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Few individuals have Lucy Letby’s capacity for cold-blooded evil. Her victims’ families, and the entire nation, can sleep a little easier knowing that this “Mary Poppins” killer, who preyed on the most vulnerable while showing the world a kind facade, has been brought to justice.
Yet we also need to face a frightening truth. Our health system has serious issues that cannot be fixed by locking up one murderer. They are deep-rooted, systemic and intractable. Unless we as a nation tackle them head-on, we will find ourselves here again: comforting the bereaved; punishing the guilty; and shaking our heads at a system that somehow keeps letting us down when we need it most.
No one can stop a sick individual such as Letby from planning a murder spree. Yet a well-run health service could have stopped her crimes far sooner. Instead, Letby was working in a poorly-maintained building, where the drains could overflow into the bathroom sinks, and in a unit that was understaffed. There were too many other possible explanations for the deaths caused by her wicked acts.
The health service failed Letby’s victims. It failed them due to a lack of resources that put the most vulnerable at risk. It failed, too, thanks to a culture where HR niceties trumped expertise. At one point, the doctors who feared the worst and had tried to blow the whistle were forced to apologise to the killer in their midst. And the system failed above all due to a senior management team that seems to have put buck-passing and reputation management ahead of patient care.
None of this is new. There are disturbing echoes of the case of Beverley Allitt, a children’s nurse who murdered four infants and attempted to murder three others at a hospital in Lincolnshire in the early 1990s. In Allitt’s case, too, understaffing was one reason why the killer wasn’t caught sooner. Three decades later, and here we are again.
Similarly, in 1998, a public inquiry was set up to investigate the deaths of 29 babies undergoing heart surgery at the Bristol Royal Infirmary. It revealed shocking, widespread failures and recommended root-and-branch NHS reform. Changes were made, and yet the inquiry’s call for NHS managers to be regulated was not acted on. In 2019, the Kark Review called for board directors in the NHS to be open to disbarment for serious misconduct. Again, this was refused.
Now, we see the fruit of those failures to act. Patient safety should have come first. Instead, the Countess of Chester’s top brass seemingly sought to protect their hospital’s reputation before anything else.
The NHS is often accused of being overmanaged. Much more important is that the current system does too little to hold its managers responsible. Rather than rewarding top performers and weeding out those who cannot learn from failure, it leaves those not up to the job to fail sideways into another six-figure job.
Her colleagues called Letby “nice Lucy”. At first, they thought she couldn’t possibly be responsible for the deaths that occurred when she was on duty. But people are not angels, even if they look angelic. And though few are so wicked, we need systems that are built for imperfect, selfish human beings, not systems that only work if run by saints.
In recent years, necessary debate about NHS reform has been short-circuited by the well-meaning belief that everyone who works there is above criticism. That must end.
Those who work in the NHS do a vital task. They deserve our gratitude. And they all deserve better than the current system, which makes their jobs harder than they should be, and needlessly endangers the patients they care for.
For everyone’s sake, it is time for change. Otherwise, the disasters will keep coming. Like Harold Shipman, Beverley Allitt and now Lucy Letby. Like the Bristol Royal heart-surgery deaths, the more than 450 lives ended too soon at Gosport hospital, and the Mid Staffs scandal, where one estimate suggested between 400 and 1,200 deaths could have been avoided.
Like any other human enterprise, there are no angels in the NHS. If we want a health service we can trust, it needs to be built on stronger foundations. The current reliance on the taxpayer for all its funding cannot go on. The central allocation of resources has been proved to fail time and time again. We deserve a system that efficiently uses what it has, that brings in extra spending where needed, that does not leave hospitals with desperately understaffed teams struggling with filthy buildings. Such a system needs a culture that respects medical expertise and moderates the power of HR. And it needs, above all, responsibility at the highest levels of management.
These straightforward requirements are not too much to ask of a world-class health service. Other countries seem to manage it, as do private health firms. An honest debate would have the humility to ask what we can learn from other approaches, not just trumpet our model as the best possible answer.
Perhaps if we start from what we need and ask how to get there, rather than starting from what aspects of NHS bureaucracy are off-limits, we will get close to a real answer and transformative, revitalising and, above all, necessary reform. We should begin by insisting that NHS managers are held to account when they fail.
The NHS is now in the dock, too
If we want a health service we can trust, it needs to be built on stronger foundations