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Lucy Letby was an NHS monster Inept managers are enabling scandal

A fish rots from the head (Lucy Letby)

A fish rots from the head (Lucy Letby)


August 23, 2023   3 mins

A sense of catharsis seemed to envelop Britain when it was announced that Lucy Letby had been handed a life sentence for her crimes. The appalling 10-month litany of her homicidal activities was over. Evil had been exposed. Justice had been served. Perhaps, now, we could all move on.

To feel relief, though, is surely misguided. Nurse Letby might be behind bars, but those who ignored, shielded or enabled her remain unpunished. Regardless of their motives or excuses: the public record has shown that senior executives at the Countess of Chester Hospital obfuscated attempts to stop Letby.

This is not to say they aided and abetted her. But as any lawyer will tell you, ignorance is no defence in law. On the wards, as anywhere else, those who want the benefits, privileges and status that come with the highest level of leadership must shoulder responsibility for what happens on their watch.

Following Letby’s conviction, the Northern Care Alliance NHS Trust in Greater Manchester suspended Alison Kelly, former director of nursing and quality at the Countess of Chester. The hospital’s former CEO, Tony Chambers, also faces mounting claims that he had dismissed warnings about Letby before walking away with a £1.5 million pension.

Under Kelly and Chamber’s leadership, the neonatal unit’s head consultant, Dr Stephen Brearey, who first raised concerns in June 2015 about the link between Letby and an increase in baby collapses, was ignored. Likewise, Dr Ravi Jayaram, a consultant paediatrician at the hospital, and others, were forced by hospital bosses to apologise to Letby after was “upset” by their criticisms of her.

We don’t know what Kelly and Chambers were thinking as they watched a significant rise in the number of babies suffering serious and unexpected collapses in the hospital’s neonatal unit from 2015 and 2016 — a rise that was well above the expected local average. We do know that they failed to act decisively. We also know that they both objected  to concerns raised by Breary, Jayaram and other clinicians. These “whistleblowers” were told there was “no evidence” against the nurse “other than a coincidence”.

In my experience, such negligence can be partly the result of the professional differences — and hostilities — between those from a nursing or midwifery background and doctors and senior consultants. When doctors raise concerns about nurses, the nurses’ ranks tighten. When the roles are reversed, however, doctors are far less likely to put professional favouritism first.

And this conflict particularly afflicts maternity wards. As I warned in UnHerd last year, the Care Quality Commission found that two out of five maternity units in England were providing “substandard care to mothers and babies” — a disturbing review preceded by another damning inquiry, Dr Bill Kirkup’s three-year investigation into mass failings at East Kent Hospital Trust’s maternity care. Between 2009 and 2020, he concluded, 45 babies who died under the trust’s aegis might have survived had they received “nationally recognised standards of care”.

Taken individually, these scandals and exposĂ©s are little more than horror stories, the sort of voyeuristic fodder rinsed out by newspapers before moving onto the next tragedy. Taken together, though, they are symptoms of a greater problem: our maternity service’s dysfunctional relationship between management, staffing and patients across the board. And there is something unique about this dysfunction: while the Bristol heart scandal during the Nineties revealed how a combination of ineptitude, arrogance and an old boys’ culture had contributed to dozens of babies suffering brain damage and death following cardiac operations by surgeons, today we are seeing cases, such as Letby’s, in which the “heroes” are senior consultants who come up against bloated, self-serving and intransigent management.

Over the past days, weeks, months and years, my colleagues and I have repeatedly called for senior managers in the NHS to be more accountable. The Letby case clearly illustrates — along with the East Kent, Bristol, and Mid-Staffs scandals, the latter in which anywhere between 400 and 1,200 patients died as a result of poor care between 2005 and 2009 — there is zero jeopardy for the legions of NHS senior managers when things go wrong, and lives are needlessly lost. As Dr Breary has pointed out, a “structure akin to the General Medical Council or the Nursing and Midwifery Council” solely for NHS managers is needed to “monitor the integrity, competence, and conduct of senior NHS executives”.

But I would go further. Within its health sectors, the NHS has too many managers floating between various levels of management. This murky bureaucracy has created a culture in which weaker and weaker talent fails upwards, driving out many consultants at board level who simply can’t cope with the cumbersome ineptitude of senior management committees. Once they have ascended to management positions, people who were mediocre on the wards vent their petty grievances and exert their lack of talent by putting consultants in their place. It’s an open secret that NHS management has become a gravy train, an opportunity to put your feet up and “protect your workload”. If anything, this cynicism, laziness and inertia is as deadly as the rare cases of pure evil.

No doubt there will be those with questionable “leadership skills” who view my and colleagues’ calls for an audit of management capability — and culpability — as a witch hunt. But we’re willing to take that risk. There’s clearly something rotten at the heart of the NHS.


Dr Emma Jones is an A&E consultant based in the Midlands.


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Billy Bob
Billy Bob
9 months ago

I don’t think this is a problem unique to the NHS unfortunately. Once you reach a certain level (in both the private and public sectors) your ability to do the job seems almost irrelevant. They just float between roles, getting golden handshakes and massive payouts for their incompetence and generally failing upwards. Most are there due to being born rich and having good family contacts at the beginning of their working life anyway rather than any special talent or work ethic, at least that’s usually been my experience in dealing with them

Martin Bollis
Martin Bollis
9 months ago
Reply to  Billy Bob

I wholeheartedly agree with the first half of your comment but not the second. Maybe in the City and closed professions like barristers that still counts, but not across the board. The truly terrible managers I came across in my career were undoubtedly clever but often from quite humble backgrounds and got on by a mixture of aggression and coat tail hanging.

I suspect in the public sector the entire ethos is so therapeutised that finding an excuse, rather than holding accountable, is the fall back position.

JOHN KANEFSKY
JOHN KANEFSKY
9 months ago
Reply to  Martin Bollis

It’s true that people from more “humble backgrounds” get domesticated by these organisations. And the lure of promotion, high salary, position and a fat pension from playing along with the blame-everyone-else ethos is palpable. I was a senior manager in several public sector organisations, and know from personal experience how it works.
The BBC in-joke is “deputy heads will roll”
But coming from a privileged background certainly helps, and people from fee paying schools, Oxbridge etc are very seriously over-represented in high-paying public sector, media and related organisations.

Gary Howells
Gary Howells
9 months ago
Reply to  JOHN KANEFSKY

I suspect most public sector senior management positions are populated by the descendants of the middle class enablers of our imperial past. Unsackable sinecures and trebles all round.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Gary Howells

This would be far less so in smaller business or just starting up. The very businesses which are not encouraged by this government apparently. Instead the globalist woke companies appear to rule. In truth the smaller start up businesses are our future not the globalist woke ones who have scant concern for the countries they operate in.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Gary Howells

This would be far less so in smaller business or just starting up. The very businesses which are not encouraged by this government apparently. Instead the globalist woke companies appear to rule. In truth the smaller start up businesses are our future not the globalist woke ones who have scant concern for the countries they operate in.

Sue Whorton
Sue Whorton
9 months ago
Reply to  JOHN KANEFSKY

They didn’t use to be. It has crept back since the eighties. Heath, son of a housemaid but scholarship boy. Thatcher the grocer’s daughter. Callaghan also not privileged unlike Benn. Look at the background of emeritus professors. Grammar schools and scholarships. Now we have a bias not just in the professions but also music and the arts.

Last edited 9 months ago by Sue Whorton
JOHN KANEFSKY
JOHN KANEFSKY
9 months ago
Reply to  Sue Whorton

It’s true there was a brief period, historically unusual, when many people like me from impecunious backgrounds did well and there was more genuine meritocracy. Broadly the “Boomer” generation born mid-1930s to late 1950s.
Not quite “a shoebox in a lake” but rented house with no bathroom, money very tight, etc etc. But father was a bookseller who valued hard work and reading. University on full grant, PhD on a CASE scholarship, career in the coal industry which was unusual in that engineering and related backgrounds were advantages not hindrances.
As a friend says, these days “Norfolk Enchants” 🙂

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  JOHN KANEFSKY

It was the grammar school generation, meritocratic, enabling working class students to do well from their brains. I find calling it Boomer unhelpful.

William Edward Henry Appleby
William Edward Henry Appleby
9 months ago
Reply to  Anna Bramwell

Fully agree. I am a working class 1970s/80s grammar school kid now with a PhD and a solid income. None of this “boomer” rubbish please.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Anna Bramwell

I think boomer just means a very high birthrate for the period.

William Edward Henry Appleby
William Edward Henry Appleby
9 months ago
Reply to  Anna Bramwell

Fully agree. I am a working class 1970s/80s grammar school kid now with a PhD and a solid income. None of this “boomer” rubbish please.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Anna Bramwell

I think boomer just means a very high birthrate for the period.

Rasmus Fogh
Rasmus Fogh
9 months ago
Reply to  JOHN KANEFSKY

What made that period special is that the number of jobs for university graduates / places in the middle class, expanded very fast.That meant that middle class children were way too few to fill all the new middle class jobs, so that you could have upward social mobility for people from impecunious backgrounds, without having downwards mobility for middle class children. Now that there is no more room for expansion, we are back at zero-sum competition. And the middle class children start with a number of advantages.

Tony Conrad
Tony Conrad
9 months ago
Reply to  JOHN KANEFSKY

These days if you have the right pronouns you will survive. What a mess.

harry storm
harry storm
9 months ago
Reply to  JOHN KANEFSKY

The boomers were born between 1945 — when the war ended — and 1965. There were no “boomers” born in the mid 1930s.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  JOHN KANEFSKY

It was the grammar school generation, meritocratic, enabling working class students to do well from their brains. I find calling it Boomer unhelpful.

Rasmus Fogh
Rasmus Fogh
9 months ago
Reply to  JOHN KANEFSKY

What made that period special is that the number of jobs for university graduates / places in the middle class, expanded very fast.That meant that middle class children were way too few to fill all the new middle class jobs, so that you could have upward social mobility for people from impecunious backgrounds, without having downwards mobility for middle class children. Now that there is no more room for expansion, we are back at zero-sum competition. And the middle class children start with a number of advantages.

Tony Conrad
Tony Conrad
9 months ago
Reply to  JOHN KANEFSKY

These days if you have the right pronouns you will survive. What a mess.

harry storm
harry storm
9 months ago
Reply to  JOHN KANEFSKY

The boomers were born between 1945 — when the war ended — and 1965. There were no “boomers” born in the mid 1930s.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Sue Whorton

Thatcher has not yet been bettered in my view. she knew how to count her pennies and did not waste anything thus Britain thrived. Today the country is in hog to the global warming deception and we are paying through the nose for it. Plants need carbon to survive and thrive.

JOHN KANEFSKY
JOHN KANEFSKY
9 months ago
Reply to  Sue Whorton

It’s true there was a brief period, historically unusual, when many people like me from impecunious backgrounds did well and there was more genuine meritocracy. Broadly the “Boomer” generation born mid-1930s to late 1950s.
Not quite “a shoebox in a lake” but rented house with no bathroom, money very tight, etc etc. But father was a bookseller who valued hard work and reading. University on full grant, PhD on a CASE scholarship, career in the coal industry which was unusual in that engineering and related backgrounds were advantages not hindrances.
As a friend says, these days “Norfolk Enchants” 🙂

Tony Conrad
Tony Conrad
9 months ago
Reply to  Sue Whorton

Thatcher has not yet been bettered in my view. she knew how to count her pennies and did not waste anything thus Britain thrived. Today the country is in hog to the global warming deception and we are paying through the nose for it. Plants need carbon to survive and thrive.

Tony Conrad
Tony Conrad
9 months ago
Reply to  JOHN KANEFSKY

We should be harder on the nationalised industries as they don’t have to make a profit so it is harder to judge who are the good ones and who is not. In the private sector lazy managers are more easily shown up because of a dent in the profits whilst nationalised industries just exist on our taxes and should be watched on behalf of the tax payers.

Gary Howells
Gary Howells
9 months ago
Reply to  JOHN KANEFSKY

I suspect most public sector senior management positions are populated by the descendants of the middle class enablers of our imperial past. Unsackable sinecures and trebles all round.

Sue Whorton
Sue Whorton
9 months ago
Reply to  JOHN KANEFSKY

They didn’t use to be. It has crept back since the eighties. Heath, son of a housemaid but scholarship boy. Thatcher the grocer’s daughter. Callaghan also not privileged unlike Benn. Look at the background of emeritus professors. Grammar schools and scholarships. Now we have a bias not just in the professions but also music and the arts.

Last edited 9 months ago by Sue Whorton
Tony Conrad
Tony Conrad
9 months ago
Reply to  JOHN KANEFSKY

We should be harder on the nationalised industries as they don’t have to make a profit so it is harder to judge who are the good ones and who is not. In the private sector lazy managers are more easily shown up because of a dent in the profits whilst nationalised industries just exist on our taxes and should be watched on behalf of the tax payers.

Denis Stone
Denis Stone
9 months ago
Reply to  Martin Bollis

That’s it. Nail on the head. My experience too.

Chipoko
Chipoko
9 months ago
Reply to  Martin Bollis

Terrible managers … [get] on by a mixture of aggression and coat tail hanging.
You are so right about this. I spent most of my career at a senior level in local government (UK) followed by eight years as a full-time lecturer at a university. In both sectors top management secured promotion and appointment by (in the case of local government) sluicing up to the elected politicians in power and ruthlessly eliminating those colleagues who did not in turn sluice up to them, and appointing toadies into senior positions who would support them loyally. In both the local government and university sectors top management was more concerned about massive increases in their remuneration than service delivery, and not primarily focused on delivering national political objectives and targets set via the civil service Blob rather than supporting quality service delivery and frontline staff. Top management annual salary rises often fell between 16-20+% while their employees were told be be glad with increases between 0.25-1%! And this for years.
The 2000s saw the rise of rampant managerialism, sustained by routine use of headhunter recruitment agencies to seek and fill senior management positions with Yes-people moulded from the same politically correct (and latterly Woke) demographic. Anyone who dared question management policies risked ostracisation at best, cancellation at worst. The senior ranks of the public and private sectors are now filled with managerial clones who adhere to the management-speak, who never challenge Woke orthodoxy and who enthusiastically implement chilling management policies in order to maintain their positions and enhance their prospects for promotion as members of the Woking Class. Most people do not appreciate the horrendous implications this all has for free speech and basic democracy at every level in society.

JOHN KANEFSKY
JOHN KANEFSKY
9 months ago
Reply to  Martin Bollis

It’s true that people from more “humble backgrounds” get domesticated by these organisations. And the lure of promotion, high salary, position and a fat pension from playing along with the blame-everyone-else ethos is palpable. I was a senior manager in several public sector organisations, and know from personal experience how it works.
The BBC in-joke is “deputy heads will roll”
But coming from a privileged background certainly helps, and people from fee paying schools, Oxbridge etc are very seriously over-represented in high-paying public sector, media and related organisations.

Denis Stone
Denis Stone
9 months ago
Reply to  Martin Bollis

That’s it. Nail on the head. My experience too.

Chipoko
Chipoko
9 months ago
Reply to  Martin Bollis

Terrible managers … [get] on by a mixture of aggression and coat tail hanging.
You are so right about this. I spent most of my career at a senior level in local government (UK) followed by eight years as a full-time lecturer at a university. In both sectors top management secured promotion and appointment by (in the case of local government) sluicing up to the elected politicians in power and ruthlessly eliminating those colleagues who did not in turn sluice up to them, and appointing toadies into senior positions who would support them loyally. In both the local government and university sectors top management was more concerned about massive increases in their remuneration than service delivery, and not primarily focused on delivering national political objectives and targets set via the civil service Blob rather than supporting quality service delivery and frontline staff. Top management annual salary rises often fell between 16-20+% while their employees were told be be glad with increases between 0.25-1%! And this for years.
The 2000s saw the rise of rampant managerialism, sustained by routine use of headhunter recruitment agencies to seek and fill senior management positions with Yes-people moulded from the same politically correct (and latterly Woke) demographic. Anyone who dared question management policies risked ostracisation at best, cancellation at worst. The senior ranks of the public and private sectors are now filled with managerial clones who adhere to the management-speak, who never challenge Woke orthodoxy and who enthusiastically implement chilling management policies in order to maintain their positions and enhance their prospects for promotion as members of the Woking Class. Most people do not appreciate the horrendous implications this all has for free speech and basic democracy at every level in society.

Martin Bollis
Martin Bollis
9 months ago
Reply to  Billy Bob

I wholeheartedly agree with the first half of your comment but not the second. Maybe in the City and closed professions like barristers that still counts, but not across the board. The truly terrible managers I came across in my career were undoubtedly clever but often from quite humble backgrounds and got on by a mixture of aggression and coat tail hanging.

I suspect in the public sector the entire ethos is so therapeutised that finding an excuse, rather than holding accountable, is the fall back position.

Billy Bob
Billy Bob
9 months ago

I don’t think this is a problem unique to the NHS unfortunately. Once you reach a certain level (in both the private and public sectors) your ability to do the job seems almost irrelevant. They just float between roles, getting golden handshakes and massive payouts for their incompetence and generally failing upwards. Most are there due to being born rich and having good family contacts at the beginning of their working life anyway rather than any special talent or work ethic, at least that’s usually been my experience in dealing with them

J Bryant
J Bryant
9 months ago

The part of this story that remains unanswered is the question of her motive. I’ve read a couple of news articles which proposed variations on the theme of “she wanted attention” (and perhaps she did). The oddly-named Munchausen by Proxy Syndrome also reared its head, although no definitive conclusion was offered.
All news stories I read consistently asserted she had a normal upbringing with no earlier signs of a troubled personality. If anything, she was a boring person. That part I struggle to believe. Does someone really go from utterly normal to serial baby killer in one easy step?

Dumetrius
Dumetrius
9 months ago
Reply to  J Bryant

It’s not fashionable to say it (and I’m homosexual so I know why they don’t like the phrase but let’s not pussyfoot about) but it sounds like it is her innate ‘orientation’.

She’s just an otherwise completely normal person. Who likes to kill.

Jules Hunt
Jules Hunt
9 months ago
Reply to  Dumetrius

She probably tried it, or even accidentally did it – got a thrill and kept going. I wonder if she ever killed small animals as a child?

Tony Conrad
Tony Conrad
9 months ago
Reply to  Jules Hunt

Unusual for a woman though, the gentler sex. Will we ever know?

Alan Osband
Alan Osband
9 months ago
Reply to  Jules Hunt

No! Look at her bedroom . Not a psychopath ! I would examine her relationship with the doctor . Those at the trial didn’t think it altogether credible that they weren’t lovers ( trips to London staying overnight etc)
Did she get pregnant , and then have an abortion ? Working with the doctor and babies could have sent her crazy .
If she did it . Still think they might have died naturally

Tony Conrad
Tony Conrad
9 months ago
Reply to  Jules Hunt

Unusual for a woman though, the gentler sex. Will we ever know?

Alan Osband
Alan Osband
9 months ago
Reply to  Jules Hunt

No! Look at her bedroom . Not a psychopath ! I would examine her relationship with the doctor . Those at the trial didn’t think it altogether credible that they weren’t lovers ( trips to London staying overnight etc)
Did she get pregnant , and then have an abortion ? Working with the doctor and babies could have sent her crazy .
If she did it . Still think they might have died naturally

Tony Conrad
Tony Conrad
9 months ago
Reply to  Dumetrius

Is that normal? To me it makes light of murder.

Jules Hunt
Jules Hunt
9 months ago
Reply to  Dumetrius

She probably tried it, or even accidentally did it – got a thrill and kept going. I wonder if she ever killed small animals as a child?

Tony Conrad
Tony Conrad
9 months ago
Reply to  Dumetrius

Is that normal? To me it makes light of murder.

John Dellingby
John Dellingby
9 months ago
Reply to  J Bryant

We’ll likely never know for sure unless she confesses and elaborates. I’ve heard all sorts over the last few days whether it be related to her upbringing, psychopathic disorder, dislike of the parents etc but it could be all, some or none of those. Doesn’t help that female serial killers are somewhat rare in comparison to their male counterparts.

Dumetrius
Dumetrius
9 months ago
Reply to  John Dellingby

Could just be that she is made that way and it is just an innate tendency she has.
ie, it’s just ‘normal’ for her to do that
That would explain why her friend who stands by her (and who seems sincere) says LL doesn’t seem abnormal in any way.

Last edited 9 months ago by Dumetrius
Martin Goodfellow
Martin Goodfellow
9 months ago
Reply to  Dumetrius

No, it’s not ‘normal’. You can’t just move boundaries around to suit your definition. Her motives are puzzling, complex and not obvious to most of us. As Shakespeare said, “There is no art to find the mind’s construction in the face.” (Macbeth) We will only get an answer if she is investigated by an experienced psychiatrist.

Dumetrius
Dumetrius
9 months ago

I said ‘normal for her’.

Clearly that implies that it isn’t for anyone else.

And the fact it’s ‘normal’ for her, explains why her friend’s still standing by her. Because she probably isn’t odd. Except for this *one* thing.

Last edited 9 months ago by Dumetrius
Martin Goodfellow
Martin Goodfellow
9 months ago
Reply to  Dumetrius

By that false logic, ‘everything’ is normal, which is a contradiction in terms. You can’t be normal on your own. It’s a collective term. If she were defined as you suggest, it’s still not a reason to affirm her destructive behaviour.

Dumetrius
Dumetrius
9 months ago

This is like talking to a chicken. I give up.

Tony Conrad
Tony Conrad
9 months ago

Or excuse it. Once we do that we are on a slippery slope downwards.

Dumetrius
Dumetrius
9 months ago

This is like talking to a chicken. I give up.

Tony Conrad
Tony Conrad
9 months ago

Or excuse it. Once we do that we are on a slippery slope downwards.

Martin Goodfellow
Martin Goodfellow
9 months ago
Reply to  Dumetrius

By that false logic, ‘everything’ is normal, which is a contradiction in terms. You can’t be normal on your own. It’s a collective term. If she were defined as you suggest, it’s still not a reason to affirm her destructive behaviour.

Dumetrius
Dumetrius
9 months ago

I said ‘normal for her’.

Clearly that implies that it isn’t for anyone else.

And the fact it’s ‘normal’ for her, explains why her friend’s still standing by her. Because she probably isn’t odd. Except for this *one* thing.

Last edited 9 months ago by Dumetrius
Tony Conrad
Tony Conrad
9 months ago
Reply to  Dumetrius

I think we could be in danger as a society to say that a murderer just had an innate desire to do that. We would all be in danger if that became the thinking.

Martin Goodfellow
Martin Goodfellow
9 months ago
Reply to  Dumetrius

No, it’s not ‘normal’. You can’t just move boundaries around to suit your definition. Her motives are puzzling, complex and not obvious to most of us. As Shakespeare said, “There is no art to find the mind’s construction in the face.” (Macbeth) We will only get an answer if she is investigated by an experienced psychiatrist.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Dumetrius

I think we could be in danger as a society to say that a murderer just had an innate desire to do that. We would all be in danger if that became the thinking.

Ethniciodo Rodenydo
Ethniciodo Rodenydo
9 months ago
Reply to  John Dellingby

She probably does not know herself

Susie Bell
Susie Bell
9 months ago
Reply to  John Dellingby

Although it is a fact that the large majority of baby killers are women

Andrew D
Andrew D
9 months ago
Reply to  Susie Bell

Post-birth as well as pre?

Tony Conrad
Tony Conrad
9 months ago
Reply to  Andrew D

Oh pre-birth we have reached well over 9 million in this country, but that is just normal for our lawmakers.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Andrew D

Oh pre-birth we have reached well over 9 million in this country, but that is just normal for our lawmakers.

Alison Wren
Alison Wren
9 months ago
Reply to  Susie Bell

I would suggest that’s because they’re almost 100% likely to be the main cater. And if they are desperately inadequate for the task will kill. That’s why infanticide is a special category as it’s recognised that the experience of becoming a mother can be deranging!

Tony Conrad
Tony Conrad
9 months ago
Reply to  Alison Wren

I take your word for it. I don’t know much about it but it merits some study.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Alison Wren

I take your word for it. I don’t know much about it but it merits some study.

Tony Conrad
Tony Conrad
9 months ago
Reply to  Susie Bell

Have there been others?

Andrew D
Andrew D
9 months ago
Reply to  Susie Bell

Post-birth as well as pre?

Alison Wren
Alison Wren
9 months ago
Reply to  Susie Bell

I would suggest that’s because they’re almost 100% likely to be the main cater. And if they are desperately inadequate for the task will kill. That’s why infanticide is a special category as it’s recognised that the experience of becoming a mother can be deranging!

Tony Conrad
Tony Conrad
9 months ago
Reply to  Susie Bell

Have there been others?

Tony Conrad
Tony Conrad
9 months ago
Reply to  John Dellingby

Oh I killed them because I had a bad upbringing. I would wager that my upbringing was far worse than hers.

Tony Conrad
Tony Conrad
9 months ago
Reply to  John Dellingby

No it’s quite normal. They just have a propensity to do that.

Dumetrius
Dumetrius
9 months ago
Reply to  John Dellingby

Could just be that she is made that way and it is just an innate tendency she has.
ie, it’s just ‘normal’ for her to do that
That would explain why her friend who stands by her (and who seems sincere) says LL doesn’t seem abnormal in any way.

Last edited 9 months ago by Dumetrius
Ethniciodo Rodenydo
Ethniciodo Rodenydo
9 months ago
Reply to  John Dellingby

She probably does not know herself

Susie Bell
Susie Bell
9 months ago
Reply to  John Dellingby

Although it is a fact that the large majority of baby killers are women

Tony Conrad
Tony Conrad
9 months ago
Reply to  John Dellingby

Oh I killed them because I had a bad upbringing. I would wager that my upbringing was far worse than hers.

Tony Conrad
Tony Conrad
9 months ago
Reply to  John Dellingby

No it’s quite normal. They just have a propensity to do that.

j watson
j watson
9 months ago
Reply to  J Bryant

Psychopaths don’t always have a clear motive. Their brain structure is increasingly appreciated as distinctly and observably different.

H H
H H
9 months ago
Reply to  j watson

Maybe she’s similar to Shakespeare’s Iago. He never really gives a satisfactory explanation for his behaviour. He mentions resentment at having been passed over for promotion, but this cannot fully account for the wickedness of his actions. When asked to explain himself he merely answers:
“Demand me nothing: What you know, you know: From this time forth I never will speak word.” (V.ii.316-317).
I suspect we will never “pluck out the heart of [Letby’s] mystery.”

Tony Conrad
Tony Conrad
9 months ago
Reply to  j watson

It is proven in these days that our behaviour can alter our brain structure. The other way around one can almost justify anything because of someone’s brain structure.

H H
H H
9 months ago
Reply to  j watson

Maybe she’s similar to Shakespeare’s Iago. He never really gives a satisfactory explanation for his behaviour. He mentions resentment at having been passed over for promotion, but this cannot fully account for the wickedness of his actions. When asked to explain himself he merely answers:
“Demand me nothing: What you know, you know: From this time forth I never will speak word.” (V.ii.316-317).
I suspect we will never “pluck out the heart of [Letby’s] mystery.”

Tony Conrad
Tony Conrad
9 months ago
Reply to  j watson

It is proven in these days that our behaviour can alter our brain structure. The other way around one can almost justify anything because of someone’s brain structure.

Randle McMurphy
Randle McMurphy
9 months ago
Reply to  J Bryant

I suspect if you asked her, she wouldn’t be able to tell you why she did it.

Stuart McCullough
Stuart McCullough
9 months ago

At the moment there is no evidence to suggest that she accepts that she did do it.

Dumetrius
Dumetrius
9 months ago

You’d think if she didn’t – or thought she didn’t – she might appeal. Don’t know what the time limit on doing that would be.

Dumetrius
Dumetrius
9 months ago

You’d think if she didn’t – or thought she didn’t – she might appeal. Don’t know what the time limit on doing that would be.

Stuart McCullough
Stuart McCullough
9 months ago

At the moment there is no evidence to suggest that she accepts that she did do it.

David Morley
David Morley
9 months ago
Reply to  J Bryant

An extreme form of narcissism – the god complex in common parlance – seems most likely. The power over life and death. But I’ve yet to hear other convincing signs of narcissism, such as hypersensitivity to criticism, ego collapse in response to setbacks etc.

It could be that too much of our thinking on psychopaths is based on males and that females present differently.

Ron Wigley
Ron Wigley
9 months ago
Reply to  David Morley

No empathy is a major sign of NPD narcissistic personality disorder, Narcissistic personality disorder (NPD) is a personality disorder that involves self-loathing, a fragile self-esteem and compensatory self-importance. It is also associated with primitive defence mechanisms and a superiority complex that protect the individual psychologically. The conduct of one’s life is often disingenuous in the patient population and the avoidance of the appearance of  inferiority (dependence) is common. Research has pointed that agreeableness is exceedingly low translating to lack of empathy and altruism. NPD is characterized by a life-long pattern of:
exaggerated feelings of self-importance (grandiosity)an excessive need for admirationdelusional sense of status diminished ability or unwillingness to empathize with others’ feelings, andinterpersonally exploitative behavior.Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders.[1][2] It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.[1]
Personality disorders are a class of mental disorders characterised by enduring and inflexible maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment.[4][5][6] Criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders (DSM).

Last edited 9 months ago by Ron Wigley
Ron Wigley
Ron Wigley
9 months ago
Reply to  David Morley

No empathy is a major sign of NPD narcissistic personality disorder, Narcissistic personality disorder (NPD) is a personality disorder that involves self-loathing, a fragile self-esteem and compensatory self-importance. It is also associated with primitive defence mechanisms and a superiority complex that protect the individual psychologically. The conduct of one’s life is often disingenuous in the patient population and the avoidance of the appearance of  inferiority (dependence) is common. Research has pointed that agreeableness is exceedingly low translating to lack of empathy and altruism. NPD is characterized by a life-long pattern of:
exaggerated feelings of self-importance (grandiosity)an excessive need for admirationdelusional sense of status diminished ability or unwillingness to empathize with others’ feelings, andinterpersonally exploitative behavior.Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders.[1][2] It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.[1]
Personality disorders are a class of mental disorders characterised by enduring and inflexible maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment.[4][5][6] Criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders (DSM).

Last edited 9 months ago by Ron Wigley
Dumetrius
Dumetrius
9 months ago
Reply to  Alexandra Keep

Thanks for the link.

One difference between this and Lucia de Berk’s case is that in the three years de Berk worked in her hospital, baby deaths went down – by one – from the preceding three years. Not the case at Countess of Chester.

I will give this a watch however. Also don’t know that LL is innocent, but am uneasy – it concerns me that all or just about all the evidence is circumstantial.

Last edited 9 months ago by Dumetrius
Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Dumetrius

But very strong. Baby dies at night, LL is present. She is moved to daytime care, babies start dying during daytime but not at night. Deaths soar under her rule. She leaves and deaths return to normal: one in five years.Also she wrote hysterical confessions in her private notes. But I agree that could be just nuttiness.

Dumetrius
Dumetrius
9 months ago
Reply to  Anna Bramwell

Thank you for your comment.

The day and night thing I would have to think about.

I suppose the question with the graph they presented as proof, including day & night shifts, is : could similar be produced for any other nurse and it also look equally compelling ?

Also, in the video, they discuss how the rate of baby deaths eventually started climbing again, and is now over that when LL was on the ward,

Last edited 9 months ago by Dumetrius
Gavin McKinley
Gavin McKinley
9 months ago
Reply to  Dumetrius

All the evidence against her is circumstantial.
While the rate of perinatal deaths at the Countess of Chester Hospital was above the national average in 2015 ~ 2016, the death rate continued to rise after she was removed from duty (based on ONS data according to the “Science on Trial” website).
There have been repeated miscarriages of justice, based on flawed statistics. There is an excellent Science article “Unlucky Numbers” (link at end) covering two cases where nurses (Lucia de Berk and Daniela Puggliali) were acquitted of murdering patients. Halfway down, there is a graphic demonstrating how statistics can be made to create the impression of guilt. These two cases illustrate, how, once someone falls under suspicion, investigators will look for patterns, which do not exist, finding evidence that incriminates, while ignoring evidence that exonerates.
https://www.science.org/content/article/unlucky-numbers-fighting-murder-convictions-rest-shoddy-stats

Gavin McKinley
Gavin McKinley
9 months ago
Reply to  Dumetrius

All the evidence against her is circumstantial.
While the rate of perinatal deaths at the Countess of Chester Hospital was above the national average in 2015 ~ 2016, the death rate continued to rise after she was removed from duty (based on ONS data according to the “Science on Trial” website).
There have been repeated miscarriages of justice, based on flawed statistics. There is an excellent Science article “Unlucky Numbers” (link at end) covering two cases where nurses (Lucia de Berk and Daniela Puggliali) were acquitted of murdering patients. Halfway down, there is a graphic demonstrating how statistics can be made to create the impression of guilt. These two cases illustrate, how, once someone falls under suspicion, investigators will look for patterns, which do not exist, finding evidence that incriminates, while ignoring evidence that exonerates.
https://www.science.org/content/article/unlucky-numbers-fighting-murder-convictions-rest-shoddy-stats

Dumetrius
Dumetrius
9 months ago
Reply to  Anna Bramwell

Thank you for your comment.

The day and night thing I would have to think about.

I suppose the question with the graph they presented as proof, including day & night shifts, is : could similar be produced for any other nurse and it also look equally compelling ?

Also, in the video, they discuss how the rate of baby deaths eventually started climbing again, and is now over that when LL was on the ward,

Last edited 9 months ago by Dumetrius
Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Dumetrius

But very strong. Baby dies at night, LL is present. She is moved to daytime care, babies start dying during daytime but not at night. Deaths soar under her rule. She leaves and deaths return to normal: one in five years.Also she wrote hysterical confessions in her private notes. But I agree that could be just nuttiness.

J Bryant
J Bryant
9 months ago
Reply to  Alexandra Keep

Interesting link.

Simon S
Simon S
9 months ago
Reply to  Alexandra Keep

Thank you very much for this. From that article I also found this: https://rexvlucyletby2023.com/
However, the handwritten notes do seem to present pretty clear evidence of her guilt.

Alexandra Keep
Alexandra Keep
9 months ago
Reply to  Simon S

& thank you for this link.

Gavin McKinley
Gavin McKinley
9 months ago
Reply to  Simon S

The green piece of paper where she appeared to confess to killing the babies could have reflected her state of mind. She may have believed herself responsible for the deaths because of a feeling that she wasn’t a good enough nurse. She must have been under a lot of stress, given that she was under suspicion for a long time before her arrest. She had plenty of time to dispose of such evidence, if she was guilty. And if she was guilty, and wanted to get caught, why deny the charges? None of it makes any sense. When a person is suspected of being guilty, people will read ill intent into things that have innocent explanations. The MailOnline recently claimed that she had used a secret code “LO” to record the dates of her crimes. The reality turned out different – see
https://lawhealthandtech.substack.com/p/ll-part-11-an-example-of-fair-honest?utm_source=post-email-title&publication_id=1232545&post_id=136369717&isFreemail=true&utm_medium=email

Alexandra Keep
Alexandra Keep
9 months ago
Reply to  Simon S

& thank you for this link.

Gavin McKinley
Gavin McKinley
9 months ago
Reply to  Simon S

The green piece of paper where she appeared to confess to killing the babies could have reflected her state of mind. She may have believed herself responsible for the deaths because of a feeling that she wasn’t a good enough nurse. She must have been under a lot of stress, given that she was under suspicion for a long time before her arrest. She had plenty of time to dispose of such evidence, if she was guilty. And if she was guilty, and wanted to get caught, why deny the charges? None of it makes any sense. When a person is suspected of being guilty, people will read ill intent into things that have innocent explanations. The MailOnline recently claimed that she had used a secret code “LO” to record the dates of her crimes. The reality turned out different – see
https://lawhealthandtech.substack.com/p/ll-part-11-an-example-of-fair-honest?utm_source=post-email-title&publication_id=1232545&post_id=136369717&isFreemail=true&utm_medium=email

Dumetrius
Dumetrius
9 months ago
Reply to  Alexandra Keep

Thanks for the link.

One difference between this and Lucia de Berk’s case is that in the three years de Berk worked in her hospital, baby deaths went down – by one – from the preceding three years. Not the case at Countess of Chester.

I will give this a watch however. Also don’t know that LL is innocent, but am uneasy – it concerns me that all or just about all the evidence is circumstantial.

Last edited 9 months ago by Dumetrius
J Bryant
J Bryant
9 months ago
Reply to  Alexandra Keep

Interesting link.

Simon S
Simon S
9 months ago
Reply to  Alexandra Keep

Thank you very much for this. From that article I also found this: https://rexvlucyletby2023.com/
However, the handwritten notes do seem to present pretty clear evidence of her guilt.

Chantal Ettling
Chantal Ettling
9 months ago
Reply to  J Bryant

..

Last edited 9 months ago by Chantal Ettling
Marie Jones
Marie Jones
9 months ago
Reply to  J Bryant

Her parents must be suffering abominably – she is their beloved only child – but I can’t help thinking there is something just so ‘over-the-top’ almost suffocating, about the relationship between the three of them.
I was surprised to hear that her father was so involved with the case when the various consultants started raising concerns about her, and her mother’s cry of, ‘It was me. Take me!’ (Or words to that effect) when she was found guilty.
It just all seems so melodramatic. Maybe Letby is in some way addicted to drama and high emotion. There can’t be much which is more emotional and dramatic than the death of a tiny baby.

Sarah Atkin
Sarah Atkin
9 months ago
Reply to  J Bryant

To answer the last question, yes…apparently, they do. I struggle with this too. It’s so disturbing. She appeared ‘normal’ but is a monster.

Dumetrius
Dumetrius
9 months ago
Reply to  J Bryant

It’s not fashionable to say it (and I’m homosexual so I know why they don’t like the phrase but let’s not pussyfoot about) but it sounds like it is her innate ‘orientation’.

She’s just an otherwise completely normal person. Who likes to kill.

John Dellingby
John Dellingby
9 months ago
Reply to  J Bryant

We’ll likely never know for sure unless she confesses and elaborates. I’ve heard all sorts over the last few days whether it be related to her upbringing, psychopathic disorder, dislike of the parents etc but it could be all, some or none of those. Doesn’t help that female serial killers are somewhat rare in comparison to their male counterparts.

j watson
j watson
9 months ago
Reply to  J Bryant

Psychopaths don’t always have a clear motive. Their brain structure is increasingly appreciated as distinctly and observably different.

Randle McMurphy
Randle McMurphy
9 months ago
Reply to  J Bryant

I suspect if you asked her, she wouldn’t be able to tell you why she did it.

David Morley
David Morley
9 months ago
Reply to  J Bryant

An extreme form of narcissism – the god complex in common parlance – seems most likely. The power over life and death. But I’ve yet to hear other convincing signs of narcissism, such as hypersensitivity to criticism, ego collapse in response to setbacks etc.

It could be that too much of our thinking on psychopaths is based on males and that females present differently.

Chantal Ettling
Chantal Ettling
9 months ago
Reply to  J Bryant

..

Last edited 9 months ago by Chantal Ettling
Marie Jones
Marie Jones
9 months ago
Reply to  J Bryant

Her parents must be suffering abominably – she is their beloved only child – but I can’t help thinking there is something just so ‘over-the-top’ almost suffocating, about the relationship between the three of them.
I was surprised to hear that her father was so involved with the case when the various consultants started raising concerns about her, and her mother’s cry of, ‘It was me. Take me!’ (Or words to that effect) when she was found guilty.
It just all seems so melodramatic. Maybe Letby is in some way addicted to drama and high emotion. There can’t be much which is more emotional and dramatic than the death of a tiny baby.

Sarah Atkin
Sarah Atkin
9 months ago
Reply to  J Bryant

To answer the last question, yes…apparently, they do. I struggle with this too. It’s so disturbing. She appeared ‘normal’ but is a monster.

J Bryant
J Bryant
9 months ago

The part of this story that remains unanswered is the question of her motive. I’ve read a couple of news articles which proposed variations on the theme of “she wanted attention” (and perhaps she did). The oddly-named Munchausen by Proxy Syndrome also reared its head, although no definitive conclusion was offered.
All news stories I read consistently asserted she had a normal upbringing with no earlier signs of a troubled personality. If anything, she was a boring person. That part I struggle to believe. Does someone really go from utterly normal to serial baby killer in one easy step?

Jonathan Andrews
Jonathan Andrews
9 months ago

We have idealised “our NHS” for decades and nurses and doctors have been called angels and heroes. This means we forget that they are people. They mostly will do their best to help people but they make errors and they have bad days like the rest of us.

We hear how hard they work, how dedicated they are but I don’t believe this. They are, on average, as dedicated as the rest of us. Like everyone else, they take shortcuts. I hardly blame them, life is impossible otherwise.

I’m not sure how I would have handled doctors bringing a story to me as those in Chester. I hope, I would have suspended the nurse and involved the police. I don’t think I’d have worried about reputation but I do think I’d have found the allegations hard to believe.

One question, were the doctors who raised concerns worried that she was incompetent or murderous? If the latter, why didn’t they go directly to the police when their managers refused to act on their concerns?

Steve Murray
Steve Murray
9 months ago

Precisely this. Working in the NHS is a career, like any other (mine lasted 35 years). I suspect the managers found the claims too incredible at first, but were also looking to advance their careers without having to deal with such a major issue. Of course, that’s now backfired, and at horrendous cost to the families concerned. The managers should now be prosecuted for corporate manslaughter.
The careers of the doctors might well have imploded if they’d gone to the police and the evidence found not to stack up. I’m pretty sure there’s an “escalation of concerns” protocol that’d mean the doctors may have found it difficult to obtain the level of work elsewhere, having gained a reputation for going above the heads of management. It’s always a case of fallible human judgement.

Anna Bramwell
Anna Bramwell
9 months ago

They had already been threatened with the loss of their careers if they did that. The power of these managers to punish and to protect is extraordinary.

Andrew McDonald
Andrew McDonald
9 months ago

How many of the managers involved were clinicians in managerial posts? It makes a difference to the debate.

Jonathan Andrews
Jonathan Andrews
9 months ago

I understand that both of the key positions were held by clinicians.

Jonathan Andrews
Jonathan Andrews
9 months ago

I understand that both of the key positions were held by clinicians.

Steve Murray
Steve Murray
9 months ago

Precisely this. Working in the NHS is a career, like any other (mine lasted 35 years). I suspect the managers found the claims too incredible at first, but were also looking to advance their careers without having to deal with such a major issue. Of course, that’s now backfired, and at horrendous cost to the families concerned. The managers should now be prosecuted for corporate manslaughter.
The careers of the doctors might well have imploded if they’d gone to the police and the evidence found not to stack up. I’m pretty sure there’s an “escalation of concerns” protocol that’d mean the doctors may have found it difficult to obtain the level of work elsewhere, having gained a reputation for going above the heads of management. It’s always a case of fallible human judgement.

Anna Bramwell
Anna Bramwell
9 months ago

They had already been threatened with the loss of their careers if they did that. The power of these managers to punish and to protect is extraordinary.

Andrew McDonald
Andrew McDonald
9 months ago

How many of the managers involved were clinicians in managerial posts? It makes a difference to the debate.

Jonathan Andrews
Jonathan Andrews
9 months ago

We have idealised “our NHS” for decades and nurses and doctors have been called angels and heroes. This means we forget that they are people. They mostly will do their best to help people but they make errors and they have bad days like the rest of us.

We hear how hard they work, how dedicated they are but I don’t believe this. They are, on average, as dedicated as the rest of us. Like everyone else, they take shortcuts. I hardly blame them, life is impossible otherwise.

I’m not sure how I would have handled doctors bringing a story to me as those in Chester. I hope, I would have suspended the nurse and involved the police. I don’t think I’d have worried about reputation but I do think I’d have found the allegations hard to believe.

One question, were the doctors who raised concerns worried that she was incompetent or murderous? If the latter, why didn’t they go directly to the police when their managers refused to act on their concerns?

Joe Mealing
Joe Mealing
9 months ago

The banality of evil. Something seriously needs to happen to hold these NHS mandarins criminally to account, if necessary. The SMCR can put finance managers behind bars. How are human lives less important than insider trading?

Charlie Dibsdale
Charlie Dibsdale
9 months ago
Reply to  Joe Mealing

I think there is a deeper malaise in the NHS, in that its culture needs to change. Blame culture and defensiveness is rife. I have worked in the Nuclear industry where every single person even the most junior can stop work if they feel something is wrong, and their voice is taken seriously. The culture also encourages admitting to making mistakes, so they are reviewed and become learning opportunities for everybody. We have to do this to maintain nuclear safety. I have read Dr Atul Gawande’s (a surgeon) “The checklist manifesto”, and was amazed at some of the mistakes expert surgeons make whilst in the operating room. Using procedures (that are in effect checklists) that are understandable and that are known to work is de-rigour in the Nuclear domain. The NHS is in a mess, it is adequately funded but needs fundamental reform from the ground up. Changing the culture to being open is going to be long and difficult – but that is where reform needs to start. There is no point blaming ‘managers’ in general terms – the NHS is massively complex and it needs managing, but managing in a spirit of openness, accountability, collaboration and understanding the clinicians and their perspectives.

Last edited 9 months ago by Charlie Dibsdale
Wendy Barton
Wendy Barton
9 months ago

Yes.  Culture change has to be led from the top.  In addition, since almost no-one likes change, there has to be a compelling reason for workers to accept it.  In the private sector, the compelling reason is frequently the threat of a redundancy programme, or sacking.  Can’t see that being imposed on the NHS workforce. 

Anna Bramwell
Anna Bramwell
9 months ago

No it doesn’t need managing. Private hospitals have a couple of non medical staff with clearly defined roles: Bandages get ordered, patients are sent home, promptly and efficiently. Remember the NHS doctor who lay down surrounded by the 40 pieces of paper needed to discharge a patient?

Samir Iker
Samir Iker
9 months ago

That’s a good example. But there is another cultural difference that appears apparent – between more masculine, blunt, maths based cultures (which likely dominates nuclear) and feminine, feelings based cultures, what you see in medicine or say teaching.

Both have positives and drawbacks. The former can lead to over aggressive macho trans as you often see on trading desks. But is also more willing to face the harsh truth, even if it doesn’t reflect positively on you.

On the other hand, the more feminine culture is often too focused on avoiding hurt feelings, more likely to be captured by “equity” and “inclusion”.

Of course, sheer greed was one reason the managers failed to spot the obvious.
But another key factor was the emphasis on not “upsetting” the poor thing, refusal to face evidence and rely on “feelings”.

Rasmus Fogh
Rasmus Fogh
9 months ago

The nuclear industry and aviation do have an advantage here. They are extremely safe normally, with very rare mishaps, and if you are sufficiently worried you always have the option of not flying or closing the reactor down. In hospitals, let alone units with premature babies, mishaps, people getting sicker, and dying happen all the time. And if you think procedures are not safe or staffing levels are too low you still cannot close the doors and leave the patients waiting in the ambulances till things improve.

Andrew McDonald
Andrew McDonald
9 months ago
Reply to  Rasmus Fogh

That’s absolutely right – and hospitals are the last resort in the NHS, the door that can never be closed, however unsafe it may be to accept more patients and more risk. So the whistleblower at the door of A&E is a non-starter. And when everyone in the organisation knows this, there’s no great impulse to welcome the examination of error and risk in all the other departments.

Andrew McDonald
Andrew McDonald
9 months ago
Reply to  Rasmus Fogh

That’s absolutely right – and hospitals are the last resort in the NHS, the door that can never be closed, however unsafe it may be to accept more patients and more risk. So the whistleblower at the door of A&E is a non-starter. And when everyone in the organisation knows this, there’s no great impulse to welcome the examination of error and risk in all the other departments.

Linda M Brown
Linda M Brown
9 months ago

Fewer managers to spread the blame around would be a start. A bloated bureaucracy is never a sign of competence

Wendy Barton
Wendy Barton
9 months ago

Yes.  Culture change has to be led from the top.  In addition, since almost no-one likes change, there has to be a compelling reason for workers to accept it.  In the private sector, the compelling reason is frequently the threat of a redundancy programme, or sacking.  Can’t see that being imposed on the NHS workforce. 

Anna Bramwell
Anna Bramwell
9 months ago

No it doesn’t need managing. Private hospitals have a couple of non medical staff with clearly defined roles: Bandages get ordered, patients are sent home, promptly and efficiently. Remember the NHS doctor who lay down surrounded by the 40 pieces of paper needed to discharge a patient?

Samir Iker
Samir Iker
9 months ago

That’s a good example. But there is another cultural difference that appears apparent – between more masculine, blunt, maths based cultures (which likely dominates nuclear) and feminine, feelings based cultures, what you see in medicine or say teaching.

Both have positives and drawbacks. The former can lead to over aggressive macho trans as you often see on trading desks. But is also more willing to face the harsh truth, even if it doesn’t reflect positively on you.

On the other hand, the more feminine culture is often too focused on avoiding hurt feelings, more likely to be captured by “equity” and “inclusion”.

Of course, sheer greed was one reason the managers failed to spot the obvious.
But another key factor was the emphasis on not “upsetting” the poor thing, refusal to face evidence and rely on “feelings”.

Rasmus Fogh
Rasmus Fogh
9 months ago

The nuclear industry and aviation do have an advantage here. They are extremely safe normally, with very rare mishaps, and if you are sufficiently worried you always have the option of not flying or closing the reactor down. In hospitals, let alone units with premature babies, mishaps, people getting sicker, and dying happen all the time. And if you think procedures are not safe or staffing levels are too low you still cannot close the doors and leave the patients waiting in the ambulances till things improve.

Linda M Brown
Linda M Brown
9 months ago

Fewer managers to spread the blame around would be a start. A bloated bureaucracy is never a sign of competence

Charlie Dibsdale
Charlie Dibsdale
9 months ago
Reply to  Joe Mealing

I think there is a deeper malaise in the NHS, in that its culture needs to change. Blame culture and defensiveness is rife. I have worked in the Nuclear industry where every single person even the most junior can stop work if they feel something is wrong, and their voice is taken seriously. The culture also encourages admitting to making mistakes, so they are reviewed and become learning opportunities for everybody. We have to do this to maintain nuclear safety. I have read Dr Atul Gawande’s (a surgeon) “The checklist manifesto”, and was amazed at some of the mistakes expert surgeons make whilst in the operating room. Using procedures (that are in effect checklists) that are understandable and that are known to work is de-rigour in the Nuclear domain. The NHS is in a mess, it is adequately funded but needs fundamental reform from the ground up. Changing the culture to being open is going to be long and difficult – but that is where reform needs to start. There is no point blaming ‘managers’ in general terms – the NHS is massively complex and it needs managing, but managing in a spirit of openness, accountability, collaboration and understanding the clinicians and their perspectives.

Last edited 9 months ago by Charlie Dibsdale
Joe Mealing
Joe Mealing
9 months ago

The banality of evil. Something seriously needs to happen to hold these NHS mandarins criminally to account, if necessary. The SMCR can put finance managers behind bars. How are human lives less important than insider trading?

Hugh Bryant
Hugh Bryant
9 months ago

Monolithic systems always fail. Not sometimes. Not usually. Always.

Cosimo Smith
Cosimo Smith
9 months ago
Reply to  Hugh Bryant

Pithy. I already sense the wagons are quietly circling. Like the apparatchik’s answer to any EU problem is always ‘more Europe’ the enquiry will cite well recognised change management problems and the result will be more bureaucracy, tighter systems, lessons learned, more meetings about meetings. We won’t hear: the problem is inherent in the monolith, break it up, private sector competence, individual accountability.

Last edited 9 months ago by Cosimo Smith
Cosimo Smith
Cosimo Smith
9 months ago
Reply to  Hugh Bryant

Pithy. I already sense the wagons are quietly circling. Like the apparatchik’s answer to any EU problem is always ‘more Europe’ the enquiry will cite well recognised change management problems and the result will be more bureaucracy, tighter systems, lessons learned, more meetings about meetings. We won’t hear: the problem is inherent in the monolith, break it up, private sector competence, individual accountability.

Last edited 9 months ago by Cosimo Smith
Hugh Bryant
Hugh Bryant
9 months ago

Monolithic systems always fail. Not sometimes. Not usually. Always.

Simon Neale
Simon Neale
9 months ago

We don’t know what Kelly and Chambers were thinking as they watched a significant rise in the number of babies suffering serious and unexpected collapses in the hospital’s neonatal unit from 2015 and 2016 — a rise that was well above the expected local average.

True, but I think we can all have a pretty good guess. It has to do with career progression, that ÂŁ1.5 million pension pot (strewth!), reputational damage, school fees, luxury vehicles, and second homes.
These were people who saw that there were positions in society where there were huge rewards available in exchange for their skills and labour facilitating healing on a grand scale. Underneath the welter of denial, blame-avoidance, obfuscation, prevarication, and bland modern management-speak, these people are utter failures. Perhaps our only hope is that the useless frauds come to realise this, because the way we have set things up means that there will probably be no personal consequences for them other than a few articles like this.

Jonathan Andrews
Jonathan Andrews
9 months ago
Reply to  Simon Neale

I watched again last night a episode of Yes Prime Minister. The story was of a civil service pay rise and how the top of the service put themselves on a par with those at the top of commerce and industry. Of course, the ignored the reality that private CEOs would be sacked, soon as look at you, if profits fell.

Jonathan Andrews
Jonathan Andrews
9 months ago
Reply to  Simon Neale

I watched again last night a episode of Yes Prime Minister. The story was of a civil service pay rise and how the top of the service put themselves on a par with those at the top of commerce and industry. Of course, the ignored the reality that private CEOs would be sacked, soon as look at you, if profits fell.

Simon Neale
Simon Neale
9 months ago

We don’t know what Kelly and Chambers were thinking as they watched a significant rise in the number of babies suffering serious and unexpected collapses in the hospital’s neonatal unit from 2015 and 2016 — a rise that was well above the expected local average.

True, but I think we can all have a pretty good guess. It has to do with career progression, that ÂŁ1.5 million pension pot (strewth!), reputational damage, school fees, luxury vehicles, and second homes.
These were people who saw that there were positions in society where there were huge rewards available in exchange for their skills and labour facilitating healing on a grand scale. Underneath the welter of denial, blame-avoidance, obfuscation, prevarication, and bland modern management-speak, these people are utter failures. Perhaps our only hope is that the useless frauds come to realise this, because the way we have set things up means that there will probably be no personal consequences for them other than a few articles like this.

John Dellingby
John Dellingby
9 months ago

I think the main thing that needs to come out of this is that whistleblowers need to be given appropriate protection. In the aftermath of this, many have given examples of where themselves and others who have reported concerns and are then treated as the problem by management. It might well be that the public sector as a whole needs an equivalent to the FCA for whistleblowers to report issues to.

Appreciate it’s yet another layer of bureaucracy, but the Lucy Letby case demonstrates the current systems gaping flaws.

Aw Zk
Aw Zk
9 months ago
Reply to  John Dellingby

The author is right that the refusal of NHS managers to investigate allegations against Lucy Letby fits into a wider story of scandals within the NHS. However, I think the NHS scandals fit into a wider story of scandals within the public sector.

In a series of provincial towns and cities it has been shown that public institutions with a legal duty to protect children failed underage girls who were being plied with drink and drugs and raped by gangs made up predominantly by Muslim men. In a number of trials it has been found that the criminal was on probation at the time of their crimes and their assessment and supervision was woefully substandard. Abuse of disabled people in care homes has gone unchecked despite the existence of a system of inspection. The Metropolitan Police is not the only force to be found to be unwilling and unable to prevent officers committing crimes seemingly with impunity.

Across the public sector systems of management and regulation have repeatedly failed because the people working within them are more concerned with protecting themselves and their organisations than protecting the public they are supposed to be serving. What sort of person does that?

Guardian readers. For decades one of the main conduits for recruitment of white collar public sector workers, and especially management, has been The Guardian newspaper. In the era before the decline of print the Tuesday and Wednesday editions of The Guardian included Education and Society sections which contained a few pages of articles but were otherwise filled with job adverts and sometimes those sections ran to over a hundred pages. Now those job adverts are mostly online but thousands of jobs are advertised on The Guardian’s website. The public sector is stuffed with Guardian readers.

Guardian readers: handmaidens to evil.

Last edited 9 months ago by Aw Zk
mike otter
mike otter
9 months ago
Reply to  Aw Zk

Thanks – the beobachter as its called in our house is itself a pathogen. I saw one piece where a writer ideated experimenting how much torture the TV personality Kirsty Allsop could stand from a taser! Like the advocacy of acid attacks on Farrage and the nurse who said Tory voters should not be resuccitated the perp will certainly tell you they were “joking”. The spirit of Mengele is indeed alive, the “rancid Angel of Death flying free”

Last edited 9 months ago by mike otter
Addie Shog
Addie Shog
9 months ago
Reply to  mike otter

I wonder if that writer get in as much trouble as Jeremy Clarkson did for that article about Meghan Markle.

Addie Shog
Addie Shog
9 months ago
Reply to  mike otter

I wonder if that writer get in as much trouble as Jeremy Clarkson did for that article about Meghan Markle.

j watson
j watson
9 months ago
Reply to  Aw Zk

Actually you’ve missed the point an Investigation was requested from the RCPCH but that medical professional body failed to spot the evidence or flag the right concern. It’s not clear why from what we know to date and hopefully the Inquiry will get to the bottom of that. They will have had access to all the notes and one assumes interviewed all the key staff?
I appreciate grasping details, nuance and being inquisitive before full judgment may be occasionally beyond yourself. That’s ok. Default to prejudice and drivel being much more fun too.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  j watson

The outsourced report writer apparently failed to look at the individual case notes. Are you supporting this?

j watson
j watson
9 months ago
Reply to  Anna Bramwell

We need to understand if this is true and why they failed don’t we AB? And if when the report conclusions were made available to Board that was clear and also if RCPCH dropped the Chair a note to flag this fundamental omission. I’d reserve judgment til we hear a bit more. The initial ‘cover one’s backside’ statements from most parties are not the same as an independent investigation.

j watson
j watson
9 months ago
Reply to  Anna Bramwell

We need to understand if this is true and why they failed don’t we AB? And if when the report conclusions were made available to Board that was clear and also if RCPCH dropped the Chair a note to flag this fundamental omission. I’d reserve judgment til we hear a bit more. The initial ‘cover one’s backside’ statements from most parties are not the same as an independent investigation.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  j watson

The outsourced report writer apparently failed to look at the individual case notes. Are you supporting this?

mike otter
mike otter
9 months ago
Reply to  Aw Zk

Thanks – the beobachter as its called in our house is itself a pathogen. I saw one piece where a writer ideated experimenting how much torture the TV personality Kirsty Allsop could stand from a taser! Like the advocacy of acid attacks on Farrage and the nurse who said Tory voters should not be resuccitated the perp will certainly tell you they were “joking”. The spirit of Mengele is indeed alive, the “rancid Angel of Death flying free”

Last edited 9 months ago by mike otter
j watson
j watson
9 months ago
Reply to  Aw Zk

Actually you’ve missed the point an Investigation was requested from the RCPCH but that medical professional body failed to spot the evidence or flag the right concern. It’s not clear why from what we know to date and hopefully the Inquiry will get to the bottom of that. They will have had access to all the notes and one assumes interviewed all the key staff?
I appreciate grasping details, nuance and being inquisitive before full judgment may be occasionally beyond yourself. That’s ok. Default to prejudice and drivel being much more fun too.

Sue Whorton
Sue Whorton
9 months ago
Reply to  John Dellingby

This shouldn’t have been about whistleblowing but about multidisciplinary team cooperation. Professionals rely on each other. If there is no trust between disciplines then it all goes wrong, not just in extreme cases like this but just ordinary work stress and unnecessary inefficiencies.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Sue Whorton

Trust between the management cadre and the med8cal staff seems lacking, quite rightly. What on earth are these layers of senior managers doing! And the trustees? A pyramid of uselessness.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Sue Whorton

Trust between the management cadre and the med8cal staff seems lacking, quite rightly. What on earth are these layers of senior managers doing! And the trustees? A pyramid of uselessness.

Carmel Shortall
Carmel Shortall
9 months ago
Reply to  John Dellingby

As I stated elsewhere in these comments… for an insight of how whistleblowers are still persecuted in the NHS read Dr Peter Duffy’s book: Whistle in the Wind.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  John Dellingby

More important, why didnt autopsies pick up eg the insulin poisoning, the pattern of abnormal deaths.

mattyslinger
mattyslinger
9 months ago
Reply to  John Dellingby

Totally agree. Reporting a problem to someone that stands to lose from the outcome is never a good idea. The police have anti-corruption squads and the NHS should have an equivalent for malpractice. As distasteful as it may be you need someone in place whose initial reaction by design is that you are guilty.

Last edited 9 months ago by mattyslinger
Aw Zk
Aw Zk
9 months ago
Reply to  John Dellingby

The author is right that the refusal of NHS managers to investigate allegations against Lucy Letby fits into a wider story of scandals within the NHS. However, I think the NHS scandals fit into a wider story of scandals within the public sector.

In a series of provincial towns and cities it has been shown that public institutions with a legal duty to protect children failed underage girls who were being plied with drink and drugs and raped by gangs made up predominantly by Muslim men. In a number of trials it has been found that the criminal was on probation at the time of their crimes and their assessment and supervision was woefully substandard. Abuse of disabled people in care homes has gone unchecked despite the existence of a system of inspection. The Metropolitan Police is not the only force to be found to be unwilling and unable to prevent officers committing crimes seemingly with impunity.

Across the public sector systems of management and regulation have repeatedly failed because the people working within them are more concerned with protecting themselves and their organisations than protecting the public they are supposed to be serving. What sort of person does that?

Guardian readers. For decades one of the main conduits for recruitment of white collar public sector workers, and especially management, has been The Guardian newspaper. In the era before the decline of print the Tuesday and Wednesday editions of The Guardian included Education and Society sections which contained a few pages of articles but were otherwise filled with job adverts and sometimes those sections ran to over a hundred pages. Now those job adverts are mostly online but thousands of jobs are advertised on The Guardian’s website. The public sector is stuffed with Guardian readers.

Guardian readers: handmaidens to evil.

Last edited 9 months ago by Aw Zk
Sue Whorton
Sue Whorton
9 months ago
Reply to  John Dellingby

This shouldn’t have been about whistleblowing but about multidisciplinary team cooperation. Professionals rely on each other. If there is no trust between disciplines then it all goes wrong, not just in extreme cases like this but just ordinary work stress and unnecessary inefficiencies.

Carmel Shortall
Carmel Shortall
9 months ago
Reply to  John Dellingby

As I stated elsewhere in these comments… for an insight of how whistleblowers are still persecuted in the NHS read Dr Peter Duffy’s book: Whistle in the Wind.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  John Dellingby

More important, why didnt autopsies pick up eg the insulin poisoning, the pattern of abnormal deaths.

mattyslinger
mattyslinger
9 months ago
Reply to  John Dellingby

Totally agree. Reporting a problem to someone that stands to lose from the outcome is never a good idea. The police have anti-corruption squads and the NHS should have an equivalent for malpractice. As distasteful as it may be you need someone in place whose initial reaction by design is that you are guilty.

Last edited 9 months ago by mattyslinger
John Dellingby
John Dellingby
9 months ago

I think the main thing that needs to come out of this is that whistleblowers need to be given appropriate protection. In the aftermath of this, many have given examples of where themselves and others who have reported concerns and are then treated as the problem by management. It might well be that the public sector as a whole needs an equivalent to the FCA for whistleblowers to report issues to.

Appreciate it’s yet another layer of bureaucracy, but the Lucy Letby case demonstrates the current systems gaping flaws.

AC Harper
AC Harper
9 months ago

We really don’t want another layer of bureaucracy to regulate NHS managers. It would soon be captured by the medical machine and be ineffective but probably very expensive.
You just need just two things:
1) A completely separate register of whistle-blowers concerns, kept securely.
2) A willingness to prosecute ineffective managers who turn a blind eye as accessories to murder, conspiracy, or some such legal charge.
A few prosecutions would focus the attention. You could roll out the register to cover other public services too – although I rather expect there would be a lot of resistance to being held accountable.

Stuart McCullough
Stuart McCullough
9 months ago
Reply to  AC Harper

I agree, but the level of jeopardy for failure or ineptitude in such leadership positions needs to extend to the loss of all accumulated benefits. The scale of pension pots available are a driving factor in the motivation of these types of people. The objective being to get to the finish tape as quickly as possible and then run off with their lifetime security. Just look at the life paths of 3 of the 4 main individuals in this tragic saga
By all means pay people for the responsibility they shoulder, but they need to live and operate with the real risk that they will lose it all if they don’t match up to their obligations.

Stuart McCullough
Stuart McCullough
9 months ago
Reply to  AC Harper

I agree, but the level of jeopardy for failure or ineptitude in such leadership positions needs to extend to the loss of all accumulated benefits. The scale of pension pots available are a driving factor in the motivation of these types of people. The objective being to get to the finish tape as quickly as possible and then run off with their lifetime security. Just look at the life paths of 3 of the 4 main individuals in this tragic saga
By all means pay people for the responsibility they shoulder, but they need to live and operate with the real risk that they will lose it all if they don’t match up to their obligations.

AC Harper
AC Harper
9 months ago

We really don’t want another layer of bureaucracy to regulate NHS managers. It would soon be captured by the medical machine and be ineffective but probably very expensive.
You just need just two things:
1) A completely separate register of whistle-blowers concerns, kept securely.
2) A willingness to prosecute ineffective managers who turn a blind eye as accessories to murder, conspiracy, or some such legal charge.
A few prosecutions would focus the attention. You could roll out the register to cover other public services too – although I rather expect there would be a lot of resistance to being held accountable.

Jonathan N
Jonathan N
9 months ago

It struck me that the problem with the reporting of Letby was that it was treated as an employment issue rather than a healthcare issue. Rather than setting up a regulatory structure (which will swiftly ossify into an institution equally concerned to protect its own reputation), it ought to be enough to establish a formal reporting procedure which, once activated, places a statutory duty on the manager to investigate, report and reach conclusions in writing for which he will thereafter be held responsible. The managers must be made to understand that it is their neck on the line if they get it wrong.

Last edited 9 months ago by Jonathan N
Malcolm Knott
Malcolm Knott
9 months ago
Reply to  Jonathan N

Perhaps something along the lines of the senior civil servant’s right to require a specific direction in writing if the minister wishes to override professional advice?

Emmanuel MARTIN
Emmanuel MARTIN
9 months ago
Reply to  Jonathan N

What you describe exists in finance.
It is cumbersome, but it somewhat works.

Malcolm Knott
Malcolm Knott
9 months ago
Reply to  Jonathan N

Perhaps something along the lines of the senior civil servant’s right to require a specific direction in writing if the minister wishes to override professional advice?

Emmanuel MARTIN
Emmanuel MARTIN
9 months ago
Reply to  Jonathan N

What you describe exists in finance.
It is cumbersome, but it somewhat works.

Jonathan N
Jonathan N
9 months ago

It struck me that the problem with the reporting of Letby was that it was treated as an employment issue rather than a healthcare issue. Rather than setting up a regulatory structure (which will swiftly ossify into an institution equally concerned to protect its own reputation), it ought to be enough to establish a formal reporting procedure which, once activated, places a statutory duty on the manager to investigate, report and reach conclusions in writing for which he will thereafter be held responsible. The managers must be made to understand that it is their neck on the line if they get it wrong.

Last edited 9 months ago by Jonathan N
Andrew Fisher
Andrew Fisher
9 months ago

This article makes some excellent points – which have a far wider relevance in the public sector (and maybe beyond) as anyone who has worked in one will appreciate. Utterly mediocre people who are good at following the latest interview or “performance appraisal” fads often rise through the ranks.

In general, I don’t believe in blame culture and scapegoating individuals – sacking or even imprisoning when bad things happen in an organisation. This is not what usually happens in the aviation industry, which is one reason it does learn and implement lessons very quickly after accidents. This is in very stark contrast to medicine, where scandal after scandal has occurred, and there is an almost routine closing of ranks and obfuscation against investigation. On a practical level, dragging in the lawyers isn’t always the best thing to do.

However, I do think it is reasonable that grossly negligent managers should be removed from their posts. The probably more likely scenario is people in managerial positions, who just aren’t up to the role, feel they can coast etc. These should be offered demotion to some administrative role perhaps or losing their employment altogether.

Gordon Black
Gordon Black
9 months ago
Reply to  Andrew Fisher

Yes, the Aviation Industry has a safety-based ethos (“obsession” might be a better word), a modus operandi which should be legally enforced on any other outfits involving life and death decisions. Having worked all my life in aviation I will reemphasise your words ‘stark contrast‘.

Gary Howells
Gary Howells
9 months ago
Reply to  Gordon Black

The Checklist Manifesto: How to Get Things Right. Atul Gawande https://amzn.eu/d/0EgskIQ

The aviation industry obsessively uses checklists to do the right things snd do them right. And transgressors are held accountable. Our public sector managers are unsackable.

This book brilliantly explains the purpose and effectiveness of checklists.

Do the right things and do them right.

Steve Murray
Steve Murray
9 months ago
Reply to  Gary Howells

There are regular audits of procedures in the NHS, where checklists are used to ensure things are being done correctly (e.g. use of theatre instruments and swab counts; prescription of pre-operative antibiotics for prophylactic purposes, to list but a small number) but these are often viewed by staff as tiresome and “bureaucratic”. Indeed, that’s what some managers are employed to do! They do throw up instances of poor practice which can then (in theory) be addressed, without pointing fingers at individuals.

Gordon Black
Gordon Black
9 months ago
Reply to  Gary Howells

Checklists are useful but, inevitably, mistakes are made. The ethos is :- immediately admit to your mistake: nobody is punished: ‘lessons are learned‘: you are trusted.
Cover up your mistake, and subsequent investigation establishes your cover-up, you are in big trouble.

Steve Murray
Steve Murray
9 months ago
Reply to  Gary Howells

There are regular audits of procedures in the NHS, where checklists are used to ensure things are being done correctly (e.g. use of theatre instruments and swab counts; prescription of pre-operative antibiotics for prophylactic purposes, to list but a small number) but these are often viewed by staff as tiresome and “bureaucratic”. Indeed, that’s what some managers are employed to do! They do throw up instances of poor practice which can then (in theory) be addressed, without pointing fingers at individuals.

Gordon Black
Gordon Black
9 months ago
Reply to  Gary Howells

Checklists are useful but, inevitably, mistakes are made. The ethos is :- immediately admit to your mistake: nobody is punished: ‘lessons are learned‘: you are trusted.
Cover up your mistake, and subsequent investigation establishes your cover-up, you are in big trouble.

Gary Howells
Gary Howells
9 months ago
Reply to  Gordon Black

The Checklist Manifesto: How to Get Things Right. Atul Gawande https://amzn.eu/d/0EgskIQ

The aviation industry obsessively uses checklists to do the right things snd do them right. And transgressors are held accountable. Our public sector managers are unsackable.

This book brilliantly explains the purpose and effectiveness of checklists.

Do the right things and do them right.

Gordon Black
Gordon Black
9 months ago
Reply to  Andrew Fisher

Yes, the Aviation Industry has a safety-based ethos (“obsession” might be a better word), a modus operandi which should be legally enforced on any other outfits involving life and death decisions. Having worked all my life in aviation I will reemphasise your words ‘stark contrast‘.

Andrew Fisher
Andrew Fisher
9 months ago

This article makes some excellent points – which have a far wider relevance in the public sector (and maybe beyond) as anyone who has worked in one will appreciate. Utterly mediocre people who are good at following the latest interview or “performance appraisal” fads often rise through the ranks.

In general, I don’t believe in blame culture and scapegoating individuals – sacking or even imprisoning when bad things happen in an organisation. This is not what usually happens in the aviation industry, which is one reason it does learn and implement lessons very quickly after accidents. This is in very stark contrast to medicine, where scandal after scandal has occurred, and there is an almost routine closing of ranks and obfuscation against investigation. On a practical level, dragging in the lawyers isn’t always the best thing to do.

However, I do think it is reasonable that grossly negligent managers should be removed from their posts. The probably more likely scenario is people in managerial positions, who just aren’t up to the role, feel they can coast etc. These should be offered demotion to some administrative role perhaps or losing their employment altogether.

Susan Grabston
Susan Grabston
9 months ago

The managerial layers comment is on point. Interesting side effect of blood pressure tablets: they leach sodium out of the system slowly over time leading to delirium if this process goes too far. My elderly mother found herself in this position last Christmas. She presented in hospital with both physical and psychological symptoms having collapsed, seemingly psychotic, at home. Treated by both psych and medical teams she moved around the hospital (quite literally) for 3 weeks. The problem was getting the appropriate sign off for release. In the end I did a deal with a Ward Sister desperate for beds and removed her myself. Kafkaesque experience whicj told me all I need to kkow about NHS admin.
More practically, if you are on BP tablets consider 6 monthly walk in blood tests for sodium depletion. Caring for an elder (my mother lives with us) is hard, but there are learnings for one’s own ageing and occasional sunlit uplands when you do something constructive and an uncompromised “win”.

Lesley Keay
Lesley Keay
9 months ago
Reply to  Susan Grabston

Thank you for the info. It is quite astonishing that the GP didn’t organise regular blood tests, but again this seems to be par for the course these days. I have recently been prescribed a type of NSAID painkiller which can cause kidney damage if used long-term and a blood tests should be done every six months or so to check the kidneys. I didn’t learn this from the GP who prescribed the drug but from a friend who had been prescribed them by a different GP. Go figure.

Steve Murray
Steve Murray
9 months ago
Reply to  Lesley Keay

Edited.

Last edited 9 months ago by Steve Murray
Steve Murray
Steve Murray
9 months ago
Reply to  Lesley Keay

Edited.

Last edited 9 months ago by Steve Murray
Lesley Keay
Lesley Keay
9 months ago
Reply to  Susan Grabston

Thank you for the info. It is quite astonishing that the GP didn’t organise regular blood tests, but again this seems to be par for the course these days. I have recently been prescribed a type of NSAID painkiller which can cause kidney damage if used long-term and a blood tests should be done every six months or so to check the kidneys. I didn’t learn this from the GP who prescribed the drug but from a friend who had been prescribed them by a different GP. Go figure.

Susan Grabston
Susan Grabston
9 months ago

The managerial layers comment is on point. Interesting side effect of blood pressure tablets: they leach sodium out of the system slowly over time leading to delirium if this process goes too far. My elderly mother found herself in this position last Christmas. She presented in hospital with both physical and psychological symptoms having collapsed, seemingly psychotic, at home. Treated by both psych and medical teams she moved around the hospital (quite literally) for 3 weeks. The problem was getting the appropriate sign off for release. In the end I did a deal with a Ward Sister desperate for beds and removed her myself. Kafkaesque experience whicj told me all I need to kkow about NHS admin.
More practically, if you are on BP tablets consider 6 monthly walk in blood tests for sodium depletion. Caring for an elder (my mother lives with us) is hard, but there are learnings for one’s own ageing and occasional sunlit uplands when you do something constructive and an uncompromised “win”.

Anna Lloyd
Anna Lloyd
9 months ago

Hospitals are too big. I hate them. They’re impossible to manage being the size they are. I worked as PA to a medical director in one. Awful job. We should just have smaller hospitals and more of them, nestled amongst the community, like in the old days. The north east is a brilliant example of this, lots of small hospitals and two excellent larger hospitals (very clean). Oxfordshire is a total disaster, the trust is massive and the John Radcliffe I would avoid at all costs because it’s far too big – and you can’t even park your car! Also it’s understaffed due to Oxford being too expensive for normal people to live, eg nurses. Btw, I’ve yet to find any convincing evidence of Lucy Letby’s guilt. Can anyone provide? I’ve looked everywhere but all I find is this staff rota and a weird note in her house.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Anna Lloyd

All? Come on. LL present at all deaths? Night time care, babies die. Daytime care, babies die during the day. She leaves and 1 baby dies in five years. Actually it js incredibly convincing. Like the link with smoking and lung cancer.

David Hewett
David Hewett
9 months ago
Reply to  Anna Lloyd

I am afraid you are woefully uninformed. You have “yet to find any convincing evidence of guilt”. How arrogant. Did you sit through ten months of evidence? Have you read the transcripts? Of course not, but don’t let that stop your speculation and your willingness to set aside the verdict of those 12 people who did. As to your view that all hospitals should be small, just how do you think you can provide all the linked medical specialties we take for granted in a small unit? The answer is that you can’t. If you want tiny hospitals, don’t expect to have any complex care, cardiac surgery, neurosurgery, etc.

Andrew D
Andrew D
9 months ago
Reply to  Anna Lloyd

Agree with all your points up to btw. Small is beautiful.

Anna Bramwell
Anna Bramwell
9 months ago
Reply to  Anna Lloyd

All? Come on. LL present at all deaths? Night time care, babies die. Daytime care, babies die during the day. She leaves and 1 baby dies in five years. Actually it js incredibly convincing. Like the link with smoking and lung cancer.

David Hewett
David Hewett
9 months ago
Reply to  Anna Lloyd

I am afraid you are woefully uninformed. You have “yet to find any convincing evidence of guilt”. How arrogant. Did you sit through ten months of evidence? Have you read the transcripts? Of course not, but don’t let that stop your speculation and your willingness to set aside the verdict of those 12 people who did. As to your view that all hospitals should be small, just how do you think you can provide all the linked medical specialties we take for granted in a small unit? The answer is that you can’t. If you want tiny hospitals, don’t expect to have any complex care, cardiac surgery, neurosurgery, etc.

Andrew D
Andrew D
9 months ago
Reply to  Anna Lloyd

Agree with all your points up to btw. Small is beautiful.

Anna Lloyd
Anna Lloyd
9 months ago

Hospitals are too big. I hate them. They’re impossible to manage being the size they are. I worked as PA to a medical director in one. Awful job. We should just have smaller hospitals and more of them, nestled amongst the community, like in the old days. The north east is a brilliant example of this, lots of small hospitals and two excellent larger hospitals (very clean). Oxfordshire is a total disaster, the trust is massive and the John Radcliffe I would avoid at all costs because it’s far too big – and you can’t even park your car! Also it’s understaffed due to Oxford being too expensive for normal people to live, eg nurses. Btw, I’ve yet to find any convincing evidence of Lucy Letby’s guilt. Can anyone provide? I’ve looked everywhere but all I find is this staff rota and a weird note in her house.

Paul T
Paul T
9 months ago

Well this is the deified NHS we have now. This is the NHS that “allowed” (a claim often and confusingly levelled at the government) hundreds of thousands of people to die during COVID. I mean if they get the credit for all the lives saved then they must take responsibility for all the lives lost.

Paul T
Paul T
9 months ago

Well this is the deified NHS we have now. This is the NHS that “allowed” (a claim often and confusingly levelled at the government) hundreds of thousands of people to die during COVID. I mean if they get the credit for all the lives saved then they must take responsibility for all the lives lost.

Denis Stone
Denis Stone
9 months ago

On top of all this, when most of us are doing our best to become colour-blind (if not naturally so), we have the RCN President, Sheila Sobrany, trying to turn this into a racial issue. See e.g. the nursingnotes web site. Who’s the racist here? Anyone else feel angry about this?

elaine chambers
elaine chambers
9 months ago
Reply to  Denis Stone

Utterly insane tryng to turn this case into race issue!

elaine chambers
elaine chambers
9 months ago
Reply to  Denis Stone

Utterly insane tryng to turn this case into race issue!

Denis Stone
Denis Stone
9 months ago

On top of all this, when most of us are doing our best to become colour-blind (if not naturally so), we have the RCN President, Sheila Sobrany, trying to turn this into a racial issue. See e.g. the nursingnotes web site. Who’s the racist here? Anyone else feel angry about this?

Malcolm Knott
Malcolm Knott
9 months ago

My theory is that many people in higher management have secured their positions because they talk well; they know what they are supposed to say and they are articulate and persuasive. This narrow skill is easily taken to equate with all-round ability and competence which it most certainly does not.
I suspect, too, that when recruiting higher management people often ask the wrong question viz. ‘What positions has s/he held?’ rather than ‘Are the people this person now works for desperate not to lose him/her and if not, why not?’
A modest proposal: All employers’ references should be strictly private and confidential, in perpetuity, and immune from any form of legal redress. In other words employers and managers should be completely free to speak their mind and tell the unvarnished truth about their employees and subordinates.

D Glover
D Glover
9 months ago
Reply to  Malcolm Knott

A modest objection; wouldn’t the dissatisfied employer give a good confidential report so as to see the back of the useless blighter?

Malcolm Knott
Malcolm Knott
9 months ago
Reply to  D Glover

A good point. I am sure it happens now. Worse are those stitch-up deals when an employee negotiates a decent reference in exchange for a non-disclosure agreement.

Terry Davies
Terry Davies
9 months ago
Reply to  D Glover

That’s certainly happened…..

Malcolm Knott
Malcolm Knott
9 months ago