{"id":41246,"date":"2018-01-29T16:06:21","date_gmt":"2018-01-29T15:06:21","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41246"},"modified":"2018-02-23T17:00:04","modified_gmt":"2018-02-23T16:00:04","slug":"rachel-clarke-the-hadiza-bawa-garba-case-is-a-watershed-for-patient-safety","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/29\/rachel-clarke-the-hadiza-bawa-garba-case-is-a-watershed-for-patient-safety\/","title":{"rendered":"Rachel Clarke: The Hadiza Bawa-Garba case is a watershed for patient safety"},"content":{"rendered":"

We need the GMC to set a powerful precedent by speaking up about the dangers of rota gaps, says Rachel Clarke<\/p>\n

\"\"<\/a>Watershed moments, if genuine, are palpable. We can feel it when something tectonic is afoot. Who will forget how, last year, the blackened shell of Grenfell Tower fractured a country\u2019s belief in itself as fundamentally humane? Or the fury unleashed by Harvey Weinstein\u2019s victims, and the potency of #MeToo as it rips round the globe?<\/span><\/p>\n

Medics have a habit of thinking nothing matters quite so much as medicine. But last week\u2019s successful appeal<\/a> by the General Medical Council to have paediatric trainee, Hadiza Bawa-Garba, permanently struck off the medical register is nothing if not an NHS watershed.<\/span><\/p>\n

What is at stake here\u2014as unsafe staffing continues to wreak havoc on our ability to provide patient care\u2014is whether the profession\u2019s regulator finally has the gumption to confront this reality. Or, will it continue to ignore the state of the health service, thus permitting individual practitioners whose abilities\u2014it knows full well\u2014are so crippled, so often, by skeleton staffing, to shoulder the blame for NHS-wide failings? If ever there was a moment to put patients first, this is it\u2014as people continue to die on trolleys in hospital corridors, or at home while waiting for the ambulance that never arrives.<\/span><\/p>\n

In 2015, Bawa-Garba was convicted of gross negligence manslaughter for the avoidable death, from sepsis, of a six year old boy, Jack Adcock, after a jury concluded her mismanagement of the child was \u201ctruly exceptionally bad.\u201d The GMC then insisted that public confidence in the profession could not be maintained unless Bawa-Garba was permanently erased from the register.<\/span><\/p>\n

Superficially, this may seem reasonable enough. A young child had died in unforgivable circumstances, a doctor criminally convicted. So why has her treatment so convulsed the profession? We are angered, in part, by the absence from the GMC\u2019s narrative of the possibility that Bawa-Garba\u2019s negligence arose because it was the working conditions into which she was thrust that day that were \u201ctruly exceptionally bad.\u201d Rota gaps forced her to cover two other doctors\u2019 jobs as well as her own work. Her consultant was off on a teaching day. The hospital IT had broken down, causing chaos.<\/span><\/p>\n

So what, precisely, was Bawa-Garba meant to do? Down tools and say it was unsafe for her to work? Is that what we should all do now\u2014simply walk out on our patients when rota gaps are dangerous? Or struggle on, sick with dread, knowing a patient may slip through the understaffed net, and that we too may face criminal conviction as a consequence?<\/span><\/p>\n

When this question was put to him last week on BBC Radio 4, the GMC\u2019s chief executive, Charlie Massey was evasive, refusing to answer. Small wonder doctors are afraid. Many of us battle daily with understaffed bedlam. Fancy a spot of corridor medicine, anyone? Picking the patient you think will die next in the corridor, to award them the one empty space in Resus? Yet the GMC\u2019s only advice to those trainees now terrified of both treating and not treating their patients is platitudinous\u2014essentially, to tell someone senior you think conditions are suboptimal.<\/span><\/p>\n

That, frankly, is not helpful. What is the point of frontline doctors speaking out about understaffing when all those with actual clout\u2014the GMC, the CQC, Jeremy Hunt, and the prime minister\u2014know that in today\u2019s overstretched NHS, patients are jeopardised by rota gaps daily. It is ironic that the profession\u2019s regulator, so committed\u2014ostensibly\u2014to NHS candour, is itself refusing to be candid in public about the dangers to patients of endemic understaffing.<\/span><\/p>\n

Last week, doctors took matters into their own hands, crowdfunding \u00a3160,000 in donations in less than 24 hours to provide expert legal opinion for Bawa-Garba. Those are sobering statistics for a regulatory body that purports to uphold public confidence in doctors\u2014yet appears to have lost the trust of its rank and file.<\/span><\/p>\n

Vague and hollow reassurance from the regulator no longer cuts it for doctors. We need action, not empty words. In the spirit of preserving patient safety, the GMC could set a powerful precedent by speaking bluntly about the dangers of rota gaps. It could insist we report every single one of them, and make it quick, easy, and\u2014crucially\u2014safe for us to do so. A simple, anonymised GMC form on which we can document every staff shortage without fear of employer retribution. It could collate these data nationally and publish them openly. Imagine the force of a GMC divulgence of the scale and repercussions of doctor understaffing.<\/span><\/p>\n

Recently, I had a conversation with a senior figure in the NHS who, irked by doctors speaking out, asked me: \u201cDon\u2019t you think you have a corporate responsibility to maintain public confidence in the NHS?\u201d I took a deep breath. The rot that passes for \u201ccandour\u201d could not have been phrased more succinctly. \u201cNo,\u201d I replied. \u201cI think quite the opposite. Covering up risks, if they exist, is the exact opposite of candour. If I thought it was okay to spin away reality, I\u2019d be a politician, not a doctor.\u201d<\/span><\/p>\n

It is time for the GMC to choose. Does it wants to be part of the problem or the solution? Because, right now, every one of us could state the same refrain: #IAmHadiza.<\/span><\/p>\n

Rachel Clarke<\/strong> is a specialty doctor in palliative medicine. Follow her on Twitter @doctor_oxford<\/span><\/i><\/p>\n

Competing interests<\/strong>: None.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

We need the GMC to set a powerful precedent by speaking up about the dangers of rota gaps, says Rachel Clarke […]<\/p>\n

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