Intended for healthcare professionals

Rapid response to:


Health secretary orders review into use of medical manslaughter

BMJ 2018; 360 doi: (Published 06 February 2018) Cite this as: BMJ 2018;360:k592

Rapid Response:

Re: Health secretary orders review into use of medical manslaughter

Has the Government played its part?

It is a belated but welcome decision by the Health Secretary to set up a review so that health ‘professionals know where they stand with respect to clinical liability or professional misconduct’. This should leave the British public confused as to how these decisions had been made in the past in the face of the discrepancy between the interpretation of the regulation by the highest legal and professional authorities in the country. Almost for the first time it is being recognised that the situation is far more complex as a consequence of ‘systems failures’ which could have devastating outcomes for those involved. Is there any hope for those who have been let down in the past before this enlightenment.

The problem as indicated by Rob Hendry director of the Medical Protection Society is multifactorial which influences the judgment made of an individual at any one time. Of the many factors and circumstances that may influence an individual’s behaviour, need Sir Norman Williams be reminded of the Health Secretary’s failure to recognise the profound influence of non compliance with the statutory obligations of the ‘Duty of Quality’ imposed by the Health Act 1999 and expressed in the hallowed declaration of Clinical Governance:

“A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

Would it not be incumbent on Sir Norman to inquire into or comment on how far the Health Secretary has fulfilled his statutory obligations in the circumstances involving the plight of Hadiza Bawa-Garba? Or is it to be treated as a defunct law. Believe me they do exist. ‘It could be regarded an act of treason to place a postage stamp bearing the British king or queen’s image upside-down’ or ‘It is illegal to die in the Houses of Parliament’. However ludicrous or hilarious they might sound they have not been expunged. Some laws, however, seem to be defunct even as the law is included in the corpus juris. They never seem to be tested. Their very existence denied as Mr Andrew Lansley, then Health Secretary, did when he claimed that “The NHS currently has no legal obligation to improve continuously the quality of care”. This despite the similarity of the wording

It would be no surprise that the government would narrow the remit of Sir Norman’s review to avoid the exposure of its failure to comply with statutory obligations.

I hope that there would be a challenge to the Health Secretary to give us the assurance that he and his predecessors comply with the requirements of Duty of Quality as required in Health Act 1999.

It is on record that Peter Wilmshurst and many others have questioned their own Fitness to Practice having been revalidated and declared Fit to Practise. Believe the GMC or the admission by the doctors themselves? This unquestionably raises the validity of their revalidation. Revalidation is defined in the Medical Act 1983 as an ‘evaluation of the medical practitioners’ fitness to practise’. It is clear that the practitioners themselves have no confidence in the declaration of their Fitness to Practise and rightly so since their fitness to practise can never be established as required in law. (Please see more on revalidation in the rapid response to; There but for the grace of God: Fiona Godlee in the last issue of the BMJ: 3 Feb 2018.)

I sincerely hope that the legal minds addressing this issue would demand evidence of compliance with the Medical Act 1983 and Medical Act 1999. The British public cannot be fooled forever.

Competing interests: No competing interests

13 February 2018
Anton E Joseph
Emeritus Consultant
Croydon University Hospital CR7 7YE
Croydon University Hospital, Croydon CR7 7YE