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ss triple helix - winter 2023,  the Letby effect; a warning to NHS culture

the Letby effect; a warning to NHS culture

Bex Lawton, Head of Nurses and Midwives
Pippa Peppiatt, outgoing CMF Head of Nurses and Midwives
Chris Holcombe, CMF Associate for Healthcare Leadership
One of the most horrifying scandals ever to hit the NHS was that of Lucy Letby, a neonatal nurse who was found to have killed seven babies in her care and attempted to murder six more.

We cannot even begin to imagine the grief the families involved in this case must have gone through over these last eight years, and are still going through. The atrocities committed by Lucy Letby are chilling and deeply distressing. Our first thoughts should be for these families and to pray for them as they come to terms with this awful loss.

But we cannot ignore the impact this has had on the NHS. Firstly, the impact has been acutely felt by the nursing profession. That one of their own, someone tasked with the care of the most vulnerable in a profession that has some of the highest trust levels among the British public, should take the lives of those in their care so callously seems incomprehensible. As The Guardian said on 22 August, 'the nursing profession faces a long task to reassure families and patients that crimes and apparent failings will not be repeated'. [1]

But it has also has had an impact on those in management positions. Several paediatricians raised concerns about the abnormally large number of neonates dying or suffering adverse events whenever Letby was on the wards. The hospital management dismissed these concerns and even reprimanded the doctors for harassing a popular nurse, requiring them to apologise to Letby. [2]

Patient safety was not put first, nor was the dogged pursuit of the truth. Reputational concerns and a desire not to upset the feelings of the individual involved seem to have taken priority. There are good whistle-blowing policies and governance structures. But these policies 'sit on a shelf'. At the same time, there is enormous pressure from above that gives a very different message - 'do not complain, do not cause a scandal, meet the targets, do everything - regardless of resource - while also delivering this year's cost savings'. Even though this is patently impossible.

There is an unequal fight between a good, well-written policy and the daily pressure, whose message is in many ways the opposite. The government, NHS England, CEOs, and Trust Boards don't always want to hear the truth.

The government's primary concerns are re-election and avoiding & limiting reputational damage. This culture is cascaded down through the system, not least through Trust CEOs, whose jobs are on the line if they are deemed responsible for reputational damage and the ensuing political fallout. With an average tenure of only three years for an NHS CEO, this is a well-grounded fear!

There is often no honest conversation. The consequences are likely to be severe for all involved. Cheshire Constabulary have opened a corporate manslaughter investigation against the Countess of Chester Hospital's senior leadership team. [3] And a public enquiry has just begun into the whole case. [4] Many of those involved may face criminal proceedings, and every decision will be scrutinised. Rightly so, but also with long-term consequences that may only push the problems down on managers and ward staff, and avoid the hard questions about NHS and political cultures that have contributed to Letby's crimes going unheeded for too long

In today's NHS, true honesty is not always a welcome message. It has not ended well for most whistle-blowers in the NHS, in the same way as it did not end well for many of the prophets of the Old Testament. Yet God did, and still does, call us to champion the truth and to speak up for the voiceless, as he called Jeremiah to speak to King Zedekiah, or Nathan to King David, or Moses to Pharaoh.

If you have been affected by the issues raised by the Lucy Letby case or find yourself struggling with whistle-blowing issues in your workplace, please get in touch with our Pastoral Care Team, who are there to offer a listening ear, prayer, and, where appropriate, onward referral to other services.

(accessed 28/11/2023)
  1. Booth R. Nurses 'rocked to core' by Lucy Letby murders fear impact on public trust. The Guardian. 22 August 2023.
  2. Moritz J, Coffey J, Buchanan M. Hospital bosses ignored months of doctors' warnings about Lucy Letby. BBC News Online. 18 August 2023.
  3. Sawer P, Bullen J. Lucy Letby hospital to be investigated over corporate manslaughter. The Telegraph. 4 October 2023.
  4. O'Donoghue D, Moritz J. Lucy Letby public inquiry formally opened by judge. BBC News Online. 22 November 2023.
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