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Lessons to Learn in Health

Nicola Biggerstaff

The worst child serial killer in modern British history was, thanks to the gross failures of upper management, allowed to continue on her killing spree under the guise of our prized healthcare system. Now with the announcement of a public inquiry into management practices at the hospital where she worked, and with questions being asked about how her actions went, not undetected, but unquestioned, by upper management for so long, now is a crucial time to assess the true damage being caused by the managerial culture of our NHS.

Lucy Letby was last month found guilty of the murder of seven babies as well as the attempted murder of six others while she worked as a neonatal nurse at the Countess of Chester Hospital. She has since been sentenced to life in prison with a whole life order, only the fourth woman in Britain to ever be given such an order, meaning she will never be released.

Police have since identified “suspicious” circumstances concerning around 30 more babies that were once in her care at the Countess of Chester, as well as others at the Liverpool Women’s Hospital during her training placements. The investigation, Operation Hummingbird, remains open and ongoing.

Gross failures in both management and administrative practices compounded the tragedy. According to the BBC, not only were multiple concerns raised by clinicians on the ward dismissed with little to no follow up, but they also claim that deaths were not properly reported, causing them to not be picked up by the wider NHS system, and that when Letby was finally reassigned to a role which did not involve direct contact with patients in late 2016, she was placed in the very same department as the internal staff charged with investigating her.

Having been described by psychologists and commentators alike as a textbook narcissist and sociopath, this would have been an ideal opportunity for her to repair her own image, with no outside scrutiny or objectivity, no checks or balances, no true assessment of her actions and behaviour.

Her eventual arrest in 2018 came after concerns were raised by consultants on the unit as far back as October 2015, just four months after the suspicious deaths and collapses on the neonatal ward began. Staff were continually in conversation with upper management through 2016, even going so far as to recommend a self-referral to external investigators. However, these concerns went largely ignored, with upper management even forcing staff to apologise to Letby for any “stress and upset caused”.

It is clear that the conduct of the upper management at the hospital, and the wider role of the board, should be brought under the microscope. We hope the newly announced inquiry, which has been granted the legal power to compel evidence, will reinstate staff confidence in a reformed management system, one in which staff can feel confident in raising concerns and complaints regarding procedure and conditions.

Letby’s defence during the ten-month long trial argued that Letby was “a dedicated nurse in a system which has failed”. While the latter part of that sentence is certainly truer than the former, using the NHS and its well documented shortcomings as a smokescreen for her crimes is truly reprehensible. The same could be said for those who are using the Letby case as a scapegoat for their own political agenda, those who wish to dismantle and/or privatise the NHS in its entirety, saying that this simply would not have occurred in a privatised system when this is simply not the case.

We cannot stop the existence of truly evil people, but we can become vigilant enough to spot them early, and we can empower staff to feel safe enough to hold each other accountable without professional or social repercussions in the workplace. Had the concerns of staff been listened to at the time, had the proper protocols been stringently followed without the interference of upper management, many of these babies’ deaths and life-changing injuries could have been prevented.

The politically driven, target-led management culture that exists in the NHS is to the detriment of both dedicated clinical staff and patients. A culture in which staff have been disempowered, fearful of litigation or disciplinary action at every turn, spending precious hours filling out paperwork to cover their backs ‘just in case’, when that time could be spent caring for the patients in their care.

A shift to clinically led self-management, as well as a culture of longer-term planning which would outlast the next election cycle, would ensure that accountability in our healthcare system works from the ground up. It would empower staff to put the needs of patients above targets, and give them the confidence that their concerns will be taken seriously.

We all know this cannot happen overnight, especially within the current restraints of our elected governments. In the meantime, increased safeguards for whistle-blowers in our NHS should be an utmost priority, ensuring that even within the crumbling system which exists currently, there are people, patients and public alike, who will listen, and who will actively campaign for change.

2 thoughts on “Lessons to Learn in Health”

  1. Alasdair Macdonald

    Changing the cultures of institutions – from the local bowling club to the NHS – is not an easy thing to do, and the larger the organisation the more protracted is the period of change. And, the larger the organisation the more people and groups involved who have particular interests which they seek to preserve. It is not just ‘senior managers’ who can be guilty of this. Professional organisations ‘defend’ particular aspects which benefit their members rather than the organisation as a whole and, in the NHS, patients, too.

    As you have indicated, transparency is essential and transparency means people will be called to account for their actions. Now, ‘calling to account’, sadly, has overtones of blame and the accountability procedures are sometimes carried out in adversarial ways. It is the fear of the consequences of being blamed that causes people to be defensive, even when there is no need to be. And, being defensive leads to risk aversion and inhibits the creativity that all organisations need to ensure they continue to be effective in a changing world.

    Even in the most well tried of systems, things can go wrong, sometimes because someone makes a mistake or fails to do something, but also because of unexpected circumstances, over which no individual or group was responsible for.

    We have to accept that such things happen and make continuous self evaluation and reflection part of our way of working. We must be able to admit we make mistakes without being damned as persons, which is what blaming entails. Being able to admit to mistakes requires people to be working within an ethos of trust and respect where all participants are able to speak without fear of recrimination. The theatre cleaner should be able to point to some action by the lead surgeon which might cause a problem, without being inhibited by the gulf in status.

    And, this, in turn requires us to reflect on what we mean by ‘status’ and its impact on the effective functioning of an organisation.

  2. In a thoughtful paper, it is a radical change of register to call someone “evil” who has a mental illness diagnosis. There you have moved into religious territory.

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