Manslaughter caused by gross negligence is a common law offence that has long existed in English jurisdiction. Although circumstances and context can be highly influential in determining the outcome of inadvertent errors, English law does not permit sufficient consideration of such issues. [---] We examine some of the key considerations that mitigate against punishment alone from being the optimal response to death caused by gross negligence during healthcare delivery. Instead we suggest that a broader focus on patient safety and the public interest is called for to ensure safe systems of work by enhancing organisational accountability and the promotion of professional and institutional duty of candour. We conclude by offering positive proposals for change.