Letby disaster epitomises flaws in NHS

by Phil Banfield

The tragic events of the Lucy Letby case show the urgent need for an independent regulator for non-clinical managers

Location: UK
Published: Friday 25 August 2023
Phil Banfield

It is impossible to make sense of the awful, appalling crimes in the Lucy Letby case. Words cannot begin to describe how distressing the details of these crimes are, nor the anguish for the families of the victims, and all the healthcare staff involved that will haunt them all forever.

These horrific events will sit uncomfortably with doctors across the country who are universally asking, 'how on earth did it take over a year after repeated concerns and warnings were raised by consultants before any criminal investigation into the deaths was ordered?'

This is the unbelievable worst-case scenario that has turned out to be true. It epitomises systemic flaws and failings in our health service where doctors and healthcare staff are not appreciated for flagging that there is something seriously wrong happening to their patients. This must be the last straw and the turning point in a shameful and toxic culture.

As doctors, we are obliged to report concerns when we identify risks to patient safety, yet there is a sense felt by many of my colleagues that in doing so, they face resentment and are seen as the problematic, questioning ones who just think they know best.

When it comes to the science, evidence and expertise behind patient care, we do often know more than most, and critically, are trained to seek out – and keep seeking out – explanations for when the outcomes are not as expected. We have a duty to understand what may have gone wrong and what could be done differently in future for the next patient in similar circumstances.

Too often our voices are stifled because truths are uncomfortable or may carry potential reputational damage for an individual, an organisation – or a government. Ironically, the most damage comes from not listening to these concerns, the sometimes-fatal consequences of delayed investigations and late interventions. The lack of senior doctors on executive and board positions in NHS organisations is just one example of how valuable independent representation on a clinical level is absent.

This case raises serious questions about how healthcare providers are governed. The board claimed that they were misled because they didn’t have specialist medical knowledge to assess what was being raised. It is unacceptable that there was no way for senior doctors to raise serious concerns directly with non-executive directors.

The case of Lucy Letby shows the devastating and unspeakable harm that can come from doctors and healthcare staff feeling worried or even threatened for raising patient safety concerns. Ultimately, doctors who were prevented from raising concerns with the police, owing to the potential reputational damage to the trust, prevailed.

The threat of a vexatious GMC referral and investigation can take an enormous toll on a doctor’s mental health and wellbeing. The gravity of such a threat should not be underestimated. A GMC investigation can end a career and seems to be being deliberately used as a deterrent to stop doctors from raising or continuing to pursue legitimate patient safety concerns across the UK.

Of course, this case is not the first time where the concerns of senior doctors were poorly handled or dismissed and serious failures have occurred as a result. As far back as 2013 where Sir Robert Francis KC published a report outlining the causes of serious failures in care at Mid Staffordshire NHS Foundation Trust, identifying a range of issues of medical negligence, poor culture and lack of transparency.

For years, the BMA has campaigned for a change in the culture of blame and suspicion within the NHS and has long called for non-clinical managers to be regulated. The Letby case shows we are a long way off the change that is needed.

We need a regulatory mechanism for holding senior non-clinical managers to account’, in line with the way clinical staff are held to account by our regulator. The inquiry into the murder of innocent babies in Chester must be put on full statutory footing with the powers to compel witnesses to attend. Unless those involved are made to provide evidence, the Government will be perpetuating the view that non-medical managers are beyond accountability.

Importantly any inquiry must identify any instances where doctors were badly treated for raising safety concerns, including consideration of threats of referrals to the GMC. It must offer solutions that increase the likelihood of openness, transparency and an NHS that will act when there are safety issues.

The BMA will continue to stand by doctors who bravely speak out and challenge threats to patient care. The current whistleblowing protections also need legislative reform – too often cases fail not because the safety concern wasn’t valid but because the legal process relies on causation between raising a protected disclosure and subsequent detriment – an incredibly high threshold.

Doctors need assurances that their concerns will be listened to and taken seriously, but patients must be in a position where they feel heard and listened to as well. We cannot allow something like this to ever happen again, we owe it to these babies whose lives have been taken so cruelly.


Phil Banfield is BMA council chair