The Authority's Chief Executive and Williams Review panel member, Harry Cayton, shares his thoughts on what he thinks about the Review and the recommendations it puts forward.
The publication of Professor Sir Norman Williams’ Review of Gross Negligence Manslaughter in Healthcare is an important moment in the many consequences of the General Medical Council’s (GMC) erasure of a doctor who had been convicted following the death of a child in her care. It is not the end of the story however, the doctor’s appeal against her erasure will be heard by the Court of Appeal this summer and the GMC has commissioned its own review, by Dame Clare Marx, chair of the Faculty of Medical Leadership and Management, into how gross negligence manslaughter and culpable homicide are applied to medical practice.
I should declare an interest as I was a member of Sir Norman's advisory panel. The evidence we received,
all of it published here opened my eyes to the many misunderstandings and sometimes misrepresentations of the facts and issues that have swirled around this case.
Prosecutions for gross negligence manslaughter are rare
The first thing perhaps to know is that prosecutions for gross negligence manslaughter are rare and convictions rarer; that the majority occur in the construction industry and only a small number of health professionals have been so convicted, some of whom had their convictions overturned on appeal. The anxiety by doctors to this exceedingly rare event may have been misplaced but needed to be addressed. In addition the conviction in the criminal court seems to have become muddled up with the decision by the MPTS to suspend the doctor and subsequent successful appeal by the GMC to have her erased.
The Review's recommendations
The Williams Review is worth a read to unravel the facts and clarify the issues. Sir Norman's recommendations cover the approach taken to investigations of gross negligence manslaughter by the police, coroners and the Crown Prosecution Service. He considers the role played by expert witnesses in trials of this kind and the difficulty of finding people who are both appropriately expert in clinical matters and competent to give evidence in Court. He unpicks the misunderstanding around the use of health professionals’ reflective statements by the Courts or by regulators. Finally he looks separately at regulators, the decisions they make following a conviction and the right of appeal by the GMC.
In summary the Review makes the following key recommendations:
- that there is revised guidance into investigation and prosecution of gross negligence manslaughter in healthcare to improve consistency and set the threshold clearly as ‘truly exceptionally bad’
- that human factors and systemic issues of care are considered to put the actions of individual healthcare professionals into context
- that bereaved families be provided with better information and consistent support
- that there should be training and accreditation for expert witnesses and that their value should be better recognised
- that regulators should make clear that they will not use reflective statements in disciplinary proceedings and that the General Optical Council and the GMC should lose the legal right to demand such material
- that the GMC should lose its right of appeal against the Medical Practitioners Tribunal Service (MPTS) which should continue with the Professional Standards Authority
- that research should be done into differential outcomes for registrants in disciplinary proceedings and over-representation of Black, Asian and ethnic minority registrants in fitness to practices cases be investigated and addressed.
These are sensible and proportionate recommendations. They recognise that investigations for gross negligence manslaughter arise from avoidable deaths, that bereaved families need support and that professionals need to have confidence that the prosecuting authorities and the regulators are fair and consistent in their approach.
It is encouraging that the Secretary of State has accepted Sir Norman's report. We now need to see the recommendations put into effect.
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