Letby inquiry will be same old story

Published by The i paper (21st August, 2023)

A nurse killing newborn babies in a hospital is shocking and unpredictable. Lucy Letby seemed so ordinary, so familiar, so like many more of those wonderful women working in wards across the country, that it is chilling to see this 33-year-old with fairy lights and fluffy toys in her bedroom join the ranks of reviled serial killers. “It can’t be Lucy. Not nice Lucy,” exclaimed Stephen Brearey, lead paediatric consultant on the Countess of Chester neonatal unit, after seeing data tying her to the fatalities. One police officer later commented that “she was an average nurse” – and this is what makes her behaviour so alarming and baffling.

Letby perverted her noble craft in a malevolent mission to inflict misery on families who should have been experiencing the greatest of joys. She took care to conceal her evil deeds. Her colleagues could never have imagined they had a murderer in their midst when newborns began dying in greater numbers. Yet one element of this case is disturbingly predictable: the discovery that whistleblowers seem to have been stifled when they saw what might have been happening, their fears dismissed by health chiefs more concerned about damaging publicity and the hospital’s reputation than the lives of vulnerable little patients.

Doctors accuse their hospital trust of negligence in its failure to address concerns they raised for almost two years before police were called in. They told the court they were pressurised by senior executives “not to make a fuss” when raising the alarm, although one reportedly even told his manager they were “harbouring a murderer”. Yet they were told to apologise and attend mediation sessions with the child-killer. And this delay may have led to the deaths of more babies and more bereaved families. “I do genuinely believe that there are four or five babies who could be going to school now who aren’t,” consultant paediatrician Ravi Jayaram told ITV News.

These issues must be addressed by the inquiry – although in one more cruel twist, the complacent Health Secretary Steve Barclay does not deem this investigation worthy of statutory status, so witnesses are not legally required to participate. This means key figures can duck attempts to discover the truth behind the killing spree in a neonatal unit. Barclay should rectify this mistake fast  – just as his ministry was forced recently to put an inquiry into the deaths of mental health patients in Essex on statutory basis after intense pressure from grieving families.

Yet there have been more than 100 such investigations into NHS failures since the first modern healthcare inquiry in 1969. This equates to about two each year. They keep coming up with similar conclusions that expose the dangers of defensive management, dire communication, disempowered staff and patients, systemic inertia and silenced whistleblowers – as seen again in this distressing case. The flow of often-forensic reports is followed by sanctimonious talk of learning lessons, pledges of reform, promises of change. Then we see the same problems emerge again after another tumultuous wave of needless grief, pain and suffering.

That inquiry 54 years ago – into abuse of people with learning disabilities held at Ely psychiatric hospital in Cardiff – stressed the need for staff to raise concerns “without fear of victimisation”. Then health secretary Richard Crossman said the “odious and alarming” targeting of whistleblowing nurses was “the biggest single deficiency” exposed by the probe.

Since then a series of safety scandals has underscored the crucial importance of listening to those raising concerns – whether staff, patients or families – and responding with openness rather than closing ranks. These included the avoidable deaths of up to 170 children after cardiac surgery in Bristol and hundreds of patients dying due to hideous neglect in two mid-Staffordshire hospitals.

Yet it is like Groundhog Day: nothing seems to change the toxic culture that corrodes the NHS with often fatal consequences. Victims tend to be elderly, disabled or women, reflecting blinkered attitudes that plague society. Last year saw publication of a damning final report into the Shewsbury maternity scandal, where 201 babies and nine mothers may have needlessly died and many infants left with serious disabilities.

The trust “failed to investigate, failed to learn and failed to improve and therefore often failed to safeguard mothers and their babies at one of the most important times in their lives,” said its author Donna Ockenden. One obstetrician talked of a “culture of fear” where “staff felt unable to speak up because of risk of victimisation” – the same issue raised more than half a century earlier in the Ely scandal.

Protective legislation has been introduced for health whistleblowers. There have been demands for more accountability from a succession of politicians: Jeremy Hunt, the longest serving health secretary, even wrote a book showing how trusts destroy those raising concerns in their dismal efforts to evade accountability. Yet the medical bureaucracy clings to hierarchies and fails to mimic sectors that put safety at their heart.

Every health service depends on human beings, fallible creatures that can make mistakes. So everyone accepts the need for a no-blame culture that hinges on truth and transparency, places patient safety at core of everything and empowers whistleblowers. Yet the same blundering pattern of denial, inertia and delay plays out again and again.

Tristan Reuser, a senior eye surgeon in Birmingham, told the BBC last month how managers turned on him after he blew the whistle on patient safety. This led to his suspension and sacking, sparking suicidal thoughts, followed by a tribunal finding he was unfairly dismissed. Having campaigned on these issues for 15 years, I have heard similar depressing stories from medical professionals and bereaved parents who dared speak out on safety grounds to challenge systemic failings.

Letby was a mystifying aberration, a serial killer masquerading as a nurse. Yet she exposes an affliction that remains all too virulent in our sanctified health service – a lethal culture of arrogance, denial and inertia that will not be solved by one more inquiry.

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