The Hadiza Bawa-Garba case has shone a spotlight on a ‘climate of fear’ in the NHS which affects patient safety and staff well-being.
That is the view of patient safety expert Sir Robert Francis who said the case shows the legal system ignores the ‘human factors’ behind decision making.
Sir Robert, who carried out the review into the causes and failings in care at the Mid-Staffordshire NHS Foundation Trust, said investigations into mistakes must be blame-free and staff given the opportunity to reflect on errors and take remedial action where required.
‘The biggest threat to the freedom to speak up is fear,’ Sir Robert said.
‘The biggest concern on that front for doctors and nurses is fear of being prosecuted. You will all be familiar with the case of Dr Bawa-Garba – in my view the system of justice does not take into account in a proper and informed way systemic issues particularly looking at the human factors behind decision making.’
Sir Robert, speaking at the Westminster Health Forum conference in London yesterday, added: ‘It’s not a system which is conducive to openness and learning and a blame-free culture. But we are not going to get away from prosecution and people being held to account until the public can be confident that proper processes are in place to address their grievances. Patients and their families need to properly involved in the process of looking at what happened after things go wrong.
‘Investigations need to be blame free and the outcome of all of this must not only be full disclosure of what happened, why it happened, a recognition by all professionals involved of what their part was and a commitment to take any remedial action. Only then can we get the trust the patients and public need to end the climate of fear.’
Sir Robert also said more action was desperately needed to ensure staff feel able to speak up in their trusts and that whistleblowers are welcomed rather than hounded out.
He said: ‘Staff are entitled to work in an environment where they feel able to raise concerns. Raising concerns should be normal and not exceptional. In order for this freedom to take place, we need to be free of bullying and oppressive behaviour.’
Sir Robert said proper leadership, staff being able to reflect on what they and colleagues do without fear and prompt, swift, fair investigation to establish facts rather than blame were all key values the NHS needs to adopt.’
Following the case, the BMA secured a number of commitments from the GMC, including that it would never ask doctors to provide reflective statements if investigating concerns about them, and to push for the standardisation of exception reporting.
Also, following widespread pressure from the medical profession, the GMC has asked two academics to examine why some groups of doctors are referred to the GMC in greater numbers than others.
Last month Dr Bawa-Garba was granted leave to appeal her removal from the medical register in the court of appeal.
Dr Bawa-Garba, a paediatrics trainee, was convicted of gross negligence manslaughter in 2015 and suspended from the medical register for 12 months by the Medical Practitioners Tribunal Service last June. The GMC appealed the decision to the high court, and in January she was erased from the medical register.
But in March Lord Justice Simon granted permission for Dr Bawa-Garba to appeal the erasure.
BMA council chair Chaand Nagpaul said: ‘I've impressed on the Government the outcry provoked by the ruling, and the impact it has had on doctors fearing being blamed and punished for factors outside their control.'
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