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Would criminalising healthcare professionals for wilful neglect improve patient care?

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g133 (Published 23 January 2014) Cite this as: BMJ 2014;348:g133
  1. Jo Bibby, director of strategy1,
  2. Christine Tomkins, chief executive2
  1. 1The Health Foundation, London WC2E 9RA, UK
  2. 2Medical Defence Union, London SE1 8PJ, UK
  1. Correspondence to: Jo Bibby Jo.Bibby{at}health.org.uk, Christine Tomkins christine.tomkins{at}themdu.com

The government is consulting on bringing such a crime to the statute books. Jo Bibby says it would deter poor care that results in severe harm but not death, but Christine Tomkins thinks sufficient sanctions already exist and that such a move would be likely to be detrimental in a number of ways, not just in reducing openness.

Yes—Jo Bibby

The House of Commons health select committee held hearings in response to two inquiries into the tragedy that unfolded at Mid Staffordshire NHS Foundation Trust between 2005 and 2009, where many of the excess deaths and harms might have been caused by staff negligence. Giving evidence, the chairman of the two inquiries, Robert Francis QC, said that “there did not seem to me to be a range of criminal sanctions available to reflect the sorts of terrible things I found.”1 I believe that the government’s proposal in Hard Truths,2 its response to Francis’s inquiry, to legislate on sanctions where individuals or organisations are unequivocally guilty of wilful or reckless mistreatment of patients is necessary, albeit not sufficient, to improve care.

Purpose of legislation

Legislation serves several purposes. Here, it would be expressive—a statement about boundaries of acceptability and a deterrent to deviant behaviour—and, if necessary, restorative—ensuring society’s need for justice is met. There are many instances when introduction of legislation to curb behaviours has led to improvements in the quality of other aspects of our lives. For instance, the drink driving laws, contested by many at the time, have been associated with an 82% reduction in drink driving related deaths over the past 30 years3 4; compulsory wearing of seatbelts has saved an estimated 60 000 lives over the past 25 years5; and recent smoking legislation protects smokers and non-smokers from the harmful effects of tobacco. In healthcare you might …

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