. Dr Bawa-Garba’s treatment in particular by her regulator, the GMC, and its widely criticised decision to appeal its own Tribunal’s determination not to erase her led to the erosion of doctor’s confidence in medical regulation. The case has served as a lightning rod for the increasing concern that these investigations are flawed in focussing on individual blame of professionals and in particular junior staff working at the front line of a pressurised and under resourced health service both in the UK and abroad. There is widespread concern that the wider systemic issues including training and education are not scrutinised and therefore the actions of individuals are not viewed in their wider context.
The latest chapter in the case is the publication today of the GMC’s own Independent Review of gross negligence manslaughter and culpable homicide chaired by Leslie Hamilton (and previously referred to as the Marx Review after the original Chair). The Hamilton review’s remit was intentionally wide to enable it to investigate all processes which might be engaged following an unexpected death. However, changes to the law in this area were not part of its remit.
The Review’s 29 recommendations are therefore much broader than simply the GMC’s regulatory role in these complex and protracted investigations. If followed through they will result in sweeping changes to the GMC’s own regulatory processes with the aim of better supporting families and regaining the trust of doctors. However, the report recognises the limitations of the GMC’s direct role in effecting change and the need for improved dialogue and engagement across the board with healthcare service providers, Coroners, Police and CPS and the professions. The aim is to improve the support available to families and professionals and the quality and consistency of investigation, expert evidence and opinion and decision making in criminal, coronial and GMC proceedings. The focus on quality and consistency is a welcome one as there is significant variability in the extent and quality of these investigations across the various jurisdictions resulting in highly variable and inconsistent outcomes.
The task is a large one and there is much to be done by the GMC in improving itself and working with the other stakeholders to effect wider change. At the same time, there is an urgent need for it to regain the confidence of the profession in medical regulation. In particular, the Review highlights the over representation of overseas doctors in such investigations and the need for the GMC to ensure it supports doctors new to the UK and promotes an inclusive culture and fair decision making.
One of the issues in Dr Bawa-Garba’s case which has caused much concern within the profession was the status of reflective documentation prepared as part of appraisal and training and it’s potential use in any legal proceedings. The Review recognises the potential jeopardy for professionals and recommends that government considers how these documents could be given legal protection. In the meantime, they are discloseable and professionals should review the guidance available on their content (Reflective Practitioner guidance and toolkit). Whilst the GMC state they do not require disclosure of reflective documents, they routinely suggest that it may assist those under investigation to supply evidence of reflection which in the absence of a hearing at which the professional gives evidence, will necessarily be in the form of a reflective document.
It is hoped that despite the current legislative backlog, the Government will recognise the need for legislative change to enable and drive forward the recommendations and lead to improved investigation of sudden deaths in the future.
Read the Review.