The Enablers in the Shadows: Unaddressed Accountability in the Letby Case

Justice Delayed, Justice Denied: The Unanswered Questions in the Letby Hospital Horror

There are some subjects so upsetting that putting words to paper feels a burden. To articulate the darkest deeds draws deep from the writer, leaving hollow melancholy in its wake. On such occasions, one would prefer to remain silent rather than voice the necessary questions – but this would be an abdication of duty. I know of nothing more upsetting, nothing more that leaves you so flattened while a dark depression sits on the periphery than to write about the murder of innocent children, babies.

But if those with a public platform fail to address society’s ills, however reluctantly, who will hold power to account? And even though the hand of justice has at last caught up with nurse Lucy Letby, sentencing her to 14 life terms for the chilling murders of premature infants and this monstrous killer begins her richly-deserved incarceration, uncomfortable questions still remain unaddressed.

Questions about those in authority at the hospital who allowed her killing spree to continue unchecked for so long.

Letby’s guilt is beyond doubt. But what of the spineless administrators who ignored doctors’ urgent warnings about her conduct? Consultants had raised alarms about the correlation between Letby’s presence and sudden collapses and deaths of vulnerable babies. Their pleas for vigilance were dismissed by officious suits more concerned with avoiding reputational damage than protecting innocent lives.

One of the doctors who helped unmask Lucy Letby as the nurse behind the deaths of babies at the Countess of Chester Hospital revealed how he was told by executives to ‘apologise’ to the nurse for raising concerns about her conduct.

Dr Ravi Jayaram, a consultant paediatrician, claims that the then-Chief Executive Tony Chambers told consultants in 2017 to ‘draw a line’ under their suspicions, and if they didn’t, there would be ‘consequences’.

In the aftermath, Jayaram and other members of staff wrote the apology, which read:

“We’re very sorry for the stress and upset you have experienced in the last year.”

The Silence of Authority: The Unaddressed Complicity in Letby’s Crimes

Nurse Lucy Letby has received 14 life sentences for her murder of premature babies. But what about the hospital managers who refused to listen to doctors and even made them write letters of apology to Letby? pic.twitter.com/3uahI21hKD

— Diane Abbott MP (@HackneyAbbott) August 21, 2023

The reality was Doctors were told to stay silent or face “consequences” – an appalling suppression of whistleblowing that gave Letby licence to keep killing.

• According to two consultant paediatricians, in July 2016 a hospital executive said contacting the police would damage the hospital’s reputation and turn the neonatal unit into a crime scene, after one senior doctor recommended bringing in criminal investigators.
• Another executive, Tony Chambers, then the hospital’s chief executive, instructed senior doctors to write a letter of apology to Letby on 26 January 2017 for repeatedly raising concerns about her. The apology was ordered on the basis of two external reviews, which executives felt exonerated Letby. However, neither review was designed to examine whether she, or any other member of staff, was responsible for the deaths and both recommended that several deaths be investigated further.

• Doctors were told in early 2017 that Letby’s parents had threatened to refer them to the General Medical Council after her removal from the unit, according to internal documents.

The trial at Manchester crown court heard how Letby was found to have been on duty during three unexplained deaths of babies and a life-threatening collapse over 14 days in June 2015. This was the same number of babies as would die in an average year on the unit.

Alison Kelly, the director of nursing and deputy chief executive of the hospital, was told that Letby was present during all the incidents at this time, the court heard.

Concerns were repeatedly voiced by consultants as the tragic deaths of infants continued unabated. In early July 2016, Lucy Letby was eventually removed from the neonatal unit.

During a planned inspection of the hospital, consultants informed inspectors from the Care Quality Commission (CQC) in February 2016 that they had raised patient safety concerns with hospital management. Regrettably, they felt their concerns were falling on deaf ears. The CQC promptly communicated these worries to Ian Harvey, the medical director of the hospital, on the same day.

In January 2017, senior doctors were instructed to issue apologies to Letby following two comprehensive reviews. One such review by the Royal College of Paediatrics and Child Health examined the neonatal unit’s overall operations during the period of heightened mortality. It recommended enhancements to staffing levels among other improvements. Another review scrutinized the medical records of 13 deceased infants and four who had experienced sudden collapses between June 2015 and June 2016. Although recommendations were made, a “broader forensic review” of certain deaths was proposed.

Despite these reviews, hospital executives cleared Letby of any wrongdoing in January 2017. However, bereaved parents were notified the following month that no suspicious circumstances had been found in their children’s deaths.

Letby’s removal from the unit in July 2016 triggered discussions about involving the police, but the hospital opted for two external reviews beforehand.

During a meeting in January 2017 to discuss the reports, hospital executive Chambers expressed his belief in Letby’s innocence, ordering consultants to extend apologies to her and indicating her imminent return to work on the unit. In reality, she did not return, and a police investigation was launched four months later.

Chambers left the hospital shortly after Letby’s arrest in July 2018. Dr Susan Gilby, his successor as chief executive, initiated an external review into the trust’s handling of the escalating deaths. Although the review was concluded, it has not been published yet.

In a letter dated May 2018, Chambers noted that the hospital had always kept open the possibility of a police investigation. He acknowledged that communication could have been improved but pointed to constraints due to ongoing inquiries and the police investigation.

Both Chambers and Kelly refrained from commenting during the trial. Chambers expressed his sorrow over the crimes and willingness to cooperate with any post-trial inquiry.

Beyond the Verdict: The Responsibility of Hospital Authorities in the Letby Case

The truth is by the time Letby was finally removed from the ward, a full year after the first doctor’s flagged concerns, she had already murdered multiple infants and attempted to kill several more. The hospital’s duty of care had been breached through a toxic mix of complacency, cowardice and wilful blindness by those charged with safeguarding their patients.

Hospital management allowed Letby to continue her unconscionable spree. They breached their duty of care through tunnel vision bureaucracy, rank incompetence and callous disregard for others’ suspicions.

While Letby rots in prison, her irresponsible enablers walk free – no doubt to arrogantly endanger lives again through misgovernance elsewhere.

Doubtless, no one else will join Letby in the dock. The justice system rarely troubles itself to hold officialdom to account. Expect vapid platitudes about “lessons learned” as Letby’s irresponsible enablers escape punishment.

It doesn’t sit well with anyone that this catalogue of failures will go unpunished. The needless deaths of innocents demand sweeping change. Hospital safety must come before statistics and performance metrics. Experienced doctors, not transient administrators, should have greater authority over clinical operations.

The ones who were entrusted with leadership betrayed that sacred trust. Their negligence and hubris enabled Letby’s crimes, and they must answer for it. The pursuit of justice for the victims demands nothing less.

There can be no good that can come from this appalling affair, however, let it be a reaffirmation of that timeless wisdom. Justice delayed is justice denied. Let it be a warning to all those faceless bureaucrats their actions have consequences. Bring them all to the dock and let them answer for their crimes…