Abandoning apprenticeship training for nurses has made safeguarding harder
Last Friday, Lucy Letby was found guilty of murdering seven babies and attempting to kill six more while working as a paediatric nurse in a hospital in north-west England. The sheer level of malice it takes for someone to commit such atrocities hardly bears thinking about — but Letby is not, unfortunately, the first British nursing serial killer.
The first was Beverly Allitt, who murdered four babies in 1991, but then came Colin Norris, who was convicted of the murders of four hospital patients in 2002, then Benjamin Geen, who was convicted of the murders of two patients in 2003-2004. Finally, there was Victorino Chua, who was convicted of the murders of two patients in 2011.
Why have there been so many nursing killers in the UK in recent decades? One generic reason is that people who commit serious crimes, such as murder or rape, often do so through various institutions that can provide access and a cloak of respectability. This is something that nursing can provide, in the same way as medicine, church work and policing. No one automatically suspects that public servants such as nurses or police officers will have entered into these professions in order to do harm, but this is precisely why the likes of Lucy Letby and Wayne Couzens are attracted to them in the first place — to acquire positions of power and authority over vulnerable people.
Because of this risk, it is of vital importance that professions such as these have systems in place to identify dangerous individuals as soon as possible — ideally before they are even qualified to enter into the profession. The Beverly Allitt case, which attracted huge public attention at the time, did play a role in changing the way that nurses are regulated in this country, but not in the way that nurses were educated. This, I’m afraid, is the second reason that the nursing profession has become vulnerable to people like Letby.
Since 1990, nursing has aimed to professionalise itself by placing its training on a more academic footing in higher educational institutions, as opposed to the older apprenticeship model of nurse training, in which student nurses were paid employees of the healthcare institutions in which they were embedded.
The virtues of the older apprenticeship model of nursing, in which student nurses were trained in hospital-based schools, meant that they acquired their knowledge and skills primarily via experiential learning in clinical settings. This meant that nurses could be more rooted, localised and stable; it was not uncommon for nurses who trained in their local hospital to then stay there for the rest of their lives.
This, no doubt, bred a greater degree of insularity in the profession, but it also created a workforce with a greater web of social ties — and these thick social ties helped to act as a safeguard, revealing the likes of Letby much earlier.
People with psychopathic tendencies who wish to do harm to others tend to thrive in environments which are more atomised and deracinated. The questions that the nursing profession must now ask itself, in the wake of the Lucy Letby case, is whether the profession has become analogous to a big urban metropolis, with its weaker social ties and greater levels of anonymity — and, if so, what can be done to rediscover some of the older virtues that we left behind. Would Letby have been identified if she had been trained via apprenticeship? It behoves the nursing profession to ask the question.
Peter Hurst is a mental health nurse based in England.