Hadiza Bawa-Garba has been allowed to practise again without restrictions, 10 years after a 6 year old boy in her care died of septic shock following a mistaken diagnosis of gastroenteritis.

A well regarded trainee paediatrician at the time Jack Adcock died in 2011, Bawa-Garba was later found guilty of gross negligence manslaughter. Many doctors saw her as a scapegoat for an overstretched and underfunded NHS.

An investigation at Leicester Royal Infirmary found numerous system failures on the 12 hour shift when she was working under extreme pressure, covering several wards without adequate supervision and with IT problems. 

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Dr Hadiza Bawa-Garba’s application to have her medical licence fully restored was granted today by the Medical Practitioners Tribunal Service (MPTS). The Doctors’ Association UK have supported Dr Bawa-Garba throughout her case and welcome the news that she can now work without supervision

The case of Dr Hadiza Bawa-Garba united the medical profession in fear and anger. A paediatrician in training, with a previously unblemished record, was convicted of gross negligence manslaughter for judgements made whilst doing the jobs of several doctors at once, covering six wards across four floors, responding to numerous paediatric emergencies, without a functioning IT system, and in the absence of a consultant. All when just returning from 14 months of maternity leave.

In 2018, the GMC’s aggressive pursuit of an otherwise highly regarded doctor, against the advice of the Medical Practitioners Tribunal Service (MPTS), prompted widespread outrage amongst doctors. The GMC subsequently launched an independent  review of gross negligence manslaughter led by Mr Leslie Hamilton to promote learning from this case. The Doctors’ Association UK expect them to continue to implement all the recommendations of this review

“We welcome the fact that Dr Hadiza Bawa-Garba has had her licence to practice medicine fully restored today to allow her to work independently. We are pleased that the GMC today opted for a neutral stance.
Healthcare desperately needs an open, transparent, learning culture, where harm is minimised by learning from error and failings. Scandals such as Mid-Staffs, Gosport, and Morecambe Bay repeatedly demonstrate how a culture of defensiveness and denial can escalate into widespread cover-up leaving families fighting for answers.

 
We hope that the GMC works toward full implementation of ALL 29 recommendations of the Independent review into gross negligence manslaughter so that learning can continue. Fear is toxic and blame should not be used as a tool. Jack Adcock should have received better care but this was due to system-wide failure. His death was a tragedy due to this. Our thoughts are also with his family”

Dr Jenny Vaughan, Chair of The Doctors’ Association UK, and Learn Not Blame Campaign Lead

A doctor-led lobbying group has urged the health secretary to review the GMC’s ability to appeal its own fitness-to-practice tribunal.

In a letter to Matt Hancock, the Doctor’s Association UK said the GMC’s right to appeal the MPTS has led to ‘significant unwelcome and unintended consequences’.

Earlier this year, the Court of Appeal overturned a GMC-led High Court decision to strike-off Dr Hadiza Bawa-Garba, after the MPTS had called for her suspension following the death of Jack Adcock.

Following the case, the Government launched a ‘rapid review’ into the use of gross negligence manslaughter charges in medicine, concluding that the GMC should no longer have the right to appeal MPTS decisions.

However, Pulse revealed that the GMC is not intending to halt appeals against the MPTS until the law is changed.

The letter, which is co-signed by other lobbying groups including GP Survival and Doctors in Unite, said the case made doctors ‘feel that we too, could be pursued through the courts for errors made whilst simply trying our best’.

It said: ‘We, the undersigned, all agree that the GMC cannot be trusted to take a balanced and considered approach in the sanction of doctors who have made honest mistakes in the context of system failures.’

The letter added: ‘We are concerned that should the GMC’s action continue unchecked, that there will be a further breakdown in trust between the medical profession and its regulator, and the NHS will continue to move towards a culture of fear and blame, rather than one of learning.’

The association then urges Mr Hancock to:

• Call upon the GMC to cease appealing MPTS verdicts

• Confirm that the GMC’s right to appeal MPTS verdicts will be repealed, as per the recommendations of the Williams Review

• Set out a timeframe for when and how this legislation will be changed

The letter comes after the appeals court told the GMC to show ‘restraint’ after it quashed another GMC-bid to sanction a doctor last month.

The Doctors’ Association UK believes the GMC made a serious error of judgement in aggressively pursuing Dr Hadiza Bawa-Garba in the courts, when it sought to have her struck off for honest mistakes made whilst under immense pressure.(1) This was against the advice of its own expert panel, the Medical Practitioners Tribunal Service (MPTS), who determined that Dr Bawa-Garba presented no greater risk to patients than any other competent doctor. The GMC’s action prompted widespread concern amongst the medical profession and patient safety campaigners that a junior doctor was being scapegoated for widespread systemic failures.

On Monday 13th August, the Court of Appeal threw out the GMC’s arguments and ruled that Dr Bawa-Garba could be reinstated on the medical register.

The Doctors’ Association UK believes that the GMC has shown it cannot be trusted to take a balanced and non-punitive view in its assessment of doctors in the context of system failures. The Doctors’ Association UK’s central campaign, launched in response to the GMC’s actions in Dr Bawa-Garba’s case, is Learn Not Blame, which seeks to address the problems of the blame culture within the NHS. In the spirit of this, we do not seek to scapegoat any one particular individual or group of individuals working within the GMC.

Instead, The Doctors’ Association UK has brought together over 1200 GMC-registered doctors, including Dr Philippa Whitford, MP, in writing to the GMC. Signatories include Mr David Sellu, whose conviction for Gross Negligence Manslaughter was quashed after he spent 15 months in prison. Other signatories include prominent whistleblowers and campaigners. Collectively, we call for the GMC to take responsibility for its actions and learn valuable lessons from the outcome of this case. Applying a genuinely reflective approach, as is expected of doctors in their practice, would be a significant step in restoring the confidence and trust in the GMC as a regulatory body. Lessons must be learnt to ensure that learning, openness and honesty is prioritised over blame, defensiveness and scapegoating.

Dr Samantha Batt-Rawden, Chair of DAUK, said “The GMC’s decision to pursue Dr Hadiza Bawa-Garba’s erasure from the medical register has led to an unprecedented loss of confidence in the GMC. As doctors, we recognise that mistakes happen. The GMC must now hold itself up to the same level of scrutiny that the GMC expects of doctors. We call on the GMC to reflect openly on its actions and to refer itself to the Health Select Committee for consideration of a public investigation. This, we believe, is a crucial first step towards restoring the trust of doctors and the public in the GMC.”

Dr Cicely Cunningham, Learn Not Blame Campaign (2) Lead, said “The GMC’s actions have set the patient safety agenda back by decades. We would like to see the GMC reflecting openly and honestly on its misjudgements in this case. A genuine attempt to learn from its mistakes would be a step towards restoring the confidence of the medical profession, and in moving towards the just culture the NHS so desperately needs”.

CONTACT

Contact@dauk.org

NOTES TO EDITORS

1. On 28th February The Doctors’ Association UK (DAUK) wrote a letter to Mr Charlie Massey, Chief Executive of the GMC expressing overwhelming concern regarding the handling of the Bawa-Garba case. This letter was signed by over 4500 doctors and several MPs.

2. Following the case of Dr Hadiza Bawa-Garba DAUK launched our campaign Learn Not Blame, seeking to change the way medical error is approached in the UK. Our aim is to transform the current culture of blame and fear, into one of learning. We believe this is vital for patient safety, and have received cross-party support for the campaign, as well as backing from our peers. More information on the campaign can be found here.

“In 2015, Dr Hadiza Bawa-Garba was convicted of gross negligence manslaughter for her part in the death of six-year-old Jack Adcock from sepsis. She was subsequently struck off the medical register after the doctors’ regulatory body, the General Medical Council, argued that the conviction meant that she could not be fit to practise. The court of appeal ruled on Monday that Bawa-Garba should be reinstated. I believe it was the right decision.”

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The Doctors’ Association UK is pleased that the report agrees with our written submission that the provision for the HSSIB to accredit NHS trusts to do their own ‘safe space’ investigations is an enormous conflict of interest. We are therefore delighted that the report has recommended that the entirety of part 3 of the draft Bill, relating to Trust accreditation, be dropped.

The Doctors’ Association UK is also pleased that the report agrees the value of the HSIB as an independent body, bringing medicine in line with the rail and aviation industries. ‘Safe space’ investigations will allow staff to speak freely and determine what went wrong to prevent similar mistakes happening again. If ‘safe space’ investigations are to carry the confidence of the public, the independence of the HSIB must be assured.

The Doctors’ Association UK’s central campaign is entitled “Learn Not Blame”, and seeks to engender a national conversation about the need for a just culture in the NHS. We are campaigning for a step change in the NHS so that honest error is used to drive learning and change for a safer, better NHS, rather than being a focus for individual blame. The creation of a truly independent body is a welcome step towards this.

‘For those of us observing it’s still hard to believe that we have got to the stage where an otherwise dedicated and hard working doctor has been criminally prosecuted and taken to court by the GMC for what were essentially honest mistakes [made when] working under pressure,’ she said.

Dr Bawa-Garba is appealing a decision made in January by two High Court judges that she should be erased from the medical register rather than receive the year’s suspension that had previously been imposed by the Medical Practitioners Tribunal Service (MPTS).

‘Systemic failings’

Their ruling followed a successful appeal by the GMC, which argued that suspension was ‘not sufficient’ to protect the public or maintain public confidence in the medical profession.

On Wednesday, the opening day of the appeal, Dr Bawa-Garba’s counsel James Laddie QC said there was particular concern in the medical profession over the court’s decision to disregard ‘systemic failings’ which contributed to the environment in which Dr Bawa-Garba came to make the mistakes leading to the death of six-year-old Jack Adcock in 2011.

Dr Batt-Rawden, who sat in court during the appeal’s opening yesterday, said: ‘Particularly concerning to all of us has been the GMC’s line of argument. To an observer, it seems the crux of their argument is that system failures were not relevant in Hadiza’s case, and should not have been taken into account by the MPTS when determining her level of culpability and her sanction.

‘This has huge ramifications for the medical profession and for patient safety. We are all working in an immensely pressured system, with widespread staffing issues and rota gaps. Hadiza’s story of doing the jobs of several doctors at once, across multiple wards and multiple floors, with a failing IT system, in the absence of senior colleagues or indeed a consultant is sadly increasingly common.

‘Before this case I don’t think any doctors thought that mistakes made whilst simply trying their best under such pressured circumstances would ever lead to a criminal conviction, or erasure from the register. Now, all of us are feeling vulnerable.’

In written argument before the court, Ivan Hare QC for the GMC said the appeal should be dismissed because the High Court was correct to decide that the MPTS failed to apply the relevant rule of the GMC (Fitness to Practise) Rules Order of Council 2004 and undermined the rationale for making criminal convictions conclusive evidence of the offence committed in disciplinary cases.

In response to Dr Bawa-Garba’s case, The Doctors’ Association UK has launched a new campaign ‘Learn not Blame’.

‘We must move away from a culture of blame and fear, to one of learning,’ Dr Batt-Rawden said. ‘We repeatedly fail to learn from scandals such as Mid-Staffs and Gosport and the NHS urgently needs a safe space to enable staff to speak up about patient safety issues.’

She added that there are ‘no winners’ in a culture which seeks to blame one individual for medical error whilst failing to address wider system failures.

‘Our ongoing campaign seeks to empower doctors to be part of a transformational change process working towards a shift from a culture of blame, to one of learning.’

She concluded: ‘An unsuccessful appeal today would do further damage to a profession whose morale is already at rock bottom, and signals a further move away from the open, transparent NHS that we all want to see.’

We need a culture of learning, not of blame and persecution. We need a culture of compassion and care for all who are served by it and all who work in it. A culture where mistakes and harm are prevented by openness, listening and learning. And where mistakes and harm do happen, change, not blame, is the outcome. A just culture. This is the only way we will see a real improvement in patient safety.

This campaign has been born out of a growing awareness amongst clinicians of how a toxic mix of defensiveness and concern for reputation management above all else can lead to blame-seeking culture. This is bad for doctors and worse still for patient safety.

Most patients and families, when things go wrong in healthcare, just want to know honestly what happened and make sure that the same thing never happens to anyone else. But many people face a brick wall when seeking answers from NHS organisations, and get pushed into an adversarial complaints procedure, or even litigation.

Equally, staff who raise concerns often find themselves the subject of counter-accusations, victimisation and blame, instead of having their concerns acted upon. Staff are forced into a formal whistleblowing procedure, where the ensuing legal action may bankrupt them and ruin their careers.

This campaign aims to bring doctors together to say – enough. This has to stop.

The campaign will encourage individuals to commit to action within their own sphere of influence, and join together as a movement to put pressure on NHS leadership to mirror that change and commit at a Trust or Health Board level to an open, learning and just culture.

Look out for more details coming soon, and how YOU can be the change.

#LearnNotBlame