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June 28, 2018

Private Eye Medicine Balls 1464 February 2, 2018
Filed under: Private Eye — Dr. Phil @ 2:58 pm

Shoot the Junior Doctor

The government’s 2015 manifesto commitment that the NHS ‘will offer you the safest and most compassionate care in the world’ has looked terminal since the winter crisis (Eyes passim) but may now have been killed off forever after the striking off by the GMC of Dr Hadiza Bawa-Garba. Health secretary Jeremy Hunt has questioned the GMC over the decision, but he too must act urgently to legislate for mandatory safe staffing and skill mix, time-limited shifts and compulsory breaks for acute and emergency NHS care – even if routine care has to be postponed as a result. A plane would be grounded without the right staff to fly it and a safe number of passengers on board. But every day in the NHS patients die because of staffing gaps and a lack of beds to cope with the demand.

Hunt talks a lot about ‘zero avoidable harm’ in the NHS and – just last week – ‘zero in-patient suicides’ but his track record on the essential safe staffing to support this is poor. The NHS provides widespread exceptional care but its recurrent weakness is that it has had, for decades, far fewer staff and beds per head of the population than other comparable countries (Eyes passim ad nauseum). If the government was serious about safety, it would have invested in increasing staff numbers far sooner, and expanded bed numbers so that hospitals are not dangerously full every winter with patients dying because they can’t access prompt emergency care. A brave Hunt would have supported legally enforceable safe staffing and skill mix rotas long ago. Instead, the safe staffing work of NICE was side-lined as too costly, and Hunt blundered into a highly damaging war with junior doctors to try to stretch them across more weekend shifts when they argued there were already far too many dangerous gaps in the rotas on weekdays and more staff (and beds) were urgently needed. The winter crisis shows how right they were to speak up, but the striking off of Dr Bawa-Garba by the GMC may drive them back to secrecy and cover up, fearful that telling the truth will leave them hung out to dry.

Dr Bawa-Garba admits and deeply regrets making serious errors in the care of Jack Adcock, a seriously ill 6-year-old boy who died in Leicester Royal Infirmary (LRI) on 18 February 2011
But MD – and many other doctors – would have made similar errors if forced to work in such an unsafe, unregulated environment. Bawa-Garba, a highly regarded junior doctor with an unblemished career before and since Jack’s death, had no consultant cover for her emergency paediatric shift (he was delivering a guest lecture outside the hospital) and the registrar on the children’s assessment unit was also absent. If the NHS had mandatory safe staffing and skill mix levels, managers at LRI would be obliged to transfer other staff to emergency care even if routine procedures were cancelled. Instead Dr Bawa-Garba was cut adrift and expected to cope in impossible circumstances.

Bawa-Garba had just returned from 13 months’ maternity leave and had little experience of working on the child assessment unit. Her crucial induction training was cancelled due to lack of staff. She had to cover six hospital wards across four floors, responsible for dozens of critically ill children during an inhuman 13 hour shift, with no time from food, drink or rest. The IT system crashed and the results alerting system never came back online. An emergency prevented her from attending the vital morning handover. Despite this absurdly dangerous environment, she helped save a child after cardiac arrest, performed a lumbar puncture, stabilised a child having epileptic seizures and provided compassionate, competent and highly complex care. Amidst dozens of high pressure decisions, she made three diagnosis and treatment errors, all in Jack Adcock’s care. But in a safely staffed team, they would either not have happened or would likely have been checked and corrected.

A jury decided Dr Bawa-Garba was guilty of gross negligence manslaughter and the GMC argued this should automatically mean she should be struck off, rather than supported to return to work. The judges ruled that ‘each case would turn on its own facts’ which in this instance were sufficient to merit her erasure. The facts included her own feedback to her consultant that she could have done better, and her honest self-reflection notes she voluntarily submitted to the trial. A vast sum of money has been raised for her appeal, largely donated by those who know they would have made similar errors in such dangerous circumstances. Hunt must now push for safe staffing legislation in the most dangerous specialties, many of which have daily staffing gaps. And the GMC must admit that in pursuing, blaming and erasing Dr Bawa-Garba it has made a serious error that is likely to make NHS cover-ups even worse, and even more young doctors walk away from the highest-pressure jobs.