Lucy Letby was an NHS monster

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?

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?

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

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 £1.5 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.

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.

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.

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.

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”.

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.

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.

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?

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.

The regulation of managers overdue and concur with, and also that some are not v good. However the Author has yet to do any real management so let’s see how she gets on if/when she does. It ain’t quite so easy. Her notion that nurses close ranks and doctors less so is nonsense and shows the limits to date of Author experience.
Let’s remember the two key people advising the CEO were the Medical and Nursing Directors – both v senior clinicians. Now it may well be that they’d gone ‘native’ and saw a false narrative too easily – ‘poor nurse being bullied who at face value seemed delightful’ etc. CEO has much to answer for too, but I’m sure he’ll flag in the Inquiry that he was being advised by senior clinicians. And clearly the submission of standard data by the Trust’s Information team woeful.
There is definitely though something in the ‘reflex’ to protect reputations a key factor here. When an organisation is pilloried in public the consequences ripple across all it’s care as recruitment/retention and morale are adversely affected. So it’s sometimes not just personal reputations that creates the ‘reflex’ but a broader view on maintaining services. However this is where Boards, which include NEDs, must strike the balance and not leave it to individual Execs.
The ‘external’ bodies brought into investigate also missed some key clinical markers that the deaths were from deliberate poisoning. Furthermore the Clinical Lead for Neo-Natal has also indicated, I think, he went back and looked at records for 2015 and spotted a clear indication of poisoning – insulin spike with no corresponding peptide rise – ‘barn-door’ indication that something had been injected. Why did they not see that then? Leaves one with impression that the whole lot of them have much to explain and crucial the Inquiry digs into this asap.

As a manager, my job was about trying to set standards and support team members so that,collectively, we delivered what we were supposed to deliver. Failure was, to use a sporting term, losing the dressing room. What intrigues me is the job of a hospital boss. It strikes me that you need a pretty special character to earn the respect and cooperation of several professional tribes in a complex organisation which is always trying to find ways to meet unpredictable workloads. Where does the NHS find such people? My wild guess is that the job itself is on the border between just about doable and more or less impossible. In which case the issue is about structure and process as well as people. Am I way off the mark?
I have just looked at the job description, which leads me to think I might be close.

Not everybody agrees. Have you seen this piece and the links to the evidence to support the claim that the trial was a miscarriage of justice
The Lucy Letby trial and verdict: not everybody is convinced that justice was done (normanfenton.com)

Sowing the seeds of doubt. Something I’ve come to respect from my membership of Unherd since 2020 and the questions that we began to ask in response to events then. Please do visit this Science on Trial Site. You may, like me, have a number of questions about the validity of LL’s conviction on the basis of circumstantial evidence, once you’ve had chance to read. It’s comprehensive and informed.
https://rexvlucyletby2023.com/

Think about some of the other major medical scandals: Dr Chris Day and Dr Bawa Gaba. Both of them faced organisational dysfunction.

When a baby died under Bawa Gaba she was quickly thrown under the bus without there ever being any accountability over why the IT systems had failed, no induction was provided, and far fewer than safe staffing numbers were rota’d. She can face manslaughter charges before a manager gets a slap on the wrist.

When Chris Day was instructed to do the ludicrous task of simultaneously covering ICU and medical admissions, he blew the whistle for the recipe for disaster that it was. Instead of funding more doctors to cover gaps, they spent £100k’s silencing him and covering up their risky decisions.

With zero accountability, managers are free to rotate around Trusts, do nothing, and pass all responsibility onto doctors and nurses

Media have lost any ability to think critically over the Letby case. From June 2015 to mid 2017 nobody had any evidence to support a single crime had even been committed. All they had was an unexplained increase in the number of deaths and collapses after the unit had increased the number of highly vulnerable babies it was treating at the same time as having a staff shortage!

I do hope Ms Letby spends the rest of her natural life in Prison*, but I very much fear she won’t.
When one Harry Roberts was convicted of murdering three Metropolitan Policemen in 1966, he received a mandatory Life sentence and it was said that he would ‘spend the rest of his life in Prison’. In fact the mandatory Life sentence** actually meant a mere 30 years.
In the event he ultimately spent 46 years in Prison but was eventually released at the tender age of 78. He still lives incidentally.
No doubt in 46 years, but probably much sooner, Ms Letby will be released back into the community.

(*At enormous Public expense.)
(**One of irritating little legal deceits that so bedevils the Law).

Having worked in the NHS i can vouch for the toxic cultures of patronage/buggins turn and leveraging by those who know where the bodies lie (literally). I have seen the same in large European banks, US EPC co’s and a few other places. So i think the thrust of the article is sound, but there are many other issues highlighted by this case: 1. There is no actual proof of guilt, just very strong assocation and probablility, which informs about UK’s “judicial” system. 2. The infighting since the case has protagonists with titles like “celebrity Doctor” or “TV pathologist”. This seems highly inappropriate. The things that make someone a celebrity may be genuine, – James Hetfield, Venus Williams etc, or not so much – Katy Price, the Kardashians. All ply their various trades with skill. I do not want health professionals trying to serve the vicissitudes of celebrity whilst trying to keep the day job going – same for CEOs and CFOs, lawyers, cancer researchers, bus drivers etc etc.

Why does this article not mention the role of the medical director in the trust. He was one of the senior executives referred to and all three were from clinical backgrounds. It’s inaccurate to convey the impression that senior executives are men and women in grey suits when in this case they worse uniforms and scrubs earlier in their careers. Perhaps failure to mention the medical director is because it confuses the author’s critique of ‘management’. We need a fact based and considered debate to act on the tragic lessons of Chester

Bollocks.
Letby was a privatised culture monster.
In the past, before the stealth-privatisation started, there’d have been no such useless and overpaid managers getting in the way.
Managerialism is a pernicious cult imported directly from the private sector.
I’m old enough to remember NHS hospitals when they were well ran, by medical professionals (Matrons and Drs).
The current mania for hiring more and more useless managers is one which has been lifted directly from the private sector, as part of the death by 1,000 cuts stealth-privatisation process to which the NHS has been subjected to for years.

Sorry, folks, there are so many holes in the ‘scientific’ evidence presented, which largely rely on coincidence, conjecture and misunderstanding of statistics, that this is a massively unsafe conviction.
When you factor in the clear lack of motive, the immaculate character references from pretty much everyone who ever met her, and the fact that nobody ‘suspected’ a thing until she acted as internal whistleblower against a mistake-prone consultant in the neo-natal unit, this is a verdict which should deeply trouble anyone who has nothing to gain personally from Letby being put away. She’s a martyr, not a mass murderer.

For an insight of how whistleblowers are treated in the NHS, especially if they won’t recant as the doctors forced to ‘apologise’ to Letby did, read Dr Peter Duffy’s two books: Whistle in the Wind and Smoke and Mirrors. Horrific stuff!

I listen to true crime podcasts and thought there was little that could disturb me until I read about this woman’s case. A young, and attractive, woman…with a successful career…friends…family. A serial killer of infants?
unconceivable. But to the article’s point…I would think the suspicious death of one infant would have alerted the administration. Two suspicious deaths would have required police.
The horror of bureaucracies. Absolutely the managers of the hospital should be considered accountable as well.

To my mind she was not, infact is not evil, she remains merely a human being doing what humans are capable of doing. Talk of evil invokes Devil’s, God’s and other mythical entities, none of which enriches our understanding of humanity. Rather such a lable acts as a distraction that removes our focus, focus that would otherwise allow us to see that she is of us of our society. We may not like it but we had better take note if we do not want a repetition.

The Messenger review of NHS leadership was a hopelessly limp affair. I expected much more from a Royal Marine. A missed opportunity and potentially a very costly one.

Managerial blob midwittery.

We become ever more akin to a communist state in terms of how the state behaves under any kind of criticism or investigation. Self-preservation has become paramount and the article describes so well how more and more layers of mismananagement are created in order to diffuse and obfuscate. In such a system it is essential to be able to push the blame both down and away. To a large extent this is simply human nature, but human nature requires a ‘suitable’ environment in order to flourish and this is where the state excels. Comments below suggest there might be a parallel in the private sector (and there may be examples), but the private sector remains more accountable by virtue of it’s need to remain viable in terms of it’s service proposition. The NHS offers below average outcomes across the board, yet remains a sacred cow. A survey last year identified that the NHS does ‘ok’ in most respects in comparison with other nations health systems, with one notable exception. That of keeping patients alive, where it was worse than others. You’d have thought that might have raised questions, but such as the Guardian didn’t find it worth reporting; the NHS and the Guardian being joined at the hip of course. There can be no material change to our present woes without a form of revolution in the NHS, we’ve already tried evolution and it just gets worse and worse. A cull of middle management and a robust performance assessment of senior managers might be a good place to start, but that might be only a start as the problem has become institutionalised within the NHS, much like a communist state.

A couple of comments:

It is not just the public sector that has a problem with over-mighty management divorced from the real work of the organisation, or from responsibility. The private sector has it too, in big organisations.

It is not just reputation management. When you get a complaint like this the data are uncertain, the likelihood of something that bad is low, and it would be so much nicer for everybody if the problem turned out not to exist. On top of that, people could get the bit between their teeth based on coincidences, and management has a duty of care not only to the patients and the whistle blowers, but also to those who are accused, possibly unjustly. Once the accusation is in the open morale and workplace harmony is ruined one way or the other. And as someone pointed out, the more blame is being portioned out, the more people will close ranks and protect each other.

We do need better procedures here, and probably some stautory responsibility for mangement, but it is not an easy one to set up.

“ignorance is no defence in law”
Ignorance of the law is no defence. Ignorance of facts is an ecellent one.

The managers and administrators were incompetent in bringing her to account, but her nurse colleagues were in denial about her behaviour too. It required suspicious (male) doctors to bring her down.

Problems like this are inherent to all large organizations public or private. There are certain errors that are inherent and inescapable when humans act collectively, and these errors increase in scale as an organization gets larger. Institutional corruption, managerial inertia, internal political conflicts, administrative inefficiency, all get worse the more people there are in an organization. My rule of thumb is that if it’s ‘too big to fail’ it probably shouldn’t exist at all. Break it down into smaller, autonomous pieces that don’t answer to each other, possibly even allowing them to compete for customers. Create regional/local divisions and maybe allow people from one division to seek care in another for a certain extra fee, and you’ll get the benefits of competition. It is competition that drives the efficiency and quality we associate with capitalism. Also, this creates some redundancy as the problems with one unit don’t necessarily spread to another.

About 15 years ago I was told by a senior nurse that one of her managers was an ex double glazing salesman. What do you think he knew about medical care that was more substantial than the nurse? The real problem, not just in the NHS, but in the Post Office scandal, the Grenfell murders, the contaminated blood scandal, the PPE scandal is a culture of impunity for incompetent and ignorant management: https://www.theguardian.com/uk-news/2022/dec/09/revealed-the-full-inside-story-of-the-michelle-mone-ppe-scandal and dozens of others, inluding what is happening on Teesside under Houchen: https://www.yorkshirepost.co.uk/news/politics/teesside-freeport-calls-for-investigation-into-major-redevelopment-after-corruption-allegations-4145370
Corruption in any society is not new. But 40 years of privatisation has made Britain one of the most corrupt counties on earh. If I want to put £50 cash into my bank account I have to pu my debitcard in a reader to PROVE who I am. If I want to pay £50 in CASH into my ex-wifes account that is now illegal. Apparently this is to “prevent money laundering.” In the last financial year £86 BILLION came into the City of London from obviously criminal sources,a complete blind eye is the govt responsea.

All human organizations evolve to put their own needs ahead of their nominal purpose. How long this takes appears to be a function of how many times staff have been replaced, as managerial hiring processes favor apparatchiks.
Throughout the West, ministries set up during or in the years immediately after the second world war are now thoroughly selfish. The solution is to accept this as inevitable and institute a programme of regular ‘forest fires’, in which a ministry’s managers are laid off en masse and replaced with a new organization having a similar brief, but all new managers. Front line workers would be eligible to apply for jobs at the new org.

Hear, hear! I would add that there must be a case against that board for criminal negligence or corporate manslaughter, or both. They also, wilfully or ineptly, perverted the course of justice. But the incompetence or indifference displayed in this case is not unique to the NHS. The uncontrolled growth of the “managerial class” and their influence, is crippling this country. An illusion is fostered by MBA course providers that their degree gives one the ability to manage anything without having to understand how the operation works. We have seen it in the rail industry and elsewhere. I have personally witnessed it in the airline industry where pilots and cabin crew, like the consultants in this case, are viewed with contempt by incompetent managers on twice the salary. I hark back to the time when I was a medical student and there was no hospital manager. There was a hospital secretary. The hospital was run by the consultants and the matron, who lunched together every day in a private dining room with a linen table cloth and a waitress. Imagine!

Great thinkers have proposed that part of the underlying and unspoken reason for the rise of managerialism is the diffusion of responsibility. I work in the healthcare system in Canada. We are even more management-heavy here. Trying to find who is responsible for fixing a given problem is like trying to punch a cloud. The buck stops nowhere. And it is even worse when trying to assign blame for errors. Whose head should roll? Who should have seen it coming? When everyone is responsible, no one is responsible.

The people who created The Industrial Revolution often came from often a poor background, G Stephenson, James Brindley, Thomas Telford. What needs to be assessed is whether one is creating something new or climbing an existing organisation. Also is failure easy to spot. When one was a captain of sailing ship, miner, pilot in WW2, etc if one was not good enough, one was killed.
What has taken place since 1939 is the creation of a vast numbers of white collar middle class administrators where assessment of competence is subjective: basically it comes down to whether one’s face fits.
In 1948 a matron could employ and sack cooks, cleaners, laundary staff and had a clerk to answer to her to he for maintaining supplies. By 1970s the clerk had multiplied to managers plus under managers abd even more clerks and matron answered to them. What undermined Matron’s power were the shop stewards.
Administrators fear those who have leadership. In 1948 Matron had probably an officer in WW1 and or WW2 and seen combat. I grew up in a village where the District Nurse had been a senior sister at London teaching hospital and had the North Africa Star, having served at El Alamein, Benghazi and Tobruk. She said she had thrown herself across stretcher cases as shells landed around them.
The shop stewards, mainly men who were in unskilled and semi skilled unions resented taking orders he nurses who had served in combat as officers and were often the daughters and wives of officers. The shop stewards had an inferiority complex when dealing with the likes of Emily McManus
Emily MacManus – Wikipedia
How many nurses are of the calibre of Emily MacManus?
Sisters In Arms: British Army Nurses Tell Their Story: Amazon.co.uk: Tyrer, Nicola: 9780753825679: Books
Most hospital managers lack the academic qualifications of consultants and once again we see an inferiority complex. The NHS was effective in 1940s and 1940s because senior doctors and nurses came from bckgrounds where leadership, duty and responsibility had been drilled into them from a young age and they had seen combat or served in hospitals during the Blitz.
The second rate promote the third rate. C Northcote Parkinson saw this in the late 1950s and wrote his book ” Parkinsons Law ”
C. Northcote Parkinson – Wikipedia
The administrator who rose in WW2 and then became a success afterwards was typified by Kenneth Widmerpool
Kenneth Widmerpool – Wikipedia
Robert Michels said all organistions become a bureaucratic oligarchy where they are run for the benfit of those who control them.

All the above is true, but to put things in perspective, private healthcare in the UK is outdoing the NHS in poor performance right now

One of many attempts by the far right to blame the NHS as a whole for Letby’s crimes.
Nonsense of course.

So Steve Barclay, what are you and the rest of this pathetic Government going to do about it? You have the power, use it.