NMC to update guidance on reflective practice in wake of Bawa-Garba gross negligence manslaughter case

Healthcare regulators need to review their advice about reflection, Williams report states
Support for Bawa-Garba

Healthcare regulators need to review their advice about reflection, Williams report states

Support for Bawa-Garba
Demonstrators show their support for Hadiza Bawa-Garba. 
Picture: Steven Scott Taylor/Alamy Live News

The Nursing and Midwifery Council (NMC) said it will review its guidance on reflective practice in the wake of a report into gross negligence manslaughter cases against healthcare professionals.

Health and social care secretary Jeremy Hunt commissioned his clinical adviser, the surgeon Sir Norman Williams to review the issue after promising more support for clinicians who make ‘honest mistakes’ so that they can learn from their mistakes without fear of prosecution.

The move followed the case of trainee paediatrician Hadiza Bawa-Garba, who was found guilty of gross negligence manslaughter in 2015 following the death of six-year-old Jack Adcock, who developed sepsis at Leicester Royal Infirmary in 2011.

A tribunal ruled Dr Bawa-Garba should remain on the medical register despite the conviction, but in January the doctors’ regulator the General Medical Council (GMC) succeeded in having her struck off at the High Court.

‘This review will help us promise clinicians the NHS will support them to learn rather than seek to blame’

Jeremy Hunt

As part of the Williams review, the Crown Prosecution Service provided data on the deaths of 38 patients since 1994. These led to gross negligence manslaughter prosecutions of 47 healthcare professionals, of whom 37 were doctors, nine were nurses and one an optometrist. There were 23 convictions, four of which were overturned on appeal.

Reflective practice and revalidation  

In his report recommendations, Professor Williams said regulators should ‘review and, if necessary, amend guidance on how healthcare professionals carry out reflection’.

Reflective practice is an important feature of the revalidation process. Currently, registrants facing fitness to practise (FtP) proceedings are not required to present evidence of reflection on the incidents being investigated, but they can do so voluntarily.

‘Chilling effect on the ability to learn from mistakes’

An NMC spokesperson said a review would help ‘support a culture of learning and improvement’.

The spokesperson added: ‘We will assess whether our guidance on reflective practice should be updated to provide further clarity.’

Mr Hunt said: ‘I was deeply concerned about the unintended chilling effect on clinicians' ability to learn from mistakes following recent court rulings.

‘This review will help us promise them that the NHS will support them to learn rather than seek to blame.’

In April, the NMC outlined a strategy for FtP aimed at encouraging nurses and midwives to admit mistakes at the earliest opportunity.

A public consultation into the changes closed on 8 June and the outcome will be published in due course.

Related material

Read the Williams review here

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