On 6 February 2018 I informed the House that I had asked Professor Sir Norman Williams to carry out a rapid policy review of gross negligence manslaughter in healthcare settings. This review was prompted by concerns among healthcare professionals that errors could result in prosecution for gross negligence manslaughter, even in the face of broader organisation and system failings. In particular, there was concern that this fear had had a negative impact on reflection and learning by healthcare professionals, which is vital to improving patient care.
My Department is today publishing the report of Sir Norman’s rapid policy review and a copy is attached.
Any investigation of a healthcare professional for suspected gross negligence manslaughter begins with the death of a patient. A life needlessly cut short and a family grieving. Sir Norman and his Panel have heard from such families. Their experiences were vital in informing this review and I would particularly like to thank them for their courage in providing evidence to the review.
The report finds that prosecutions and convictions of healthcare professionals for gross negligence manslaughter are rare. It also finds that the legal test for the offence is set at an appropriately high level. This should reassure healthcare professionals that only where conduct is ‘truly, exceptionally bad’ and in consideration of ‘all the circumstances’ will the bar for gross negligence manslaughter be met.
However in order to provide greater consistency the report makes recommendations to improve the investigation of allegations of gross negligence manslaughter involving healthcare professionals. These include:
- developing an agreed understanding of gross negligence manslaughter that reflects the most recent case law;
- improvements to the way that healthcare professionals provide expert advice and evidence; and
- improvements to local investigations into unexpected deaths in healthcare to provide a full understanding of the cause of death, ensuring improvements are made to reduce the likelihood of similar incidents.
The report also considers the impact of criminal and regulatory investigations on the willingness of healthcare professionals to reflect on their practice. It finds that reflective material is rarely sought in such investigations. Nonetheless, in order to provide clear assurance to professionals, the report recommends that those regulators that have a power to require information from registrants when investigating their fitness to practise should have this power removed in respect of reflective material.
Finally the report looks at the regulation of healthcare professionals. It makes a number of recommendations for further work to understand inconsistencies in the way that different regulators carry out their fitness to practise functions. It also finds that the General Medical Council’s right to appeal decisions of the Medical Practitioners Tribunal Service has resulted in a lack of confidence in their regulator as well as having an unanticipated impact on the willingness of doctors, especially trainees, to reflect fully on their practice. Since the PSA has a near identical right of appeal to Medical Practitioners Tribunal Service decisions, it is clear that there would be no gap in the law where regulatory action is being taken as a result of a serious criminal conviction, and the report recommends that the GMC’s right of appeal should be removed.
These 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. This will support improvements in patient safety.
I thank Sir Norman and his panel for their work in delivering this important report. I accept the recommendations in full
This statement has also been made in the House of Lords: