Intended for healthcare professionals


Criminalisation of unintentional error in healthcare in the UK: a perspective from New Zealand

BMJ 2019; 364 doi: (Published 07 March 2019) Cite this as: BMJ 2019;364:l706
  1. Rohan Ameratunga, adult and paediatric immunologist and honorary associate professor1,
  2. Hilary Klonin, consultant paediatric intensivist2,
  3. Jenny Vaughan, consultant neurologist34,
  4. Alan Merry, deputy dean and specialist anaesthetist15,
  5. Jonathan Cusack, honorary senior lecturer6
  1. 1Auckland City Hospital and University of Auckland, Park Rd, Grafton 1010, Auckland, New Zealand
  2. 2Department of Paediatrics, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
  3. 3Ealing Hospital, North West London Healthcare NHS Trust, Uxbridge Road, Southall, London, UB1 3HW, UK
  4. 4Charing Cross Hospital, Imperial College Healthcare NHS Trust. Fulham Palace Road, London W6 8RF
  5. 5University of Auckland, Auckland 1142, New Zealand
  6. 6Leicester Medical School, Infirmary Road, Leicester LE1 5WW, UK
  1. Correspondence to: R Ameratunga rohana{at}

Legal reform in New Zealand that saw changes to the prosecution of health professionals for gross negligence manslaughter may have important lessons for the UK in light of the recent case of Hadiza Bawa-Garba, say Rohan Ameratunga and colleagues

Key messages

  • Healthcare systems should provide an adequate and effective response to patients who have been unintentionally harmed while receiving care

  • To improve patient safety we need a greater focus on learning and resolution rather than retribution and blame, recognising the importance of protecting confidential personal reflective practice while encouraging open disclosure and system transparency

  • In line with the recommendations from the Williams review, England and Wales should have a higher threshold for criminal prosecution in response to deaths that arise despite conscientious efforts to care for patients under difficult circumstances

  • We urgently need to improve the clinical working environment and resourcing for safe functioning of hospitals

On 18 February 2011, Jack Adcock, a 6 year old child, died at the University Hospitals of Leicester (UHL) NHS Trust. Hadiza Bawa-Garba, a paediatric trainee doctor, under light supervision and with many other responsibilities, was tasked with his care and subsequently charged, tried, and convicted of gross negligence manslaughter. This case was complex. The legal and regulatory aftermath was protracted and controversial (box 1, box 2),6 which prompted the Secretary of State for Health and Social Care to commission a rapid review of gross negligence manslaughter.7

Box 1

An overview of the case and its aftermath

Hadiza Bawa-Garba had completed five years of specialty training in paediatrics and had recently returned from 13 months’ maternity leave, rotating to University Hospitals of Leicester (UHL) NHS Trust from a different hospital. She was not offered any opportunity to undertake the hospital induction programme and had last undertaken general paediatric practice four years earlier. On arrival at the department, on the morning of 18 …

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