Re: Would criminalising healthcare professionals for wilful neglect improve patient care?
Jo Bibby argues that wilful neglect should be criminalized. But the devil is in the detail. The caveats that she cites: 'we would need clarity in the interpretation of "wilful" and thorough evaluation of its impact' and 'although legislation will hopefully deter rare and extreme cases...' underline how shaky the whole proposition is.
Doctors in the UK, uniquely amongst comparable countries, are subject to multiple jeopardies: civil legal action, employer/Trust disciplinary measures, GMC referral and even, as Christine Tomkins points out, criminal action. These processes may be used in serial or in parallel and are invariably traumatic and lengthy for both the claimants and the complained against.
Jo Bibby uses Mid Staffs in part to justify the idea of a criminal charge of 'wilful neglect'. But this is not a good example. The GMC has not proceeded with investigations against Mid Staffs doctors referred to it - and the burden of proof in a GMC case is somewhere between that of a civil and criminal court. Is it really likely that a criminal case would succeed where an action requiring a lower burden of proof is discontinued? Further, given that doctors almost invariably work in teams would an action against one mean that everyone else in the team became an 'accessory to wilful neglect'?
To my medical colleagues from overseas, this debate highlights a curious and punitive characteristic that pervades the healthcare debate in this country, once an exemplar of fairness. The UK's medical regulator, the GMC, disciplines a far greater proportion of doctors that comparable European countries - or even the USA. The NHS's civil litigation bill is now over £1 billion per year, around 1% of the NHS's total budget. Medical indemnity praemia are rising exponentially in many specialties and the cost of medical regulation is now at least an order of magnitude higher than it was two decades ago.
We could do worse than consider no-fault compensation schemes and completely redesign the proto Victorian systems for disciplining medical and nursing professionals. But the threat of criminalizing them is neither a sophisticated nor proportionate response, nor one that is likely to work.
Competing interests:
No competing interests
03 February 2014
Christoph Lees
Consultant in Obstetrics and Fetal-Maternal Medicine
Rapid Response:
Re: Would criminalising healthcare professionals for wilful neglect improve patient care?
Jo Bibby argues that wilful neglect should be criminalized. But the devil is in the detail. The caveats that she cites: 'we would need clarity in the interpretation of "wilful" and thorough evaluation of its impact' and 'although legislation will hopefully deter rare and extreme cases...' underline how shaky the whole proposition is.
Doctors in the UK, uniquely amongst comparable countries, are subject to multiple jeopardies: civil legal action, employer/Trust disciplinary measures, GMC referral and even, as Christine Tomkins points out, criminal action. These processes may be used in serial or in parallel and are invariably traumatic and lengthy for both the claimants and the complained against.
Jo Bibby uses Mid Staffs in part to justify the idea of a criminal charge of 'wilful neglect'. But this is not a good example. The GMC has not proceeded with investigations against Mid Staffs doctors referred to it - and the burden of proof in a GMC case is somewhere between that of a civil and criminal court. Is it really likely that a criminal case would succeed where an action requiring a lower burden of proof is discontinued? Further, given that doctors almost invariably work in teams would an action against one mean that everyone else in the team became an 'accessory to wilful neglect'?
To my medical colleagues from overseas, this debate highlights a curious and punitive characteristic that pervades the healthcare debate in this country, once an exemplar of fairness. The UK's medical regulator, the GMC, disciplines a far greater proportion of doctors that comparable European countries - or even the USA. The NHS's civil litigation bill is now over £1 billion per year, around 1% of the NHS's total budget. Medical indemnity praemia are rising exponentially in many specialties and the cost of medical regulation is now at least an order of magnitude higher than it was two decades ago.
We could do worse than consider no-fault compensation schemes and completely redesign the proto Victorian systems for disciplining medical and nursing professionals. But the threat of criminalizing them is neither a sophisticated nor proportionate response, nor one that is likely to work.
Competing interests: No competing interests