Evidence submitted by the RCoA to the Williams Review into Gross Negligence Manslaughter in Healthcare

The Royal College of Anaesthetists, alongside other medical royal colleges, has been invited to submit oral and written evidence to the Williams Review into Gross Negligence Manslaughter in Healthcare (GNM), called by the Secretary of State for Health and Social Care.

Our written submission highlights the role that systemic failures can play in these rare and tragic cases and calls for a more balanced approach and greater clarity in determining when allegations of GNM apply to healthcare professionals. The focus for regulators and everyone else involved needs to be primarily on learning, not punishment, especially if there is evidence to show that there was no intention to cause harm and the practitioner shows insight into their failings and has learnt from them.

Below is a summary of the recommendations in our submission:

  • Establishment of a limited number of police constabularies or police unit(s) in England to investigate these rare cases of alleged healthcare professional criminal activity and to work with the Crown Prosecution Service to an agreed set of standards and procedures to ensure consistency and equitable processing of cases.
  • Enrolment of credible expert witnesses to advise on these cases, who are up to date and hold a current licence to practise, in order to offer balanced evidence and clinical advice that takes into account systemic failures, alongside issues around clinical competence. In addition the setting up of framework of essential and desirable criteria that expert witnesses should be expected to reach and maintain, underpinned by appropriate training and life-long learning.
  • Application of a ‘deliberate harm and recklessness test’ to ascertain whether a healthcare professional should be prosecuted for gross negligence manslaughter (GNM), coupled with consideration of systemic failures and workplace pressures.
  • Adequate protection of doctors’ reflections, so that these are not used in an adversarial fashion in judicial proceedings or by healthcare regulators.
  • Review of governance arrangements for regulators in appealing fitness to practise tribunals’ decisions, as greater clarity is required on how decisions to appeal are made and who is accountable for making them.
  • A more supporting and balanced approach by regulators in guiding doctors through fitness to practise proceedings and closer collaboration with other healthcare regulators and independent investigators, such as the Healthcare Safety Investigation Branch.

The full submission can be viewed here

13 April 2018