18 | Nursing in Practice | Autumn 2023
COLUMNIST
Watch this space : The implications
of the Lucy Letby case
Amid the horror over babies ’ deaths at the Countess of Chester Hospital , Marilyn Eveleigh questions the effectiveness of whistleblowing in the face of NHS managers who seem to prioritise budgets and reputation
Marilyn Eveleigh , nurse adviser and independent trainer in East Sussex
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Like most nurses , I felt horror and concern as I followed the judicial revelations and extensive media commentary on Lucy Letby . It has really affected me because she was one of us . Nurses have rightly been quick to point out that she is an exception , but she has momentarily tarnished the reputation of a highly trusted profession .
It is an historic case , up there with those of Beverley Allitt and Harold Shipman . Lady Thirlwall ’ s public inquiry will expose nursing and health services to deeper scrutiny . Like previous inquiries , it will identify failures and recommend wider changes to reduce the risk of recurrence , not just at the Countess of Chester Hospital .
Have past recommendations been effective ? Successive inquiries have highlighted that an understaffed and poorly supported workforce lies behind many cases of harm and negligence . In the Letby case , medical and nursing shortages appear not to have been a significant factor , with the focus instead on hospital management .
Though Letby was an individual perpetrator , the media have rushed to allocate blame to NHS managers for not listening to concerned doctors .
Over the years , management and executive boards have increasingly come under the spotlight , accused of blocking safer clinical care . Organisational leaders are being called to account for decisions to ignore concerns , for example . In the latest case , managers could potentially face corporate manslaughter charges .
At Nottingham University Hospitals NHS Trust , despite earlier maternity negligence settlements , past cases are now being elevated to criminal status , with police investigating alleged management cover-up and silencing of whistleblowers .
After the 2013 Mid Staffs NHS inquiry report into the unnecessary deaths of hundreds of patients through poor care under a toxic organisational culture , Freedom to Speak Up Guardians were established at healthcare
The media have rushed to blame managers for not listening to doctors ’ concerns
providers . They have regular direct dialogue with chief executives to report concerns and risks that could affect patient safety and organisational decision making .
Whistleblowing is now acceptable , and indeed expected , where concerns raised via the normal channels have not been followed up .
Yet NHS whistleblowing processes and scrutiny did not stop Letby ’ s actions , despite four consultant paediatricians reporting concerns over babies dying for more than a year . This has exposed a situation whereby regulated clinicians are set against management decision makers who appear to prioritise targets , budgets and reputation . Interestingly , a third of NHS managers are regulated clinicians .
So are effective whistleblowing mechanisms in place across the NHS ? What happens in primary care ? What if concerns do get ignored ? In the Letby case , the hospital ’ s nursing director and possibly other nurse managers are now subject to NMC fitness-to-practise investigations . Watch this space .
The Thirlwall review is intended to restore the trust in healthcare services and staff that the public has a right to expect . Let ’ s hope it concludes speedily and helps give closure to the families and communities that have suffered pain and loss .