The Lucy Letby case and how the hospital dealt with it

[fandroid]

Especially for anyone who is a parent or a prospective parent, the case of Lucy Letby, who murdered babies at the Countess of Chester Hospital, brings feelings of absolute horror and fear.

I don't want this discussion to reflect on what punishment should be suitable for the murderer, nor on her character or speculation about her upbringing. I'm really interested in on how an organisation like the hospital trust reacted to the unexplained baby deaths. It appears that the doctors in charge were rightly concerned very early on, but could not get the hospital's management (including the medically qualified Medical Director) to take seriously the possibility that Nurse Letby was in some way responsible.

The case follows a previous one involving a nurse, Beverley Allit. But that happened 24 years earlier. Corporate memory is a fragile thing, and as the years went by, fewer and fewer people were even aware of the unbelievable possibility of a nurse as a serial murderer of babies.

The hospital management had to accept the almost unimaginable fact that there was a real-life horror story being played out within their organisation. That's what I'd like to discuss - how do you protect those under your care from such a remote possibility?

 

[Bantamzen]

Until we understand why she did what she did, I'm afraid there's not a whole lot we can do short of doubling up on all nursing staff administering care. There are people out there capable for whatever reasons of doing something like this, keeping them away from such responsibilities as caring is going to be nigh on impossible.

 

[Parjon]

That's what I'd like to discuss - how do you protect those under your care from such a remote possibility?

You probably don't tell doctors raising concerns to shut up about it. And when someone tells you they really think you need to call in the police, you do so. And when the person you do call in also says "an independent external review of each unexpected death", you arrange that. And you don't conclude "there is no evidence" on the basis of not having done that review. Just a hunch.

You also don't undermine reporting systems and confidence in the health service by allowing all this to pass without criminally investigating the decision making process.

Hold individuals personally responsible. Then numerous well paid executives across the country will all start behaving very differently.

 

[brad465]

I watched the Panorama episode on this case yesterday, and it seemed senior management feared for the hospital's reputation if such a case were true (and it turns out it was true). There was also the case that Lucy's personality on the surface was the polar opposite of what she was actually doing, and even her close friend interviewed wouldn't believe it unless Lucy told her she was guilty (this part was before the verdicts were delivered).

On a side note the jury in this case must have had real grit to be able to go through over all the evidence after several months of this trial. I'd expect them to get exempt from further jury service for life, like with the Shipman jury, at the very least.

 

[Fredtheshred]

NHS managers are a rare breed. There will be more deaths due to incompetence (if not murder). At the sharp end of my hospital, the lack of knowledge of what anyone is doing is absolutely breath taking. Leaving one person on duty for emergency calls, for 8 hours. All it takes is a need for the toilet and the call to get all the emergency crew to attend is unanswered......just one of many things going on right now.

Its down to just two things.

1.Cost cutting, meaning way too few staff.
2. The most incompetent managers that wouldnt be given a job in Boris Johnson's cabinet. I wish I was joking.

Crazy!

Until we understand why she did what she did, I'm afraid there's not a whole lot we can do short of doubling up on all nursing staff administering care. There are people out there capable for whatever reasons of doing something like this, keeping them away from such responsibilities as caring is going to be nigh on impossible.

We will never stop one murder, but we sure can ensure senior managers and execs have the right processes/competency to actually know what is happening in their hospitals. Trust me, their lack of knowledge is breathtaking.

 

[RT4038]

Hold individuals personally responsible. Then numerous well paid executives across the country will all start behaving very differently.

Yes - I expect they will become much more risk averse (with an adverse effect on the quantity and quality of the service provided), and filling the jobs will become much more expensive and difficult.

Perhaps we should look into the societal and cultural reasons which drive the fear of the hospitals reputation (and probably their own too) rather than bringing issues into the open for resolution....

 

[61653 HTAFC]

Yes - I expect they will become much more risk averse (with an adverse effect on the quantity and quality of the service provided), and filling the jobs will become much more expensive and difficult.

Perhaps we should look into the societal and cultural reasons which drive the fear of the hospitals reputation (and probably their own too) rather than bringing issues into the open for resolution....

Managerial Incompetence seems to be a thing at all levels of the NHS, from large multi-hospital trusts to individual GP's surgeries. My own local surgery employs a team of administrators without even a basic medical knowledge, to the extent that they made me an appointment with a specialist nurse who wasn't actually a specialist in my version of the condition concerned. There's also an attitude problem with these administrators, they view patients as an inconvenience and seem overly keen on rooting out abuse of the prescription system to the point that they see it when it isn't there.

None of this is as severe as a nurse murdering babies of course, but both things point to a system that is at breaking point and has seemingly forgotten what it's main job should be. The lionisation of the NHS during lockdown has added to this- criticism of the NHS is now viewed as treason, and it has probably attracted those with a hero complex to seek employment within the system.

 

[Parjon]

Yes - I expect they will become much more risk averse (with an adverse effect on the quantity and quality of the service provided), and filling the jobs will become much more expensive and difficult.

Perhaps we should look into the societal and cultural reasons which drive the fear of the hospitals reputation (and probably their own too) rather than bringing issues into the open for resolution....

It's an extraordinary insight that the accountability being spoken of - of not tolerating those who do or not do what should never be done or not done - should be viewed by anyone as being somehow a dangerous expectation. Or that those involved should escape accountability because it may make it harder to recruit.

Is the "talent pool" for these sorts of jobs really so rotten?

Perhaps we would get to find out how necessary these jobs are. Ha!

Does every hospital need a chief exec, board, senior management layers, comms departments, pr departments, and several other departments that only keep these in work... I think not.

 

[Mogster]

Working as an NHS line manager I recognise some issues from the Letby case, the lack of support from senior management particularly.

I was involved in an incident with some elements of the Letby case a few years ago, fortunately my department wasn’t patient facing, it would have been a complete nightmare if we had been. Senior management were actually obstructive, while making sure all responsibility was placed on local managers. I did type a long email detailing what happened, it was an interesting incident, however I’d rather not end up on the front page of the DM and I'm too busy for a meeting with the chief exec tomorrow…

It’s worth noting that Letby was viewed as a whistleblower by the senior management and the RCN. Senior management love a whistleblower, as long as the revelations don’t involve them of course. The divide and conquer opportunities are delicious…

 

[43096]

Working as an NHS line manager I recognise some issues from the Letby case, the lack of support from senior management particularly.

I was involved in an incident with some elements of the Letby case a few years ago, fortunately my department wasn’t patient facing, it would have been a complete nightmare if we had been. Senior management were actually obstructive, while making sure all responsibility was placed on local managers. I did actually type a long email detailing what happened, it was an interesting incident, however I’d rather not end up on the front page of the DM and I'm too busy for a meeting with the chief exec tomorrow…

It’s worth noting that Letby was viewed as a whistleblower by the senior management and the RCN. Senior management love a whistleblower, as long as the revelations don’t involve them of course. The divide and conquer opportunities are delicious…

It just shows how rotten to the core the NHS is: it's an organisation that is totally unfit for purpose. Nothing will be done, because it is a sacred cow.

 

[fandroid]

It's easy to dismiss the fear of reputational damage. Imagine a private health provider in the same situation. They'd double up on the resistance to a threat to their reputation. It's easy to say they should go under, but they're responsible for all the actual skilled resources under their control. A collapse of a medical organisation is never going to benefit someone on a waiting list. It's also plain daft to expect the medical specialists to actually run the organisation too. Most that I've met as a former elected hospital trust governor are very good at and enthusiastic for their specialties but have no desire to deal with the tedious daily management tasks of a highly complex organisation.

I think that the only way to head off such a rare disaster as the Letby case is to instil in everyone in an appreciation that if someone points out a possible train of events that reflect a real threat to patient safety, then everyone from top to bottom has to see that as the top priority. In that they have to be willing to accept that the prevention measures are going to hurt, both the organisation and individuals, many of whom may not be culpable at all. Accepting that for the greater good is actually possible but it needs a real feeling of teamwork and mutual support to achieve it.

 

[deltic]

Greater use of AI to identify unusual patterns in data is key to addressing some of the risk. We need a major culture change in society away from blame seeking to learning from mistakes. We had a cock up at work and it was refreshing that senior management weren't interested in blaming anyone but concentrated on addressing the issue and working to limit the chance of it happening again. Rather than damaging our reputation we gained more trust from our government client.

NHS trusts pay out millions in damages each year and as a result become very sensitive about anything that lead to more claims.

 

[Mogster]

Cameras. Every time a staff member interacts with a patient who can’t corroborate what’s happened it should be on camera. Neonates, the elderly are particular problem areas. It’s easy enough to set up loop video recording for rooms now.

The Letby case could at least have been resolved earlier if ward management could have reviewed staff interactions with the kids. Installation of covert cameras was refused in the Letby case, and the case I was involved with. In future if line management ask for it then covert recording should be made available, no questions.

 

[Bevan Price]

Public industry management structures often seems to resemble the civil service model.
1. We always need "x" numbers of management level, each managing about "n" numbers of staff.
2. We have always done things this way, so why change.
3. Do not dare to criticise "the system" - otherwise your career prospects are dim.
4. Staff promotion / selection boards tend to favour "people who fit our own image", sometimes in preference to those best fitted for the job.

We have seen time after time that parts of the senior civil service are clueless when it comes to some aspects of business, e.g. defence contracts, national IT systems for the NHS, etc., etc.

 

[Cowley]

Cameras. Every time a staff member interacts with a patient who can’t corroborate what’s happened it should be on camera. Neonates, the elderly are particular problem areas. It’s easy enough to set up loop video recording for rooms now.

The Letby case could at least have been resolved earlier if ward management could have reviewed staff interactions with the kids. Installation of covert cameras was refused in the Letby case, and the case I was involved with. In future if line management ask for it then covert recording should be made available, no questions.

A genuine question here @Mogster (and as you no doubt know, I’ve always respected your opinions on these kind of things). What are the drawbacks that have stopped CCTV being installed in many of these areas in hospitals?

The technology would seem reasonably inexpensive these days but is there anything related to doctor/patient confidentiality that might cause issues and reasons for hesitation in covering more areas?

 

[telstarbox]

Two obvious ones are patients not being able to consent to their recording and patients sometimes having no clothes on - these don't apply to the more typical uses of bodyworn cameras such as on the railway.

A camera also wouldn't pick up on wrong dose / wrong medication being given to a patient.

 

[AlterEgo]

Greater use of AI to identify unusual patterns in data is key to addressing some of the risk. We need a major culture change in society away from blame seeking to learning from mistakes. We had a cock up at work and it was refreshing that senior management weren't interested in blaming anyone but concentrated on addressing the issue and working to limit the chance of it happening again. Rather than damaging our reputation we gained more trust from our government client.

NHS trusts pay out millions in damages each year and as a result become very sensitive about anything that lead to more claims.

You didn't need AI to spot the murderer here. People were just "Oh, I bet Nurse Letby was on shift". And invariably she was, murdering babies under people's noses.

 

[Cowley]

Two obvious ones are patients not being able to consent to their recording and patients sometimes having no clothes on.

Well this is true of course.

 

[RT4038]

Managerial Incompetence seems to be a thing at all levels of the NHS, from large multi-hospital trusts to individual GP's surgeries. My own local surgery employs a team of administrators without even a basic medical knowledge, to the extent that they made me an appointment with a specialist nurse who wasn't actually a specialist in my version of the condition concerned. There's also an attitude problem with these administrators, they view patients as an inconvenience and seem overly keen on rooting out abuse of the prescription system to the point that they see it when it isn't there.

Why single out the NHS? Managerial, and administrative, incompetence seems to pervade throughout life at the moment, both in the public and private sector.

It's an extraordinary insight that the accountability being spoken of - of not tolerating those who do or not do what should never be done or not done - should be viewed by anyone as being somehow a dangerous expectation. Or that those involved should escape accountability because it may make it harder to recruit.

Is the "talent pool" for these sorts of jobs really so rotten?

Perhaps we would get to find out how necessary these jobs are. Ha!

Does every hospital need a chief exec, board, senior management layers, comms departments, pr departments, and several other departments that only keep these in work... I think not.

Why is it extraordinary? There may well be 'criminal negligence' in this case, but likely as not it may not be quite so straightforward. Yes, the talent pool is probably fairly small, and the threat of criminal prosecutions will likely make it even smaller.

If there wasn't chief exec., board ,senior management layers, comms departments etc, their work would fall on medical staff , who really are better doctoring, surgeoning, nursing etc rather than dealing with finances, press and public enquiries, administration, discipline etc.

 

[61653 HTAFC]

Why single out the NHS? Managerial, and administrative, incompetence seems to pervade throughout life at the moment, both in the public and private sector.

Firstly because it's what I have most experience with, and secondly because any other public service wouldn't really be relevant to the thread. It's also rather more important, being potentially a matter of life and death.

Whilst I'm not a psychologist, reading articles and witness statements about this horrible case does paint a picture of an individual with severe narcissistic tendencies. Had Letby been working at the housing office or even in a school she wouldn't have been able to do as much damage as she did before her misconduct came to light.

Unfortunately her actions will have an impact on the image of her (now thankfully former) profession for a long time. I can't imagine how it must feel for the parents of the babies she killed or left with lifelong injuries. We always want to think the best of those who are looking after our family members, and to have such a betrayal happen right under your nose must be absolutely devastating.

Letby at least won't be particularly popular at whichever prison she ends up at, but I hope they keep a close eye on her. Don't want her taking the easy way out.

 

[johntea]

One of the problems is the NHS are short staffed as it is, taking Letby off shift may sound simple in principle but who do you replace her with at such short notice?

I work for the NHS in a non clinical role but have learnt the process for such situations is to ‘raise a Datix’ which might get reviewed eventually…more than enough time for Letby to carry on though

We have recently implemented body cams for certain staff (e.g security) but a nurse? You sort of trust those by default…

 

[AlterEgo]

One of the problems is the NHS are short staffed as it is, taking Letby off shift may sound simple in principle but who do you replace her with at such short notice?

I work for the NHS in a non clinical role but have learnt the process for such situations is to ‘raise a Datix’ which might get reviewed eventually…more than enough time for Letby to carry on though

We have recently implemented body cams for certain staff (e.g security) but a nurse? You sort of trust those by default…

The thing is, most body cams work I know of work by continuously overwriting the footage and often are only activated when there is an incident.

Are there body cams which record absolutely constantly and the ability to store all the video for years and years?

 

[Parjon]

Seems to me that people are discussing solutions to problems but overlooking that concerns were being actively raised.

Bodycams, doubling up staff were all unnecessary. Simply that those raising concerns needed to be acted on promptly and properly.

I'm glad to see the government attempt to brush this under the carpet via "inquiry" is now being met with open calls for further criminal investigations into the timeline and events.

 

[66701GBRF]

Are there body cams which record absolutely constantly and the ability to store all the video for years and years?

Yes. There are body cams that automatically upload to a data center. How long the footage is available for depends on the company. However I would not expect footage to be available for months or years unless it has been flagged or purposely saved to some where else for some reason.

 

[Yew]

You didn't need AI to spot the murderer here. People were just "Oh, I bet Nurse Letby was on shift". And invariably she was, murdering babies under people's noses.

I'm always hesitant to suggest that a KPI dashboard could solve it (as they often end up becoming a point of obsession by middle managers, as the expense of actual organisational performance), but it does feel like a bar chart of "Deaths per shift" would have shown a huge discrepancy.

 

[61653 HTAFC]

There's a really obvious privacy/confidentiality issue with the idea of medical staff having body-cams, I can't believe anyone would seriously suggest such a measure.
What this case has shown is that staff who may have concerns about the conduct of a colleague need to both have a service they can report these concerns to, and know that those concerns will be taken seriously.

 

[Mogster]

A genuine question here @Mogster (and as you no doubt know, I’ve always respected your opinions on these kind of things). What are the drawbacks that have stopped CCTV being installed in many of these areas in hospitals?

The technology would seem reasonably inexpensive these days but is there anything related to doctor/patient confidentiality that might cause issues and reasons for hesitation in covering more areas?

I understand the concerns over privacy but in my opinion the benefits outweighs the drawbacks. The main problem seems to be cost, maintaining these systems and then deciding who should have access to recordings and why. Many NHS premises are old, parts are frequently repurposed and controlling access is a major problem. If an issue occurs and 100 people have access to a controlled area then it’s very difficult to investigate.

I do believe cameras protect staff also. During the 2011 Manchester Stepping Hill poisoning investigation GMP arrested and charged a staff member who later proved to be innocent. The staff member spent 6 weeks on remand in Styal as I remember.

 

[adc82140]

As an NHS manager (just to clarify nowhere near the area of concern here) I believe this is a dark day for the whole organisation. Yes of course one evil person carried out this act, but I'm extremely uncomfortable hearing about the lack of action from those in the management chain when concerns were brought to them. The more I read, the worse it gets. I can readily identify their behaviour based on others I have worked with in the past. It's all about protecting themselves, and their egos. Make no mistake they are in the minority, the vast vast majority of us in management want to primarily do what's best for our patients. But they are out there still, and must be flushed out.

I do feel that this "Church of the NHS" hero worship we've endured in recent years is partly responsible. People start to believe their own hype.

 

[telstarbox]

I understand the concerns over privacy but in my opinion the benefits outweighs the drawbacks. The main problem seems to be cost, maintaining these systems and then deciding who should have access to recordings and why. Many NHS premises are old, parts are frequently repurposed and controlling access is a major problem. If an issue occurs and 100 people have access to a controlled area then it’s very difficult to investigate.

I do believe cameras protect staff also. During the 2011 Manchester Stepping Hill poisoning investigation GMP arrested and charged a staff member who later proved to be innocent. The staff member spent 6 weeks on remand in Styal as I remember.

Access control is a good point - this already happens on maternity wards (or should do).

Cameras might provide evidence of 'gross' violence such as blunt force or stabbing but I don't think they would detect something as subtle as poisoning. For example in a routine blood test, the nurse is using sample tubes labelled with text about 2mm high and a tiny needle. You would have to have a high definition camera very close to the patient and even then the movement of the action might not result in clear footage.

It's important to remember that while these events are horrific, deliberate harm in the NHS remains very rare and it shouldn't deter people from using NHS services.

 

[DarloRich]

This clearly needs a full public enquiry led by a senior judge.