The lesson for me, is to follow the process ie where you have a legitimate patient safety concern... but I can legitimately say that I took all reasonable steps before going to the media. If I had got one piece of this puzzle wrong, my opponents would have had a field day.
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.
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.
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.
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.