Will the fallout from the Lucy Letby case really lead to lasting change in the NHS? The most prolific killer of babies was able to continue even as doctors raised concerns about her – to the extent that the consultants themselves were forced to apologise to her face for a ‘campaign’ of bullying, rather than their concerns being taken seriously about her presence at the deaths or collapse of all the babies at the Countess of Chester hospital. Now, doctors’ union the British Medical Association has turned on NHS managers, saying the time has come for a reckoning for the ‘unaccountable’ bosses.
NHS managers are often unfairly maligned: politicians like to raise cheap applause by promising to abolish entire swathes of them, as though health services can just run automatically or doctors have the time to take on administration as well. But it is undeniable that NHS management is not accountable in the same way as clinicians, even though their decisions can have life-or-death consequences too. The many NHS scandals over the decades have all had management failings as well as clinical mistakes. Letby was a murderer, while other scandals were about poor care, but the common thread in all of the cases is that managers were never ready to acknowledge that something was going wrong, were reluctant to share information, and went to more effort to shut down scrutiny than they did to investigate the truth. There is no professional regulation of individual managers, and while ministers have been resisting the calls for that to change this weekend, they may struggle to maintain the line.
They are also unlikely to maintain the line that the best way to investigate the lessons to be learned is through an independent non-statutory inquiry, which can work quicker than a public inquiry. Yesterday I interviewed Ann Alexander on Times Radio: she was the solicitor who worked with the families who lost loved ones to serial killer Dr Harold Shipman, and pushed for the inquiry into those killings to be made a public one too. She explained that ‘the importance of a public inquiry is that the inquiry chair has the power to subpoena witnesses to attend to ensure that documentation is provided and to encourage a complete in-depth investigation.’ Giving evidence on oath will be particularly important in a case where there are allegations of a cover-up.
Public inquiries are important, but I’ve written about enough of them over the years and in my book on the NHS to feel a little cynical about the impact they can have. Alexander described how hard the Shipman families still had to work even a decade after the inquiry to ensure that its recommendations on death certificates, for instance, were actually implemented. It is very easy for politicians to leave the conclusions of these inquiries to someone else, or more precisely no-one else, and for the lessons to disappear, only to resurface with the next scandal.
There are plenty of cultural problems that wouldn’t be solved by regulation: the tendency within the NHS is to regard things going wrong as a problem rather than an event to learn from – as in the aviation sector, for instance. This weekend NHS England chief executive Amanda Pritchard wrote to trusts emphasising the ‘importance of NHS leaders listening to the concerns of patients, families and staff, and following whistleblowing procedures’. Regulation can change the incentives in favour of listening to victims rather than treating them as inconveniences, but leaders are even more important in that, and the number of inquiries that have reached the same conclusions about managers suggests there aren’t enough leaders who recognise that they too need to change the way they work.
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