The grotesque deeds of this angel of death expose yet again the culture of denial, delay and secrecy that scars the NHS

Published by The Daily Mail (24th August, 2023)

Stephen Brearey, lead consultant in the unit in which Lucy Letby murdered seven babies and tried to kill six more, has raised an important question.

Why, he asks, can doctors and nurses be held accountable by regulations covering medical practitioners, yet some senior managers face minimal governance — and are able to swan off to other highly paid jobs, even if their careers appear to have been beset by tragedy and scandal?

Brearey, who first raised the alarm about Letby almost two years before police were finally called in, alleges managers were more worried about their reputations than the safety of their smallest patients, leaving whistle-blowing doctors feeling they were under attack. (Some managers, it should be said, dispute this.) 

But the truth is politicians of all persuasions have signally failed to heed the lessons of a series of fatal health scandals.

Instead of action, there has been hollow talk of learning from tragedy, along with shallow pledges of reform and spewed platitudes about the preciousness of the NHS — even as the most vulnerable patients continue to be betrayed.

This week Peter Furness, a former president of the Royal College of Pathologists, pointed out that many of Letby’s victims might have been saved if ministers had not delayed a key recommendation from the Harold Shipman inquiry 20 years ago.

The probe into more than 200 patients killed by the GP called for medical scrutiny of any death that did not involve a coroner. Yet, astonishingly, hospitals began to introduce this practice only four years ago — after Letby had committed her vile crimes. A statutory system will not start until next year.

It is, as one grieving mother told the court this week, shocking that someone as evil as Letby exists. 

Her colleagues could never have imagined one of their team might have been a serial killer, despite the rise in deaths of newborns. But it is beyond disturbing that, after doctors pieced together the evidence that Letby’s presence was the sinister link between deaths, their concerns were dismissed.

Yet again, seemingly indifferent health chiefs are lurking in the shadows of tragedy. Once more, we see how denial and obfuscation corrodes the sacred NHS.

Politicians talk of transparency, health chiefs create codes of conduct, managers claim to be open — but when mistakes are made and systems fail, the reaction is all too often to crush complainants and sweep concerns under the carpet. On many previous occasions, staff, patients or bereaved families have raised alarms only to be bullied, gagged or ignored.

Doctors accuse the Countess of Chester NHS Trust of negligence in its failure to address their concerns. One told the court they were beseeched ‘not to make a fuss’, while the medical director failed to respond to a request for a meeting about the spike in baby deaths for three months.

They say executives backed Letby’s protestations of victimisation after inadequate inquiries, even though one doctor reportedly told his manager they were ‘harbouring a murderer’. Incredibly, it was they who were ordered to apologise to Letby, and even to attend mediation sessions.

This pattern of behaviour by senior managers almost certainly led to more deaths. ‘I 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.

The issues will no doubt be examined by the inquiry announced last week by Health Secretary Steve Barclay — and it is critical that he puts it on a statutory basis to force witnesses to participate.

Yet it is hard to be optimistic that the findings will jolt the system sufficiently to cure it of its sickness and solve the shameful bureaucratic failings.

There have been at least 100 such investigations into failures in NHS care over the past half century — and many of these highly forensic investigations, carried out by diligent experts, have come to startlingly similar conclusions.

They have warned about the dangers of defensive management, dire communication and dysfunctional bureaucracy. Again and again, they have pleaded for whistleblowers to be taken seriously rather than stymied by intransigent health chiefs or simply ignored. Yet far too little has changed. 

The first modern healthcare inquiry, led by the lawyer Geoffrey Howe — who later became Chancellor of the Exchequer under Margaret Thatcher — was into the abusive treatment of people with learning disabilities at Ely psychiatric hospital in Cardiff. 

This influential 1969 report, sparked by public outrage after investigative journalists exposed a culture of cruelty, led to the establishment of the first NHS inspectorate.

Labour ministers praised the inquiry after it found ‘the biggest single deficiency’ was the ‘odious and alarming’ targeting of whistleblowers. They stressed the need for medical staff to be able to raise concerns in a supportive culture. 

Since then, a string of scandals including the Shipman murders has underlined the importance of listening to whistleblowers rather than closing ranks. 

Yet all too often they are still treated with contempt. Anaesthetist Stephen Bolsin said he was driven out of the country to Australia after his eight-year struggle to lift the lid on cardiac surgery failures that led to possibly 170 avoidable deaths of children in the 1990s at Bristol Royal Infirmary. The Francis inquiry into the Mid‑Staffs catastrophe —where hundreds of patients died due to sordid neglect in two mid-Staffordshire hospitals — examined what was seen as the worst hospital care failure in NHS history. 

It revealed ‘a culture of fear in which staff did not feel able to report concerns; a culture of secrecy in which the trust board . . . ignored its patients; and a culture of bullying, which prevented people from doing their jobs properly’.

The landmark report called for this to be replaced by ‘openness, honesty and transparency where the only fear is the failure to uphold fundamental standards and the caring culture’.

This sparked new efforts to protect whistleblowers. Yet the failure to do so was apparent again last year in the devastating final report into the Shrewsbury maternity scandal, where 201 babies and nine mothers may have needlessly died.

One Shrewsbury obstetrician talked about a ‘culture of fear’ that left staff scared to speak out for ‘risk of victimisation’ — his words echoing precisely the problem unearthed both by the Francis inquiry and the findings of Howe’s report more than half a century earlier into the Ely scandal.

Even now, journalists keep exposing the shocking abuse of people with autism and learning disabilities, locked up in psychiatric hospitals.

The NHS relies on fallible human beings. So it needs a culture in which those who expose problems are not blamed: a culture that rests on truth and transparency, revolves around patient safety and encourages whistleblowers rather than thwarting them.

Letby, like her fellow mass-murderer Shipman, was an aberration among these cases: a serial killer in nurse’s uniform on a malevolent mission to inflict misery on families who should have been enjoying the most magical of life experiences. She alone carries the cross of her evil.

We cannot predict the inquiry’s conclusions — but the grotesque deeds of this angel of death expose again the disturbing culture of denial, delay and secrecy that scars the NHS with such horrific consequences.

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