Gross negligence manslaughter review

Wide ranging changes to the regulations around gross negligence manslaughter in healthcare have been proposed in the rapid policy review conducted on behalf of the Secretary of State for Health, Jeremy Hunt.

The review was set up to consider the wider patient safety impact resulting from concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter. In particular, there was concern that this fear had had a negative impact on doctors being open and transparent should they be involved in an untoward event, as well as on their reflective practice, both of which are vital to learning and improving patient care.

In his report, the chair of the review panel Sir Norman Williams said, ‘There is no doubt that recent cases have led to an increased sense of fear and trepidation, creating great unease within the healthcare professions. This has been compounded by a perceived arbitrariness and inconsistency in the investigation and subsequent prosecution of gross negligence manslaughter.’

According to the review its recommendations aim to support a just and learning culture in healthcare, where professionals are able to raise concerns and reflect openly on their mistakes but where those who are responsible for providing unacceptable standards of care are held to account.

Recommendations that affect healthcare professionals include:

• Revised guidance should lead to criminal investigations focused on those rare cases where an individual’s performance is so ‘truly exceptionally bad’ that it requires a criminal sanction.
• Systemic issues and human factors will be considered alongside the individual actions of healthcare professionals where errors are made that lead to a death, ensuring that the context of an incident is explored, understood and taken into account.

Bereaved families will receive support through:

• Being informed of any untoward event which might have contributed to the death of a family member or loved one.
• Being provided with the opportunity to be actively involved throughout investigative and regulatory processes.
• An expectation that, for all bodies with a role in investigation and regulatory action, families and loved ones are supported, treated at all times with respect and receive honest explanations when things have gone wrong.

For regulatory bodies:

• The General Medical Council (GMC) should have its right to appeal fitness to practise decisions by its Medical Practitioner Tribunal Service removed.
• The GMC will no longer be able to require registrants to provide reflective material when investigating fitness to practise cases. This change will help ensure healthcare professionals are not afraid to use their notes for open, honest reflection which supports improvements in patient care.

Responding to the review Jeremy Hunt said, ‘I was deeply concerned about the unintended chilling effect on clinicians’ ability to learn from mistakes following recent court rulings, and the actions from this authoritative review will help us promise them that the NHS will support them to learn, rather than seek to blame.’

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