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RCN warns of ‘continuing down same path’ as Bawa-Garba case


The Royal College of Nursing and other professional bodies have warned of the negative implications of “continuing down the path” that occurred in the case of Dr Hadiza Bawa-Garba on safety culture.

Yesterday, the doctor, who was struck off in January this year over the death of a six-year-old boy, won her High Court appeal to practise medicine again.

“Healthcare should be viewed as a safety critical industry”

Donna Kinnair

Dr Bawa-Garba was convicted of manslaughter by gross negligence in 2015 over the death of Jack Adcock, who died of sepsis at Leicester Royal Infirmary in 2011.

Her appeal was funded by other doctors who said the original ruling would discourage clinicians from being open when reviewing mistakes.

A nurse, Isabel Amaro, was also found guilty of manslaughter on the grounds of gross negligence, after her monitoring of Jack Adcock’s condition and record-keeping were criticised.

Ms Amaro, an agency nurse at the time of the incident, was sentenced to a three-year suspended jail sentence in November 2015 and subsequently struck off the nursing register.

Responding to Monday’s legal decision, Donna Kinnair, the RCN’s director of nursing, policy and practice, said: “Healthcare should be viewed as a safety critical industry, with a focus on learning and preventing future mistakes.

“Continuing down the path we have witnessed in the Bawa-Garba case risks creating an environment in which individuals feel afraid to come forward, or even to work in pressurised, understaffed environments for fear of blame,” she said.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

“Safe and effective care can only be achieved with an adequate number of staff with the right skills, in the right place at the right time,” said Dame Donna.

She added: “We urgently need a workforce plan for England that responds to patient need, and prioritises recruitment and retention.”

In November last year, former health secretary Jeremy Hunt announced plans for a new national workforce strategy designed to help secure the long-term supply of nurses and doctors for the NHS.

He suggested the plan – to be developed by Health Education England – would draw together all the current staffing initiatives, such as nursing associates and apprenticeships.

Meanwhile, his successor Matt Hancock has pledged to launch a consultation exercise across a range of issues facing the health service workforce.

Specifically, he said it would consider issues such as bullying and harassment in the workplace, diversity and how to establish more pathways for nurses and other clinicians into leadership roles.

“It is important to explore the wider issues that create the potential for patient harm, particularly understaffing”

Derek Bell

Also commenting on the Bawa-Garba case, Professor Derek Bell, president of the Royal College of Physicians of Edinburgh, said: “Looking ahead, it is vital that lessons are learned from this case.

“It is important to explore the wider issues that create the potential for patient harm, particularly understaffing,” said Professor Bell.

“We must encourage an open and no-blame culture where the focus is on identifying and addressing risks and failures in systems of governance, and where all staff and patients are empowered to raise concerns over standards of care,” he said.

He added: “Only by doing so can we ensure that we learn from cases such as this and prevent similar tragedies from occurring.”

Professor Dame Jane Dacre, president of the Royal College of Physicians in London, said: “The judgment of the court of appeal is a welcome step towards the development of a just culture in healthcare, as opposed to a blame culture.”

She said: “On 18 February 2011, Jack Adcock was not the victim of a truly, exceptionally bad doctor, but of an overstretched system that saw a competent trainee covering the workload of several doctors.”

“There continues to be too much of a blame culture where individual health professionals are made scapegoats”

Peter Walsh

The charity Action against Medical Accidents said it was calling for all concerned with the case to “reflect deeply on how this affair has been handled”.

AvMA chief executive Peter Walsh said: “There is now an opportunity to move on and deal with some of the deep-seated issues that this controversy has highlighted.

“No-one should be under any illusion that the ruling itself changes the fact that we still have an NHS which too often leaves patients at risk and health professionals in near-impossible positions,” he said.

“There continues to be too much of a blame culture where individual health professionals are made scapegoats for systemic failures,” he said. “There still needs to be more openness and honesty when things go wrong, and accountability when appropriate.”

Mr Walsh added: “However, a lot of fear has been stirred up unnecessarily. A prosecution for gross negligence manslaughter, as happened to Dr Bawa-Garba, is incredibly rare.”


Readers' comments (4)

  • I am under the impression that nurse Amaro does not feel psychologically strong enough to take her case to the high court and face all this entails. What is her profession doing about this to ensure the same miscarriage of justice does not occur for her? It should not be left up to the individual to appeal the outcome of a hearing when there has clearly been wrongdoing on the part of the regulator

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  • That's very rich coming from the RCN considering they refused to support her when she went on trial

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  • Some of us are trying to support Nurse Amaro as best we can but it is true - the situation has completely broken her and our profession must hold some responsibility for this. This case was tragic but there were multiple contributing factors. The Bawa case has shown the issues raised and those contributing factors - it is sad that the NMC has said they have no intention of reopening the case as clearly some facts have now emerged that if the case was heard today the outcome may have differed. Nurse Amaro was unrepresented at her hearing so attended alone. She was refused the ability to appeal the criminal conviction. The outcome for the NMC hearing seems almost pre determined. She was clearly a vulnerable adult and yet was not safeguarded so consequently was unable to present herself adequately due to the psychological impact that criminal proceedings had on her and the backlash of abuse she received as a result. The hearing notes that are available on the NMC website clearly state that nurse Amaro showed insight, remorse and remediation. They also show that this was a unique situation and the chances of repetition were low. Finally they report that the outcome is measured on public interest element alone. Did the pressure of the case and the need to make someone accountable override the key principles of our regulator? The new steps that the FtP are taking outlined in the letter from the new interim chief executive to all registrants gives the impression that they will look more globally rather than look to blame. Perhaps the interim CEO could commission a review and help to give this colleague some closure. She made mistakes but as the judge stated in her criminal case she was at the lower end of the hierarchy. What for the other two nurses involved in the case? Did they have NMC hearing? How can the NMC be sure that the evidence the Trust presented was complete and reliable? Were the facts presented solid? Or was it more that Nurse Amaro could not present her case appropriately? Dr Bawa Garba received a great deal of support both financially towards her case and professionally from her peers. It is sad that when a vulnerable adult is unable to promote herself to the public, the support stops.

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  • very sad. the nmc is a let down

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