The Bawa-Garba Case, Systems Failure and the Duty of Candour
Court of Appeal (2018); GMC/NMC joint guidance on openness and honesty
Summary
In 2011, six-year-old Jack Adcock died of sepsis at a Leicester hospital. The trainee paediatrician responsible for his care, Dr Hadiza Bawa-Garba, was later convicted of gross negligence manslaughter. The medical tribunal suspended her, but the GMC appealed and the High Court ordered her erasure from the register. In 2018 the Court of Appeal overturned her erasure and reinstated the tribunal's suspension, recognising the tribunal's finding that systemic failures — an IT failure, staff shortages, lack of senior supervision and her return from maternity leave — had contributed. The case caused deep concern among doctors about blaming individuals for system failures and about whether honest reflection could be used against them. It led to reviews of how gross negligence manslaughter is handled in healthcare. Alongside this sits the professional duty of candour: doctors must be open and honest with patients when something goes wrong, apologise, and explain what will be done.
Why it matters at interview
Raises questions of individual versus system responsibility, just culture, reflection and honesty — topics interviewers use to test nuanced thinking.
Key takeaways
- Patient harm usually has system as well as individual causes.
- A 'just culture' balances accountability with learning.
- Doctors have a professional duty of candour when things go wrong.
- Honest reflection is essential to learning and must be protected.
How to use it
Use for mistake and error questions: balance personal accountability with system learning, and show you would be open with the patient.