Patient safety

11.06.18

Medical examiners to be rolled out to investigate unexpected NHS deaths

All non-coronial unexpected deaths within the NHS in England and Wales are to be investigated by medical examiners in order to improve investigations into the cause of death, Jeremy Hunt has announced today.

The announcement coincides with the publication of Professor Sir Norman Williams’s rapid policy review into gross negligence manslaughter in healthcare settings, which was ordered by the health secretary after Dr. Hadiza Bawa-Garba was convicted of gross negligence manslaughter and struck off the medical register following the death of six year old Jack Adcock, sparking outrage amongst the medical community.

Speaking to Parliament today, Hunt explained that the investigation found that prosecutions and convictions of healthcare professionals for gross negligence manslaughter are rare, and that the legal test for the offence is “set at an appropriately high level,” which he said should reassure healthcare professionals.

The report makes recommendations to improve the investigation of gross negligence manslaughter in order to provide greater consistency, which include developing an agreed understanding of the offence, reflecting most recent case law; improving the way in which healthcare professionals provide expert advice and evidence; and improving local investigations.

According to the report, the introduction of medical examiners would deliver “a more comprehensive system of assurance" for all non-coronial deaths, helping to provide a full understanding of the cause of death and ensuring that improvements are made to reduce the likelihood of similar incidents.

Although they will not be specifically concerned with gross negligence manslaughter, it is hoped that their introduction will improve the quality and appropriateness of referrals to coroners, increasing transparency for the bereaved.

Lord O’Shaughnessy, under-secretary for health, explained that medical examiners will form a key element of the death certification reforms.

With regards to the potential for criminal and regulatory investigations to deter medical professionals from reflecting on their practice, the report recommended that regulators that have the power to request reflective material when investigating fitness to practice cases have this power revoked.

Currently, the General Medial Council (GMC) has the right to appeal a High Court decision where it considers the ruling to be insufficient for the protection of the public. It is the only UK health regulator with this power and the report recommends that this right be removed.

Commenting on the recommendations, the health secretary explained: “These recommendations aim to support a just and learning culture in healthcare, where professionals are able to raise concerns and reflect openly on their mistakes but where those who are responsible for providing unacceptable standards of care are held to account.

“This will support improvements in patient safety.”

Dr. Chaand Nagpaul, British Medical Association (BMA) council chair, welcomed the news that regulators would no longer be able to request reflective material from doctors during their investigations, but argued: “We still believe they should be given full legal protection, which would foster an open environment to apply systemic analysis to adverse events to improve patient safety.”

Nagpaul stressed that safe patient care is the number one concern of doctors, but argued that this can only be guaranteed with all parties recognising the need for a learning culture and adequate resources and funding.

He added:  “While we wait to see the impact the roll-out of the medical examiner role, we still believe that the chief coroner should be consulted before any death is referred to the police for a gross negligence manslaughter investigation, and that a more robust, national approach must be adopted to minimise regional variations.”

Top image: Peter Byrne PA Wire PA Images

 

Enjoying NHE? Subscribe here to receive our weekly news updates or click here to receive a copy of the magazine!

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Two Cumbrian NHS Trusts approved for merger

20/09/2019Two Cumbrian NHS Trusts approved for merger

Cumbria Partnership NHS Foundation Trust (CPFT) and North Cumbria University Hospitals NHS Trust (NCUH) have had their plans to merge into one tr... more >
British Dental Association to protect children who miss dental appointments

20/09/2019British Dental Association to protect children who miss dental appointments

Community and special care dentistry experts at Sheffield Teaching Hospitals NHS Foundation Trust have helped to develop a toolkit as a way to sa... more >
NHS calls on remaining social media companies to clamp down on ‘potentially harmful material’

19/09/2019NHS calls on remaining social media companies to clamp down on ‘potentially harmful material’

The chief executive of the NHS in England has urged remaining social media firms to get tougher on potentially harmful material being posted onli... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

The NHS needs more senior women in leadership

The NHS needs more senior women in leadership

The gender pay gap in the NHS remains a hotly debated topic, especially as the final report from the Gender Pay Gap in Medicine Review approaches. Andrea Hester, deputy director of employment rel... more > more last word articles >

the scalpel's daily blog

An ageing population means hand care and injury prevention is more important than ever

23/08/2019An ageing population means hand care and injury prevention is more important than ever

Grey Giddins, member of the British Society for Surgery of the Hand, discusses how hand care and injury prevention have become increasingly important given the UK’s ageing population   It’s no secret that the UK’s ageing population presents challenges for the NHS. The fact that we are living longer means greater de... more >
read more blog posts from 'the scalpel' >

comment

Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >

interviews

NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >

health service focus

View all News