Jenny Vaughan writes for the BMJ: Medical Manslaughter, will the findings of an independent review be a tipping point for change

Jenny Vaughan writes for the BMJ: Medical Manslaughter, will the findings of an independent review be a tipping point for change

It’s been a busy in Medical Manslaughter land. I attach my DAUK commentary on the medical Manslaughter review out recently.

Five years ago, when I first started doing the appeal for David Sellu ( check out his new book “ Did He Save Lives? “via Foyles and Waterstones) I never dreamt of a day like this. A whole review has now essentially concluded that if any doctor is being lined up for criminal charges, it will now be expected that the setting in which they work will be equally scrutinised and that experts will have to consider if human factors like stress or fatigue were more to blame. All I could see then was darkness, a toxic hospital with its knives out and judgemental expert witnesses. Now we have moved forward and all of us here at DAUK applaud Leslie Hamilton and his panel for such an excellent set of 29 recommendations.

Guest Blog by Dr Pete Aird: “A time to heal”

A Time to Heal

This week I came across Hugh McLeave’s biography of Professor Ian Aird entitled ‘A Time to Heal’. In it Aird is described as having been ‘a brilliant surgeon, an inspired teacher and one of the great medical personalities of his generation’.

He was also, if I have my family tree correct, my grandfather's cousin.

Born in 1905 in Edinburgh he attended George Watson’s College where school certificates record he never achieved anything less than ‘Excellent’ and where contemporaries described him as one who ‘could not help himself, being a perfectionist’. He subsequent studied medicine at Edinburgh University and embarked on a career which, in time, saw him rise to become Professor of Surgery at the Hammersmith Postgraduate Medical School. Here he became best known for separating Siamese twins, most notably the Nigerian pair of Boko and Tomu. Dying in 1962, five years before I was born, meant I never met him but photographs of him are strangely familiar as, in appearance, he bore a striking similarity to my Uncle John.

Few, despite his pioneering work, remember him today and I have only once in my own career come across anybody for whom his name meant anything. My first house job was in Bristol, working as part of a urological firm in Southmead Hospital. The consultant under whom I worked, Mr Roger Feneley, had himself studied from Aird’s Textbook of Surgery, and he took some delight in imagining he was nurturing ‘the young Aird’ to become a fine surgeon in his own right. Disappointingly, I suspect, for Mr Feneley, I was in no way cut out for surgery and happily chose instead an equally satisfying career as a GP.

That textbook of surgery was not the last thing that Ian Aird wrote. His final words were found in a notebook alongside a Bible opened at Ecclesiastes 3 where he appeared to have been reading these words: ‘To everything there is a season, and a time to every purpose under the heaven: a time to be born and a time to die’. This is what, in a ‘bold and unequivocal hand’, he had written:

‘To the Hammersmith Coroner: I have taken a fairly substantial dose of barbiturates. I have never taken a drug before in my life. I have passed my apogee. My skill is going and I am in deep despair. I find myself in unmitigated gloom. Although I am a sincere and practising Christian, I cannot continue. I have burnt myself out. There is too much to do. I cannot write my book again. My department has produced the electronic control of patients in operating theatres, done the first intra-cardiac operations, transplanted the first kidney homografts in Britain, shown the connection between blood groups and disease - and there has been no distinction given to us...Ian Aird’

McLeave, who knew Aird well, interpreted that final comment, not as an embittered comment at the lack of personal recognition, such was not his nature, but rather as a reflection of the struggles he’d long had in attracting funding for his work and the active discouragement he’d experienced from within the medical profession.

The frustration that he was not achieving all that he could, together with his own excessively high standards that fuelled that frustration, culminated in producing the emotional distress with which he no longer felt able to cope. The conclusion McLeave drew was that ‘Had [Aird] taken a holiday, sought medical advice or resigned himself to living at a slower tempo, he might have lived - but he demanded nothing less than perfection in himself’.

Though I never knew Professor Aird, I recognise, both inside and outside of medicine, that same perfectionism that demands of individuals more than they are able to give and renders them both guilt ridden and unhappy. As expectations increase, both from within and without, what Atul Gawande describes as our ‘inevitable fallibility’ leaves us imagining we are moral failures simply because of our inherent ordinariness. We, and those with whom we live alongside, need to be kinder to one another, acknowledge our humanness, and stop insisting that we are more than we could ever become. There are many reasons that drive individuals to take their own life, and none but those who follow this drastic course can fully understand those reasons, even indeed if they themselves can ever understand them - but amongst those reasons lie unhelpful and unrealistic demands and expectations. Hannah Arendt had it right when she said ‘In order to go on living one must try to escape the death involved in perfectionism’.

In life, Ian Aird was fond of quoting Shakespeare’s words spoken by Cardinal Wolsey in Henry VIII:

And, when I am forgotten, as I shall be,

And sleep in dull cold marble, where no mention

Of me more must be made of, say I taught thee.

A fitting memorial for my long forgotten relative would be that he did indeed teach, and that we learnt, that perfectionism, and the demand for it, kills, just as it surely, at least partly, killed him.

Written by Dr Pete Aird General Practitioner.

This blog was originally posted on Resilent GP a closed facebook forum that aims to support GPs 8/6/19

Guest Blog: Dr Jermaine Bamfo "Experiences of being a BAME medic"

EXPERIENCES OF BEING A BAME MEDIC

Being a BAME (Black, Asian & Minority Ethnic) medic comes with its rewards and challenges. Having been raised in the cultural melting-pot of East London, my experiences of interacting with other ethnic minorities in my formative years provided me with a rich array of differing conduits through which I can form a rapport with a wide variety of patients. In saying this, there have also been challenges that I have personally faced in my medical journey, problems that my fellow BAME colleagues have experienced and many more systemic issues which have slowly become more apparent. And it is these challenges that I will be focusing on in this article…

Microaggressions are experiences which I’m sure most BAME doctors and medical students are only too aware of. There are stories about inappropriate anecdotes made during teaching sessions, the ‘politics’ of Afro-Caribbean hair and having to justify one’s appearance. Tales of having to confirm one’s role to a patient who can’t fathom that you could possibly be a doctor and feeling frustrated at how difficult it can be for someone to reconcile your ethnicity with your competency. Microaggressions are rife in our everyday experience and can easily leave one feeling drained, and demoralised.

There are further issues concerning equality. In 2016, the NHS Equality and Diversity Council released the Workforce Race and Equality Standard (WRES) report which surveyed the experiences of BAME and white staff and found that BAME staff were much more likely to be victims of harassment, bullying and abuse by staff or patients regardless of the trust’s location.  BAME staff felt more likely to be discriminated against and that equal opportunities did not exist in their place of work. A minor media storm arose in late 2018 when NHS Digital published findings exposing the pay disparity between black and white staff across the entire range of roles in the NHS. Black NHS doctors were found to be paid on average almost £10000 a year less than their white counterparts! Dr Chaand Nagpaul, the chair of the British Medical Association (BMA) said:

“BAME doctors make up more than a third of the medical workforce and play a vital role, day in day out, delivering care to patients across the country. Yet these figures confirm that they…continue to face unacceptable barriers, penalties and discrimination in the health service.”

The BMA also highlighted that pay differentials are just one marker of BAME discrimination in Medicine, with BAME doctors having reported feeling they are at greater risk of harassment and bullying at work, and only 7% of senior managers in the NHS found to come from BAME backgrounds. The BMA also found that BAME doctors are more likely to face referral to the General Medical Council, more likely to be investigated and face harsher sanctions following investigation. Dr Hadiza Bawa-Garba is a key recent case which comes to mind; a previously flawless doctor became the poster-child and scapegoat of systemic failure and the wider exceptional pressures most doctors are all too aware of. How much did her background influence the ferociousness with which she was initially investigated and sanctioned? 

Such inequalities should not exist in 2019, as everyone should have equal opportunity to reach their potential regardless of their background. Yes, there has been great progress in recent years regarding gender inequalities for example, but the need for change in resolving racial inequalities in Medicine have either for too long been ignored, or changes not seen to the extent or pace required.

Medical schools, the NHS and their affiliated management structures need to do more to empower BAME employee and student voices to inform change, while also addressing the unconscious biases and overt discriminations which exist. There needs to be practical support provided to aid race pay-gap reporting, so these discrepancies can be addressed. There needs to be work done to address the differential attainment in medical education and training, to widen access to the progression, to help secure a greater degree of fairness in fitness to practice proceedings and prevent disproportionate disciplinary action. These and more will go a long way in creating a more supportive and inclusive environment for BAME doctors and medical students.

For these reasons and more, I’m proud to be associated with Melanin Medics - a not-for-profit organisation dedicated to supporting the UK community of African-Caribbean aspiring medics, medical students and medical professionals, while also tackling the underrepresentation of African-Caribbean’s in the UK Medicine. Melanin Medics is focused on implementing practical, effective and positive solutions to help to overcome ethnic minority underrepresentation and the multiple socio-economic barriers which exist in the medical profession.

BAME doctors have cited a lack of role models as a barrier to progression, and they are more likely to feel that their background negatively affects their development opportunities. It is said that you cannot be what you cannot see, and this is why BAME representation in Medicine is key. Changes are needed to make Medicine more appealing to BAME youths, to engineer more support for BAME medical students and to strengthen the communal links of power between those already working on the frontlines and those looking to join them as they train. By increasing the exposure of young BAME doctors and placing the spotlight on those BAME doctors making major waves in the profession, and by creating a network between BAME professionals for the sharing of ideas and experiences, we can demonstrate what is required and what is achievable.

The demographic of our nation has changed significantly over the past 25 years. And while the numbers of BAME representation in Medicine have gradually increased, there is still more work to be done to further change the face of Medicine. As demonstrated in this article, there are many barriers standing in the way of a BAME medic. Despite this, we at Melanin Medics believe there is no barrier which is insurmountable. Despite the various adversities which lie in our paths, we must choose to pursue excellence!

It inspires me to see the recent influx of groups focused on increasing BAME representation in Medicine, groups looking to foster working relationships in those communities and shine spotlights on outstanding BAME medical representatives. It is great to have initiatives like the GMC’s BME Doctor’s Forum which aims to help the GMC’s regulatory work respond better to the needs of UK BAME doctors.

It cannot be denied that a great number of significant barriers to race equality in Medicine still exist – from the ‘cradle to the grave’ i.e. from the opportunity to enter medical school all the way through to the end of one’s medical career. We need to do more. We need to strive to do more. There are many roadblocks which need to be broken down and many more glass ceilings which need to be broken through; but having already seen much progress made over the last 25 years, it is entirely possible that with new movements in the offing the BAME community will get closer to parity in the near future. The NHS is held together by a rich tapestry of talent, with its various strands provided by people from all backgrounds and communities; for this reason, we must endeavour more to allow the facilitation and celebration of diversity at all levels of the NHS.

Written by Dr Jermaine Bamfo. Psychiatry Registrar.

Mentioned Links

Melanin Medics: Website https://www.melaninmedics.com Twitter @melaninmedics Instagram @melaninmedics

GMC’s BME Doctor’s Forum: https://www.gmc-uk.org/about/how-we-work/equality-and-diversity/black-and-minority-ethnic-doctors-forum

Guest Blog: Dr David Nicholl "How to Whistleblow " Part 2, Brexit - A Case Study.

Brexit - A Case Study.


As a senior Consultant involved in a number of national organisations, I found myself, in March of this year, in the unusual situation of being asked to advise NHS England in March as part of their preparations for a ‘No Deal Brexit’ scenario for pharmaceuticals in neurology. I was aware, from the media, that a large number of non-disclosure agreements had been signed (even though NDAs were meant to have been banned in the NHS some years ago). Thus, I took the precaution of speaking to my medical defence organisation prior to agreeing to participate. As it happened, when asked to assist, I was not asked to sign an NDA, but asked not to share any of the password protected documents without permission. At the time I was happy to do this- ultimately someone has to get the country ready in the event of a ‘No Deal’, even though numerous bodies had warned about the risks of No Deal in healthcare- from the Royal College of Physicians, the Chief Medical Officer  and even my own hospital Trust had warned of the patient safety risks.  However although the ‘No Deal’ plans were extensive, I became increasingly uncomfortable as:

  1. It had not been possible to stockpile all medication in every instance

  2. I was aware of some of my own patients who were having difficulty accessing medication- including brands where I knew the drug companies concerned had not been able to stockpile

  3. Although problems of pharmaceutical supply are not unique to Brexit, it was clear that there was a risk to patient safety, especially for certain select groups of patients. 

  4. Large numbers of MPs were supporting the prospect of a NoDeal Brexit, even though based on the documents I had seen, there was a very real risk of some patient harm.

The GMC guidance on raising concerns is quite specific “You must take prompt action if you think patient safety, dignity or comfort is being compromised”. Given that we were literally about to leave the European Union within a matter of days, I needed to make some important decisions quickly. I had reason to believe I was justified in making a qualified disclosure of the data I held as there was a risk to the health and safety of number of patient groups. Clearly I did not want to lose my job, but who would I make a qualified disclosure to? The list of prescribed bodies did not include any such a body that would cover a ‘No Deal policy’, clearly NHS England would have no interest in me going public. 

I personally spoke to the clerk of the Commons Health Select committee. Although they are not a prescribed body, the clerk referred me back to the list of prescribed bodies. I could have of course spoken to my MP- but given that he is a government minister, he would be conflicted with no wish for me to raise my concerns over ‘No Deal’. I did contact the GMC, they took 2 weeks to reply- by which stage we would have left the European Union- for the record, their advice was:

“Dear Dr Nicholl

Thank you for contacting us with your concerns regarding NHS England’s contingency planning for the UK leaving the European Union.

As you’re likely aware, we’re a prescribed body and are subject to a legal duty to accept and handle public interest disclosures appropriately. However, your disclosure does not fall under our specific functions as a regulator which are:

ï         Registration and licensing

ï         Medical education

ï         Professional standards

ï         Fitness to practise or any related activity

The Secretary of State for Health and Social Care deals with matters relating to the provision of public health services and would be an appropriate body to raise this with. Their contact details, from the Department’swebsite, are 

The Secretary of State for Health and Social Care 
Ministerial Correspondence and Public Enquiries Unit
Department of Health and Social Care
39 Victoria Street
London
SW1H 0EU
Website: www.gov.uk/dh

You’ve mentioned that you have already spoken to your defence body about this, however, if you need further advice during this time, Protect is an organisation that provides advice and support on whistleblowing.

More broadly, whilst it is for Government to determine public policy and present relevant legislation to parliament on issues such as these, we do recognise the need for doctors to know how they might be expected to act in the event of external events that lead to a shortage of medications to ensure the risk to patients is minimised.

I understand that NHS England has produced documents around this issue which may be helpful. The Medicines shortage guidance includes recommendations for doctors trying to source a prescribed medicine in the event of a shortage. Along with this, Professor Keith Ridge has written about the steps taken to protect the continuity of supply for medicines.

Please don’t hesitate to get in touch should you have any questions.

Yours sincerely


Thus, my educated guess that the GMC would be totally unable to help was correct. This made my next decision legitimate and defensible (even though I could not have known this at the time).

My patient, Gillian, who was still having significant problems accessing her medication – to the extent that she had been admitted to hospital in status epilepticus for the first time in 9 years- and she was willing to speak to the Press. So in the very day that I was speaking to a national conference on whistleblowing, I decided to be one myself, and speak to BBC Newsnight, 3 days before we were due to leave the EU on March 29th.  

I warned my Trust, who were happy for me to be interviewed in a personal capacity. The Newsnight broadcast (and indeed Brexit) were delayed due to legal concerns- the BBC needed to allow the drug company concerned more time for right of reply, even though they ultimately were not named in the broadcast. Newsnight in fact offered me anonymity, which I declined as given that only an exceedingly small number of clinicians had access to the confidential data- all of whom I would regard as both friends and colleagues- I really did not fancy any kind of post-broadcast witch-hunt to find the leaker. This is something that has certainly been a problem for some members of the Cabinet recently. Besides, as Oscar Wilde once said “True friends stab you in the front”. That said, it was an extremely stressful period personally, speaking up is never easy.

The Newsnight piece was broadcast on April 3rd, after broadcast I wrote to the civil servant who I had been dealing with to apologise for my breach of confidence - something I have never done to any professional in my entire career. Then I waited for the response, clearly I could no longer continue with the Brexit brief. In fact there was no direct response to me, any ire was aimed at others. A press officer tried to enquire as to why I been allowed to be interviewed, as well as sounding out if I had gone through the correct processes - I had, to the letter. The Department of Health took aim - not at me, but at the BBC for ‘scaremongering’ This I had not anticipated, but in announcing a delay to Brexit, the Prime Minister had opened up a leadership campaign, and the last thing one of the contenders, Matt Hancock, needed was anyone questioning were the No Deal Brexit plans. 

The Newsnight report was accurate and clearly in the public interest- in response I and my patient, Gillian, spoke out in defence of the BBC. Despite a delay, Newsnight eventually were able to publish on-line the ‘No Deal’ story (with significant input from others including the BMA, calling for greater transparency), on the very same day that the Prime Minister and the European Commission agreed a delay of Brexit until October 31st.  

On April 16th, the Department issued the following response to the Newsnight story “confident that if everyone does what they need to do, the supply of medicines should be uninterrupted in the event we leave the EU without a deal.”

The following week Gillian contacted me, she has been able to get her medication (probably nothing to do with the delay in Brexit) but she was extremely grateful for my efforts. 

The likelihood of No Deal has clearly fallen for now, someone else will have to deal with No Deal plans if this lunacy continues until Halloween. I wouldn’t wish this on anyone- do those who really want a No Deal Brexit fully understand what they are hoping for? As the BMA pointed out- "a culture of secrecy" could undermine the ability of medics to plan care and deliver treatment”.

As a neurologist, I certainly never saw the day I would be looking at making a judgement call over ferry versus flight for the transport of my patients’ medications. 

So in summary, I have raised concerns by following the steps I have listed above and am still in paid employment. Does that mean that I think is all hunky-dory for NHS whistleblowers? Far from it, the overwhelming evidence is that there are significant risks to whistleblowers- I have been very lucky, but I have also taken appropriate steps in mitigation to minimise the risks to my career.

Guest blog written by Dr David Nicholl Consultant Neurologist SWBH / Human Rights Activist / Leader in Just Culture

Dr Nicholl will be speaking, at Change UK’s health conference from 18:30 Tuesday 14th May,  on why he spoke to Newsnight. Other speakers include Sarah Woolaston MP. To find out more: https://voteforchange.uk/events/change-uk-health-conference/

Guest Blog: Amandip Sidhu reflecting on the harms of a "get on with it culture"

Guest Blog: Amandip Sidhu reflecting on the harms of a "get on with it culture"

Amandip Sidhu is a Learn Not Blame member and pharmacist. Tragically, Amandip lost his brother, a respected Consultant Cardiologist to suicide just a few months ago. In this heartbreaking and powerful guest blog for DAUK and the Compassionate Culture campaign, Amandip reflects on the “just get on with it” attitude of the NHS, and how we must move to kinder NHS that treats it’s staff with much needed compassion.

Guest Blog: Dr Joanna Poole, Post Mortem of a Career

Guest Blog: Dr Joanna Poole, Post Mortem of a Career

Dr Joanna Poole is an Anaesthetic trainee and a DAUK member. After sharing a blog on Twitter about wanting to quit medicine which went viral, Joanna has also been inundated with messages from fellow doctors who have found themselves in a similar situation. Now, Joanna has been invited to share her experiences with multiple Royal Colleges and Joanna is collating the responses she has received anonymously in the hope this will inspire a kinder NHS for our doctors. Joanna is a force for change and is a real example for what grassroots doctors can achieve when they speak up. We look forward to working with Joanna at DAUK.

Shame and Stigma; why doctors won’t seek help for their mental health Dr Natalie Ashburner writes

Shame and Stigma; why doctors won’t seek help for their mental health Dr Natalie Ashburner writes

“It’s not something we talk about or that everybody experiences to the same degree but I think most of us are affected, be it subconsciously or consciously by antiquated, competitive, hierarchical values. Revered doctors are those that work above and beyond the hours they are paid for, that come in even when they are sick, that prioritise work over their families, over sleep and their own health. Doctors that are kind and compassionate but that don’t allow themselves to be affected by their experiences. Doctors that would go from one cardiac arrest to the next without letting their judgement cloud or their actions falter.” 

A just culture for the NHS: Cicely Cunningham writes...

A just culture for the NHS: Cicely Cunningham writes...

 Since starting this campaign, I have often been asked the question: “What would success look like for Learn Not Blame?” To start with, I struggled to answer this question. There seemed to be many answers which applied in different situations. A world where front line staff who make mistakes are not thrown under a bus by their colleagues and organisations. A world where patients and families are heard, their questions answered, their desire for learning met. A world where doctors could go to work and know that their care was getting safer, because there was a commitment to listening to staff, acting on concerns and not repeating the mistakes of the past.

Me? I'm just an ordinary doctor... Cicely Cunningham writes

Me? I'm just an ordinary doctor... Cicely Cunningham writes

It’s been a year now since my personal campaigning journey began – from a generally opinionated clinical oncology trainee to passionate advocate for a just culture in the NHS. The story began on 25th January 2018, when I was doing what many of us do of a normal evening – scrolling through social media on my phone. But instead of the usual fluffy animal pictures, something was afoot. All the doctors I knew on social media were up in arms about a court case where the General Medical Council (GMC) had pursued a paediatric trainee to seek her erasure from the medical register – Dr Hadiza Bawa-Garba. 

What next for Learn Not Blame in 2019? Cicely Cunningham writes...

What next for Learn Not Blame in 2019? Cicely Cunningham writes...

2018 was the beginning of the Learn Not Blame campaign and what a year it was! From a phrase coined by the inimicable David Nicholl to a wave of nationwide outrage at the injustice of criminalisation of healthcare professionals for honest mistakes. Along with this outrage was the understanding that fear, blame and criminalisation of honest error – especially when made when working in a system under pressure – does nothing for patient safety. Yet too many NHS organisations are perpetuating a culture which allows this toxic mix to thrive, and patients are put at risk. The figures for avoidable harm in the NHS are staggering. And yet the pattern repeats.

"What has the GMC learnt?" DAUK asks Charlie Massey

"What has the GMC learnt?" DAUK asks Charlie Massey

The Doctors’ Association UK committee met with Charlie Massey, Chief Executive and Registrar of the GMC and Dr Colin Melville, Medical Director and Director of Education and Standards last week. We were clear to convey the anger and distrust the profession feel towards the GMC. During the meeting we covered a variety of subjects including issues raised by the Bawa-Garba case, continued appeal of MPTS decisions, weaponisation of GMC referrals, accountability of NHS managers, and mental health and wellbeing of doctors under investigation.

"What is stopping you doing something that is patently sensible?" says Rosie Cooper MP to Charlie Massey: Jenny Vaughan reports on the HSC inquiry.

"What is stopping you doing something that is patently sensible?" says Rosie Cooper MP to Charlie Massey: Jenny Vaughan reports on the HSC inquiry.

After month of campaigning by DAUK, the Health and Social Care Committee held an inquiry into gross negligence manslaughter. Dr Jenny Vaughan attended on behalf of DAUK. Read her report here: