The suggestion that criminal prosecution of medics in cases of medical negligence should be ruled out has faced a backlash.
The issue arises after the Crown Office ruled out criminal charges against obstetrician Vaishnavy Laxman following the decapitation of a baby as it was being born at Dundee’s Ninewells Hospital in 2014.
It is understandable that the proposal to shield medics from prosecution makes many people uneasy. This was one of the most horrific stories published in the Herald in recent memory, and the call from Professor David Galloway, president of the Royal College of Physicians and Surgeons Glasgow for a “genuine blame free culture” in the NHS did not go down well with some readers. Doctors were accused of ignoring the “first do no harm” principle, and of circling the wagons when things go wrong.
Why should medical staff be granted protection which is not available to others - in the construction industry, say - from culpable homicide charges?
But, as Prof Galloway suggests, that a blame culture is not conducive to fixing deeper problems, or learning from mistakes. Sir Ian Kennedy QC, expert in health ethics, argues manslaughter charges simply mean “you can pick someone, blame them and imagine you have solved the problem.”
They are both right. If there is a chance you will face criminal charges for getting it wrong, negligent or otherwise, the likely responses are concealment, scapegoating and cover up.
This is about choosing the better side of human nature, not pandering to the worst. The desire for retribution, especially in the wake of an extreme and upsetting incident is natural, as is the temptation to cover up errors after the fact. But working together to find ways to understand problems and avoid them happening is another more laudable human instinct. It is one which thrives on openness and honesty rather than defensiveness and punishment.
Countering blame with defensiveness, meeting error with anger is the social strategy which leads to whiplash claims over the most minor road accident, and companies so jumpy about their customers that they need prominent “this is hot” warnings on every drink cup. It makes everyone less likely to learn and take responsibility.
Does the threat of manslaughter charges make it more or less likely medics will close ranks? What culture is most likely to encourage openness about mistakes?
We know the answer. That culture has been developing in Scotland for 10 years now, under the Scottish Patient Safety Programme.
A world first when it was set up in 2008 to improve the safety and reliability of care and reduce the risks of harm in hospitals, it has attracted international attention. By encouraging staff to voice concerns, learn from data, and share what works, it is making NHS Scotland better. From changes which have led to 40 per cent fewer pressure ulcers every month in Scottish hospitals – saving a monthly £184,000 – to improvements in infection control and reduced levels of self harm in hospitals.
This culture is a genuine Scottish success which after 10 years is now reaching beyond the limits of our hospitals. But It is not the kind of culture which flourishes when the fear of criminal prosecution lurks in the background.
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