SPECIAL REPORT: Senior NHS, hospital trust and public health leaders have spoken to the Manchester Evening News about the case - and what they claim it reveals about a wider alleged culture of resistance within the service's senior management
The shocking testimony of one exhausted doctor at an unprecedented criminal trial revealed how senior managers reacted when concerns about Lucy Letby were first raised.
The serial killer was handed a whole-life order this week, meaning she will never be released from prison. She is the most prolific child murderer in modern history. In the wake of Letby's conviction, the Countess of Chester Hospital said: "Since Lucy Letby worked at our hospital, we have made significant changes to our services. I want to provide reassurance that every patient who accesses our services can have confidence in the care they will receive."
Dr John Gibbs was one of four consultants who warned management of the connection between the deaths and Letby, the court heard.. He told the trial a 'tipping point' was only reached in June 2016 when two brothers from a set of triplets died on successive days.The consultant said 'key safety features' were introduced at that stage, including her removal from the neonatal unit. But Dr Gibbs told the jury that a month later managers wanted to allow her back.
Alison Kelly, the director of nursing, had also been told about the suspicions by senior clinicians. It was not until July 2016 that Letby was moved off the neonatal unit as senior doctors demanded action following the deaths of two triplet brothers. The Countess of Chester declined to comment on any of the questions raised by this piece, which were put to the trust by the M.E.N. After Letby's conviction, the hospital's medical director told the media: "Since Lucy Letby worked at our hospital, we have made significant changes to our services.
"It's a very comprehensive, multi-agency process. I've not heard any mention of safeguarding through the reporting of this case." According to Dr Brearey, the CEO insisted the consultants apologise to Letby - warning them that a line had been drawn and there would be 'consequences' if they crossed it. Mr Chambers later reportedly denied saying Letby had done nothing wrong and said he was paraphrasing her father.
"I have seen whistleblowing to the Care Quality Commission [the body which regulates the NHS] about the way staff have been treated about raising concerns," she added. "The staff were being treated in the same way as those in the Lucy Letby case. The side-lining of whistleblowers comes from a 'fear of bad news', bred by 'insecurity, and 'competition', claims Prof Hall. "Executives are scared of bad news - that means they don't get to the bottom of issues and they don’t take doctors like those in the Letby case seriously.
"Instead of tackling difficult issues, they often brush them under the carpet. It's not healthy or safe for patients if staff don't feel they can speak up." Sir Duncan Nichol, chairman of the Countess of Chester Hospital during Letby’s killings before his retirement from the trust in November 2019, said in a statement to the BBC: "I believe that the board was misled in December 2016 when it received a report on the outcome of the external, independent case reviews.
Another source said non-executive directors often have multiple positions across the NHS, sitting on a number of panels, potentially limiting the amount of attention they can give to scrutiny. "The doctors involved in the Letby case are now being seen as heroes, but it must have been horrendous at the time for them, having to write an apology to a murderer."
Employing, promoting and recycling managers who 'maintain the status quo' These problems have become part of the fabric of the NHS, multiple sources claim. That is because managers who 'maintain the status quo', 'don't ask difficult questions' - those who are 'part of the club' which the NHS feels comfortable with' - are the ones in line for promotion, they say.
The then 22-year-old attacked 13 children over a period of 59 days in 1991, using methods disturbingly similar to those used by Lucy Letby. Allitt was found to be injecting children in her care with air as well as huge doses of insulin. "Whilst [Allitt] was many years ago, it's not something you would forget if you were working in the NHS at the time – where was the corporate organisational memory? It was an immediate parallel for me," one source said.
"We owe it to the babies and their families to learn lessons and I will fully co-operate with the independent inquiry announced." "The job of the board is to really check what they're being told, to speak to staff, and find out what is true. It's not the job of the board to protect the organisation, the board should be the voice of the patients," another hospital leader said.
The Institute for Government independent thinktank said: "Government spokespeople have emphasised that they think a non-statutory inquiry provides more flexibility – allowing the inquiry into Letby to report more quickly and to be shaped at least in part by the families of her victims. Speed and family involvement are critical – but given the apparent failings of institutions including the NHS, only a full statutory inquiry will do.
Many people have insisted NHS managers should face more regulation where they do not have a medical background. Prof Ardern said: "I've seen a lot of heat generated about the need for regulation of NHS managers who are not clinicians. "I've heard 'my door is always open' plenty of times within the NHS, but if no one is listening, the door being open is pointless," added Prof Hall.Will the NHS change? So sweeping are the changes required that many sources, the M.E.N. asked were sceptical of the NHS' ability to change. NHS England did not provide any further comment to the themes and issues raised in this piece.
"The NHS must positively respond and embrace constructive, objective internal and external challenge if it is to evolve and be fit for the future." "When NHS staff raise concerns, action should be taken and, if necessary, overseen by a non-executive who can use their independent role to hold the organisation to account."
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