Re your editorial on the Lucy Letby case (18 August), I have been a paediatrician since 1985, a consultant since 1996 in the UK, and since 2017 in Ireland. Like my colleagues, I am grieved and outraged at reading that NHS managers were unable to prevent Letby from perpetrating irreversible harm.
A neonatal database flagging a spike in deaths would not have helped – neonatologists, who submit the reports to these databases, were aware of the spike as it happened. They had identified the suspected perpetrator, but they were obstructed by their managers.
The consultants should have felt able to report suspicions directly to the police. An independent ombudsman might have given them more confidence, but a change in the management culture of the NHS is needed. No good will come from scapegoating individual managers via a public inquiry – this way of working has been imposed by Whitehall.
Consultants have always been the “awkward squad”, constantly complaining about staffing levels and demanding more resources. General management came in under Margaret Thatcher, reining in consultants and adjusting the hierarchy so that in an NHS trust, consultants reported to a medical director. The NHS became increasingly authoritarian after that; during the Blair years the government dictated performance indicators and ringfenced funding for programmes that were more important than doctors’ priorities. CEOs were forced to comply with targets and budgets. In authoritarian organisations, obedience and loyalty are more important than expertise. This has to change.
In the health service, we work for our patients first, our employers second and (unfortunately) ourselves last. If we forget that, we neglect our prime duty.
Dr Maybelle Wallis
Consultant paediatrician, Wexford, Ireland
• I am a senior clinical nurse with more than 40 years’ experience. Shortly after joining a community team, I felt I had no choice but to raise concerns about a colleague’s incompetence. In my opinion, shared by others and previously raised, he was a risk to patient safety. Several meetings took place within the department, but nothing was done, and he was subsequently promoted. I involved an NHS “speak up guardian”, who offered empathy but did nothing.
Shortly afterwards, I began to be bullied, and a malicious complaint was raised by a colleague against me. I was exonerated, but the whole episode was extremely disturbing and I resigned.
The culture in the NHS is about survival: keep your head down and get through each shift as best you can. Weak non-clinical managers and a lack of experienced nurses offering direct supervision feed this.
Name and address supplied
• Almost a decade ago, I was appointed to support the late MP Ann Clwyd in conducting her review of the NHS hospitals complaints system, in the wake of the Mid Staffordshire calamity.
The report identified a “toxic cocktail”, in which there was a defensiveness on the part of hospitals to hear and address legitimate concerns, a fear of complaining among patients and a lack of trust in the system. Patients witnessed pressure on clinical and other staff to be silent about untoward events. Since then, few of the recommendations of the review have been carried out to improve confidence that complaining is worthwhile and can achieve change.
When the combined pleadings of relatively powerful clinicians, such as those at the Countess of Chester, can be put aside by both NHS trust boards and managers, then what hope is there for patients or their carers who need to complain or raise an alert? The resolution of the issues surfaced by the Letby scandal cannot be left to those who allowed it to happen. It must involve a strong and independent patient voice.
Sharon Grant
Chair, Public Voice
• The events that enabled the killing of babies to continue at the Countess of Chester hospital sadly happen too often. And the reaction by those in charge to squirm mightily rather than right the wrongs are not limited to the NHS – see the scandals of the Post Office, the Metropolitan police and others.
The instinct to deny failings is predominant, easily overcoming the need to carry out the job. I believe that the motives for the extreme defensiveness adopted by hospital administrators was born of the “reform” under which hospitals transformed into virtual companies – NHS foundation trusts – with each, instead of cooperating, now competing for funding.
Eddie Dougall
Bury St Edmunds, Suffolk
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