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”.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeI 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
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.
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.
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.
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.
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.
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.
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” 🙂
It was the grammar school generation, meritocratic, enabling working class students to do well from their brains. I find calling it Boomer unhelpful.
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.
I think boomer just means a very high birthrate for the period.
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.
I think boomer just means a very high birthrate for the period.
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.
These days if you have the right pronouns you will survive. What a mess.
The boomers were born between 1945 — when the war ended — and 1965. There were no “boomers” born in the mid 1930s.
It was the grammar school generation, meritocratic, enabling working class students to do well from their brains. I find calling it Boomer unhelpful.
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.
These days if you have the right pronouns you will survive. What a mess.
The boomers were born between 1945 — when the war ended — and 1965. There were no “boomers” born in the mid 1930s.
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.
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” 🙂
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.
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.
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.
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.
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.
That’s it. Nail on the head. My experience too.
“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.
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.
That’s it. Nail on the head. My experience too.
“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.
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.
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
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?
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.
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?
Unusual for a woman though, the gentler sex. Will we ever know?
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
Unusual for a woman though, the gentler sex. Will we ever know?
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
Is that normal? To me it makes light of murder.
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?
Is that normal? To me it makes light of murder.
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.
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.
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.
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.
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.
This is like talking to a chicken. I give up.
Or excuse it. Once we do that we are on a slippery slope downwards.
This is like talking to a chicken. I give up.
Or excuse it. Once we do that we are on a slippery slope downwards.
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.
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.
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.
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.
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.
She probably does not know herself
Although it is a fact that the large majority of baby killers are women
Post-birth as well as pre?
Oh pre-birth we have reached well over 9 million in this country, but that is just normal for our lawmakers.
Oh pre-birth we have reached well over 9 million in this country, but that is just normal for our lawmakers.
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!
I take your word for it. I don’t know much about it but it merits some study.
I take your word for it. I don’t know much about it but it merits some study.
Have there been others?
Post-birth as well as pre?
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!
Have there been others?
Oh I killed them because I had a bad upbringing. I would wager that my upbringing was far worse than hers.
No it’s quite normal. They just have a propensity to do that.
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.
She probably does not know herself
Although it is a fact that the large majority of baby killers are women
Oh I killed them because I had a bad upbringing. I would wager that my upbringing was far worse than hers.
No it’s quite normal. They just have a propensity to do that.
Psychopaths don’t always have a clear motive. Their brain structure is increasingly appreciated as distinctly and observably different.
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.”
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.
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.”
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.
I suspect if you asked her, she wouldn’t be able to tell you why she did it.
At the moment there is no evidence to suggest that she accepts that she did do it.
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.
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.
At the moment there is no evidence to suggest that she accepts that she did do it.
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.
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 admiration a delusional 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).
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 admiration a delusional 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).
https://www.normanfenton.com/post/the-lucy-letby-trial-and-verdict-not-everybody-is-convinced-that-justice-was-done Worth a read.
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.
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.
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,
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
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
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,
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.
Interesting link.
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.
& thank you for this link.
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
& thank you for this link.
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
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.
Interesting link.
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.
..
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.
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.
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.
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.
Psychopaths don’t always have a clear motive. Their brain structure is increasingly appreciated as distinctly and observably different.
I suspect if you asked her, she wouldn’t be able to tell you why she did it.
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.
https://www.normanfenton.com/post/the-lucy-letby-trial-and-verdict-not-everybody-is-convinced-that-justice-was-done Worth a read.
..
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.
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.
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?
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?
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.
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.
How many of the managers involved were clinicians in managerial posts? It makes a difference to the debate.
I understand that both of the key positions were held by clinicians.
I understand that both of the key positions were held by clinicians.
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.
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.
How many of the managers involved were clinicians in managerial posts? It makes a difference to the debate.
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?
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.
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.
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?
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”.
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.
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.
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.
Fewer managers to spread the blame around would be a start. A bloated bureaucracy is never a sign of competence
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.
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?
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”.
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.
Fewer managers to spread the blame around would be a start. A bloated bureaucracy is never a sign of competence
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.
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.
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.
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.
Monolithic systems always fail. Not sometimes. Not usually. Always.
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 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.
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.
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.
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.
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”
I wonder if that writer get in as much trouble as Jeremy Clarkson did for that article about Meghan Markle.
I wonder if that writer get in as much trouble as Jeremy Clarkson did for that article about Meghan Markle.
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.
The outsourced report writer apparently failed to look at the individual case notes. Are you supporting this?
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.
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.
The outsourced report writer apparently failed to look at the individual case notes. Are you supporting this?
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”
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.
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.
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.
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.
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.
More important, why didnt autopsies pick up eg the insulin poisoning, the pattern of abnormal deaths.
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.
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.
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.
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.
More important, why didnt autopsies pick up eg the insulin poisoning, the pattern of abnormal deaths.
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.
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.
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.
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.
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.
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.
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?
What you describe exists in finance.
It is cumbersome, but it somewhat works.
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?
What you describe exists in finance.
It is cumbersome, but it somewhat works.
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.
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.
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‘.
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.
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.
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.
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.
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.
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.
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‘.
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”.
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.
Edited.
Edited.
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.
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.
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.
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.
Agree with all your points up to btw. Small is beautiful.
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.
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.
Agree with all your points up to btw. Small is beautiful.
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.
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?
Utterly insane tryng to turn this case into race issue!
Utterly insane tryng to turn this case into race issue!
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.
A modest objection; wouldn’t the dissatisfied employer give a good confidential report so as to see the back of the useless blighter?
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.
That’s certainly happened…..
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.
That’s certainly happened…..
The recruitment and promotion systems in the public sector rely almost exclusively on the false God of ‘competences’ rather than previous experience and assessment.
Competences are a spoofers charter and those who who work on such skills invariably succeed and won’t be found out when in post.
A modest objection; wouldn’t the dissatisfied employer give a good confidential report so as to see the back of the useless blighter?
The recruitment and promotion systems in the public sector rely almost exclusively on the false God of ‘competences’ rather than previous experience and assessment.
Competences are a spoofers charter and those who who work on such skills invariably succeed and won’t be found out when in post.
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.
The senior clinicians would be active practitioners of medicine. Managers are not senior clinicians, except in private hospitals.
The senior clinicians would be active practitioners of medicine. Managers are not senior clinicians, except in private hospitals.
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.
There are obviously management/administrative roles at different levels within a Hospital or Health care provider. In many the roles filled by Nurses or other Health professionals who’ve moved from direct nursing more into management. That happens less with Doctors, who tend to only get into management as Clinical or Medical Directors. Some managers have come up through an entirely management career structure. Point being it’s quite mixed which is usually quite helpful.
The unique dynamic is having professionals at the coal-face such as doctors who control the vast majority of decisions that are made every day with quite specific forms of contract you won’t find typically anywhere else. Hospitals are far from command/control environments. Learning to navigate this dynamic is often what those arriving from other industries find most difficult. Been plenty of TV documentaries showing this over last 40 years since ‘General management’ was first introduced to the NHS, by, guess who, Thatcher.
Having moved from the military to health services the culture could not have been more different. In many regards much preferable in the Hospital (NHS) setting, but some things certainly always frustrated and would not have been acceptable in the military.
Some of the individuals I saw navigate senior roles in healthcare were exceptional, some weren’t. Doubt much different to any industry. But for me too much jumping around after short periods of tenure and perhaps too much career progression linked to the wrong forms of performance indicator – albeit bear in mind politicians generally decide what the indicators are with one eye clearly on what they perceive needed for the electorate.
There are obviously management/administrative roles at different levels within a Hospital or Health care provider. In many the roles filled by Nurses or other Health professionals who’ve moved from direct nursing more into management. That happens less with Doctors, who tend to only get into management as Clinical or Medical Directors. Some managers have come up through an entirely management career structure. Point being it’s quite mixed which is usually quite helpful.
The unique dynamic is having professionals at the coal-face such as doctors who control the vast majority of decisions that are made every day with quite specific forms of contract you won’t find typically anywhere else. Hospitals are far from command/control environments. Learning to navigate this dynamic is often what those arriving from other industries find most difficult. Been plenty of TV documentaries showing this over last 40 years since ‘General management’ was first introduced to the NHS, by, guess who, Thatcher.
Having moved from the military to health services the culture could not have been more different. In many regards much preferable in the Hospital (NHS) setting, but some things certainly always frustrated and would not have been acceptable in the military.
Some of the individuals I saw navigate senior roles in healthcare were exceptional, some weren’t. Doubt much different to any industry. But for me too much jumping around after short periods of tenure and perhaps too much career progression linked to the wrong forms of performance indicator – albeit bear in mind politicians generally decide what the indicators are with one eye clearly on what they perceive needed for the electorate.
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)
In view of the recent spate of miscarriages of justice I do hope that what you infer is wrong.
However I do think the Crown Prosecution Service needs a thorough overhaul. Some of its actions appear very dubious indeed.
In view of the recent spate of miscarriages of justice I do hope that what you infer is wrong.
However I do think the Crown Prosecution Service needs a thorough overhaul. Some of its actions appear very dubious indeed.
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/
It’s a good site – sober and informed and I must admit to a certain unease about this whole sorry affair. It should worry us how much certainty about the verdict is on show given the uncertainties in the case.
Interesting, and a lot of evidence. It would take an (attempted) rebuttal from the other side before a layman like myself could evaluate whether this was conclusive or not, though.
The main overall arguments would seem to be that 1) premature babies are so unusual and so sick that it is just about impossible to know what is going on. 2) There was not enough evidence for conclusive proof. Unfortunately, taken to extremes this would mean that it would never be possible to convict anyone for killing premature babies, since there would never be enough high quality evidence, retrospectively, to give conclusive proof.
Thanks for a useful link. I’d still trust the courts as a default attitude, but at a minimum this sows some salutary doubt, and reminds us why it is not at all obvious when or whether you should launch an all-out murder inquiry in such a case.
It’s a good site – sober and informed and I must admit to a certain unease about this whole sorry affair. It should worry us how much certainty about the verdict is on show given the uncertainties in the case.
Interesting, and a lot of evidence. It would take an (attempted) rebuttal from the other side before a layman like myself could evaluate whether this was conclusive or not, though.
The main overall arguments would seem to be that 1) premature babies are so unusual and so sick that it is just about impossible to know what is going on. 2) There was not enough evidence for conclusive proof. Unfortunately, taken to extremes this would mean that it would never be possible to convict anyone for killing premature babies, since there would never be enough high quality evidence, retrospectively, to give conclusive proof.
Thanks for a useful link. I’d still trust the courts as a default attitude, but at a minimum this sows some salutary doubt, and reminds us why it is not at all obvious when or whether you should launch an all-out murder inquiry in such a case.
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
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!
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 have never worked in the NHS so it is interesting to see an insider support my suspicion that there is “something rotten at the heart of the NHS”. Without going into details, I witnessed two family members whose welfare clearly took second place to the avoidance of blame. it is true that some of the most admirable human beings I have ever met worked for the NHS but also some who behaved contemptibly. As an organisation the NHS still does far more good than harm, but the writer is correct to highlight the repeated scandals. Our health stats are worse than in other European countries for a reason.
It is the overall managerial culture rather than individuals that I suspect should be the focus of inquiry. My guess is that the combined effect of trying to avoid being sued, the normal dynamics of a bureaucratic promotion system and an industrial strength blame culture have led to a system that almost always prioritises suppressing bad news over solving problems.
The difficulty is that sacking a few token managers will only exacerbate this dysfunctional blame avoidance culture and will be a poor substitute for trying to reform it. I am not sure there is a solution. Trying to reform the culture an organisation with over a million employees is an almost impossible challenge. The comparison with Airline safety culture is often made but I see no sign that the NHS has made any progress in that direction or ever will.
I have never worked in the NHS so it is interesting to see an insider support my suspicion that there is “something rotten at the heart of the NHS”. Without going into details, I witnessed two family members whose welfare clearly took second place to the avoidance of blame. it is true that some of the most admirable human beings I have ever met worked for the NHS but also some who behaved contemptibly. As an organisation the NHS still does far more good than harm, but the writer is correct to highlight the repeated scandals. Our health stats are worse than in other European countries for a reason.
It is the overall managerial culture rather than individuals that I suspect should be the focus of inquiry. My guess is that the combined effect of trying to avoid being sued, the normal dynamics of a bureaucratic promotion system and an industrial strength blame culture have led to a system that almost always prioritises suppressing bad news over solving problems.
The difficulty is that sacking a few token managers will only exacerbate this dysfunctional blame avoidance culture and will be a poor substitute for trying to reform it. I am not sure there is a solution. Trying to reform the culture an organisation with over a million employees is an almost impossible challenge. The comparison with Airline safety culture is often made but I see no sign that the NHS has made any progress in that direction or ever will.
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).
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.
Realistically, there is *never* actual proof of guilt in a judicial system. Proof is for mathematics. Even science works off probabilities – the threshold for a publishable result is 95% confidence in the effect being true, which would mean that one in twenty times you were wrong (at best!). The best you can do, even in principle, is to get all available evidence presented, and to set a threshold for conviction that minimises the proportion of wrong convictions while not letting too many guilty off, but it is a trade-off.
It is most easily seen for rape cases. Human sexual behaviour can be extraordinarily weird. Without third-party witnesses it is just about impossible to actually *prove* that the victim did not consent in the heat of the moment. The best you can do is to say that the story of the accused is so implausible that you will find him guilty on probabilities, and accept both the innocent that get convicted and the guilty that go free in this approach.
Would you still say that if there were video evidence of a nurse administering an overdose and corresepondign tissue sample showing the drug in question? or a person smashing someones skull with a hammer? Sure when its “witness” versus “witness” its what Von Neumann called game theory or prisoners dilemma, which doesn’t apply for example when someones DNA is found allover your car bumper! ( as opposed to say a bumper removed from your car found in another location ) Some rational and empirical evidence can be incntravertable – though its rare and often dependent on language – eg the sun only rises in the east because we use that word east instead of say west to describe a particular point of the compass. Critical theory and post-structural epistemics do, IMO have some value, but there also has to be an acceptance that in some cases evidence can be objectively true, evn if only within the current paradigm. If we fail to accept that we decend back to hind brain only.
I’d say we mostly agree – or at least we do not disagree where you think we do. Truth exists, and is absolute, but how do we know it? In mathematics proof is absolute, but in anything else, we are in principle reduced to probabilities. If the test says that mister X’s DNA was all over my car bumper, that is a fact – but it does not *prove* that I was the one who drove over him. Was it Mr X, or his identical twin who left the DNA, or an extremely unlikely third person with the same DNA signature? Was there a lab error, or did the police spike the sample, or did X spit all over my car bumper the day before, or did the real culprit wipe Mr X body on my car? Or did the testing lab falsify the result? You cannot *prove* that it was none of these things, they are just extremely unlikely. For practial purposes you might well take this as proof. After all, Newton’s law is not proved either, byt this criterion – it is just so extremely probable that we do not need to consider the alternative.
So it is not that we disagree about the nature of truth, of reality. But I think you are wrong in saying things like “There is no actual proof of guilt, just very strong assocation and probablility, which informs about UK’s “judicial” system.” Judicial systems always work by probability so tha tis normal. The question is whether they set their cutoffs high enough to avoid too many wrong results.
I know we probably share more opinions than differences but i imagine a front bumper covered in blood, hair etc which was obervably attached to the car due to the presence of manufacturers sealant, fixings and paint since it left the factory!
i repair and restore cars for fun – its pretty easy to tell when an item has been removed or is still as it left the factory since about the mid 80s – before that less so esp with high end hand built vehicles
i repair and restore cars for fun – its pretty easy to tell when an item has been removed or is still as it left the factory since about the mid 80s – before that less so esp with high end hand built vehicles
I know we probably share more opinions than differences but i imagine a front bumper covered in blood, hair etc which was obervably attached to the car due to the presence of manufacturers sealant, fixings and paint since it left the factory!
I’d say we mostly agree – or at least we do not disagree where you think we do. Truth exists, and is absolute, but how do we know it? In mathematics proof is absolute, but in anything else, we are in principle reduced to probabilities. If the test says that mister X’s DNA was all over my car bumper, that is a fact – but it does not *prove* that I was the one who drove over him. Was it Mr X, or his identical twin who left the DNA, or an extremely unlikely third person with the same DNA signature? Was there a lab error, or did the police spike the sample, or did X spit all over my car bumper the day before, or did the real culprit wipe Mr X body on my car? Or did the testing lab falsify the result? You cannot *prove* that it was none of these things, they are just extremely unlikely. For practial purposes you might well take this as proof. After all, Newton’s law is not proved either, byt this criterion – it is just so extremely probable that we do not need to consider the alternative.
So it is not that we disagree about the nature of truth, of reality. But I think you are wrong in saying things like “There is no actual proof of guilt, just very strong assocation and probablility, which informs about UK’s “judicial” system.” Judicial systems always work by probability so tha tis normal. The question is whether they set their cutoffs high enough to avoid too many wrong results.
Would you still say that if there were video evidence of a nurse administering an overdose and corresepondign tissue sample showing the drug in question? or a person smashing someones skull with a hammer? Sure when its “witness” versus “witness” its what Von Neumann called game theory or prisoners dilemma, which doesn’t apply for example when someones DNA is found allover your car bumper! ( as opposed to say a bumper removed from your car found in another location ) Some rational and empirical evidence can be incntravertable – though its rare and often dependent on language – eg the sun only rises in the east because we use that word east instead of say west to describe a particular point of the compass. Critical theory and post-structural epistemics do, IMO have some value, but there also has to be an acceptance that in some cases evidence can be objectively true, evn if only within the current paradigm. If we fail to accept that we decend back to hind brain only.
Realistically, there is *never* actual proof of guilt in a judicial system. Proof is for mathematics. Even science works off probabilities – the threshold for a publishable result is 95% confidence in the effect being true, which would mean that one in twenty times you were wrong (at best!). The best you can do, even in principle, is to get all available evidence presented, and to set a threshold for conviction that minimises the proportion of wrong convictions while not letting too many guilty off, but it is a trade-off.
It is most easily seen for rape cases. Human sexual behaviour can be extraordinarily weird. Without third-party witnesses it is just about impossible to actually *prove* that the victim did not consent in the heat of the moment. The best you can do is to say that the story of the accused is so implausible that you will find him guilty on probabilities, and accept both the innocent that get convicted and the guilty that go free in this approach.
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
I entirely agree. The Medical Director failed in so many ways. He colluded in the groupthink that came from his fellow Executive Directors and ignored the very strong suspicions that came from this cluster of deaths. I know, that in his shoes I would have investigated this myself in a great deal more detail, and would have resigned before forcing those paediatricians to sign what HR had drafted for them. In my INFORMED view this was a barn door case, it needed urgent investigation and protective action. He totally failed. I cannot describe how let down those of us who have tried genuinely to fulfil the onerous responsibilities which attach to these posts by this individual who has escaped censure by the GMC by relinquishing his licence to practice.
DOI Former District Medical Officer and then Divisional Director and Associate Medical Director. I investigated a high level case 30 years ago leading to conviction after I had called in the police.
I entirely agree. The Medical Director failed in so many ways. He colluded in the groupthink that came from his fellow Executive Directors and ignored the very strong suspicions that came from this cluster of deaths. I know, that in his shoes I would have investigated this myself in a great deal more detail, and would have resigned before forcing those paediatricians to sign what HR had drafted for them. In my INFORMED view this was a barn door case, it needed urgent investigation and protective action. He totally failed. I cannot describe how let down those of us who have tried genuinely to fulfil the onerous responsibilities which attach to these posts by this individual who has escaped censure by the GMC by relinquishing his licence to practice.
DOI Former District Medical Officer and then Divisional Director and Associate Medical Director. I investigated a high level case 30 years ago leading to conviction after I had called in the police.
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.
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.
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!
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.
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.
You cannot understand humanity from the premise that evil does not exist – it does.
Absolutely correct – the use of vacuous labels serves no purpose other than to defeat the possibility of understanding how individuals might behave in this way. Advances in civilisation will not over-ride our innate animalistic natures until we explore these aspects of all our selves. Indeed, i’d say that the use of such labels is a form of denial that we are the way we are.
You cannot understand humanity from the premise that evil does not exist – it does.
Absolutely correct – the use of vacuous labels serves no purpose other than to defeat the possibility of understanding how individuals might behave in this way. Advances in civilisation will not over-ride our innate animalistic natures until we explore these aspects of all our selves. Indeed, i’d say that the use of such labels is a form of denial that we are the way we are.
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.
Really!
Have you already forgotten the terrible conduct of one Captain Christopher Air RM, when captured along with some others by the Iranian National Guard in 2007?
They were all in a RHIB from HMS Cornwall when the incident occurred.
Really!
Have you already forgotten the terrible conduct of one Captain Christopher Air RM, when captured along with some others by the Iranian National Guard in 2007?
They were all in a RHIB from HMS Cornwall when the incident occurred.
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.
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.
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.
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.
“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.
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.
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
Would be useful to have some evidence, please. My own limited experience of private healthcare is that it is vastly superior in both attitude and outcomes.
My area of clinical expertise is mental health. My evidence is anecdotal, but I’m confident that private mental healthcare is outdoing the NHS in poor care and scandals
My area of clinical expertise is mental health. My evidence is anecdotal, but I’m confident that private mental healthcare is outdoing the NHS in poor care and scandals
Would be useful to have some evidence, please. My own limited experience of private healthcare is that it is vastly superior in both attitude and outcomes.
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.
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.
Close the NHS and set up Suisse/Spanish type of compulsory payments and insurance ? How would that work in UK – more than 50% of people get some sort of hand out – and so they’d all qualify for free care!
Not a damned thing……..as usual.
Close the NHS and set up Suisse/Spanish type of compulsory payments and insurance ? How would that work in UK – more than 50% of people get some sort of hand out – and so they’d all qualify for free care!
Not a damned thing……..as usual.
So Steve Barclay, what are you and the rest of this pathetic Government going to do about it? You have the power, use it.