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Scapegoating overworked professionals benefits nobody – the root causes must be tackled

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Google “Dr Hadiza Bawa-Garba” and you’ll find a raft of supportive opinions from the British Medical Journal, medic bloggers and fellow doctors who believe she’s a scapegoat.

Dr Bawa-Garba is the medic who was convicted of manslaughter by gross negligence for errors that may have led to the death of six-year-old Jack Adcock. In addition to a two-year suspended prison sentence she was suspended from the medical register for a year by the Medical Practitioners Tribunal Service.

The General Medical Council appealed the suspension in the High Court, wanting Dr Bawa-Garba struck off the register; last week the court ruled in the GMC’s favour.

A nurse, Isabel Amaro, was also convicted of manslaughter by gross negligence for her part in the death of Jack Adcock and struck off by the Nursing and Midwifery Council – although her case has not made the same headlines or garnered the same public support.

”I think Mr Hunt is right to highlight that this latest incident undermines his long-running campaign to make the NHS a safer place”

Many doctors joined forces to raise money for Dr Bawa-Garba’s legal fees, and large groups of doctors are now refusing to openly document their mistakes for fear that they may be used against them.

It hardly creates the learning culture that Jeremy Hunt, secretary of state for health and social care, has tried so enthusiastically to promote.

The secretary of state has now decided that health professionals require his protection, and has ordered a review of the way fitness to practise cases are handled by the regulators.

The review, which is due to report back by the end of April this year, will be led by Sir Norman Williams, former president of the Royal College of Surgeons.

I think Mr Hunt is right to highlight that this latest incident undermines his long-running campaign to make the NHS a safer place by making it more transparent, open to admitting errors and learning from them.

Of course, FTP should be there to weed out the small number of practitioners who are incompetent or malicious. But should it be used to remove people from practice who work hard but are so physically and mentally exhausted by their working conditions that they fail to make a sound professional judgement on a single occasion?

“Whatever the review concludes, changing the way fitness to practise cases are run by the regulators will not be an easy undertaking”

Should they be deleted from the registers for making mistakes that are a result of being so overworked and under-resourced that they cannot provide the care that is safest, best and most appropriate for their patient?

Surely the employer, the system and the organisation bear most of the blame. So why is it only frontline staff who publicly carry the can?

Reviews tend to hear a lot of evidence, highlight where a host of contributory factors have failed and point out where the system needs to change to prevent this from happening again. Whether the recommended changes happen is another story.

Having done battle with the medics over the junior doctors’ pay, and now struggling to fill nursing posts, Mr Hunt has evidently decided it’s time he showed some support for the professions, or he’ll end up running his local GP surgery himself, and asking Philip Hammond to put in a night shift on his local acute trust ward.

But whatever the review concludes, changing the way fitness to practise cases are run by the regulators will not be an easy undertaking. Where the law and regulation blur, it will be hard to disentangle them.

Can you really write into regulation that health professionals who have been found guilty of manslaughter can return to their jobs? How do you construct a law that says it’s OK to be found guilty of medical negligence if you take into account all these mitigating factors? How do you evidence those factors? And prove their impact on the case?

“The system is on its knees, and it is seriously damaging the health professionals propping it up – and affecting their patients”

These cases are highly complex, and I am not sure Mr Hunt can do anything to make them less so.

He would be better off fixing the problem that’s the root cause of this tragic case – the circumstances so many health professionals are working in. And the answer to that, Mr Hunt, is to fix the staffing crisis and make sure nurses, doctors and other health professionals have enough staff to support them in their clinical practice.

We’ve read a dozen reports, from Francis in 2013 to the recent health select committee report into the nursing workforce. Coupled with the falling number of students applying for nursing courses and the poor retention figures, they all add up to the same thing.

The system is on its knees, and it is seriously damaging the health professionals propping it up – and affecting their patients. You don’t need yet another review, Mr Hunt. You need to do something about staffing or more scapegoats will shoulder the blame.

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