Questions of management accountability in the wake of the Letby trial

31 August 2023

The trial of Lucy Letby culminated in her conviction for the murder of seven babies and attempted murder on a further six occasions. The former neo natal nurse received a whole life sentence at Manchester Crown Court for these horrific crimes.

Whilst cases like this are thankfully extremely rare, what concerns me and many other observers, is the number of warnings raised by medical colleagues whilst Letby was still working on the neonatal unit of the Countess of Chester Hospital; tragically if these warnings had been acted upon, it may have prevented some of the babies’ deaths.

As the chain of events came to light through the trial, media focus turned to the hospital management at the Countess of Chester Hospital NHS Foundation Trust, during those critical years. Dr Stephen Brearey the lead clinician in the neonatal unit at the Trust, has been speaking publicly since the trial, he says, out of a duty of candour to the parents of the victims and to the public.

Dr Brearey first raised concerns to management in June 2015 that nurse Lucy Letby was present at unusual baby deaths and collapses. Doctors raised concerns again in October 2015 after the death of a 4-week-old girl, whom Letby murdered on her fourth attempt.

In March 2016 a neonatal ward manager raised concerns that Lucy Letby was a common factor in all of the deaths. However, it was not until July 2016 that the nurse was removed from the neonatal unit, on the insistence of senior doctors, after the deaths of Child O and Child P (two triplets) within 24 hours of each other. Dr Brearey has argued that the police should have been contacted in February 2016, when he escalated concerns about Lucy Letby and asked for an urgent meeting with hospital management. However, this meeting did not occur for a further three months. Tragically, police involvement at that time might have saved Child O and child P, who were the last two babies Lucy Letby was convicted of murdering. From April 2016 Letby was removed from nightshifts and the police were finally contacted in May 2017.

Two reviews were conducted by the Trust in 2016. One by the Royal College of Paediatrics and Child Health and another by an external independent neonatologist. At a board meeting in January 2017, executives allegedly used the reports to exonerate Lucy Letby. A statement was read out from Letby at the meeting, stating how distressing the allegations against her had been and the consultant paediatricians were ordered to apologise and enter into a mediation process with her.

Looking at these deaths in hindsight, it is hard to understand how the warnings of senior doctors, regarding a specific nurse, treating the most vulnerable of patients, could have been ignored for so long. Dr Brearey and his colleagues have accused management of bullying and intimidating doctors to stop making a fuss. One of those doctors instructed to apologise to Letby was Dr John Gibbs, now retired; in an interview with the Guardian, he poignantly states: “If you are not going to listen to the consultants, you are in big trouble.”

Furthermore, as reported in the Guardian, Sir Duncan Nichol, former Chair of the Countess of Cheshire Hospital NHS Foundation Trust now claims the board was misled by hospital executives, having been told there was no criminal activity pointing to any one individual.

Lack of hospital management accountability

This brings us to a key concern that this case raises, in that there is no apparent accountability for hospital management, in the same way there would be for doctors and nurses and there is a growing call for them to be regulated.

Any failings by a doctor can be referred to the General Medical Council (GMC) and, for a nurse, to the Nursing and Midwifery Council (NMC). Management staff, who oversee the running of the hospital and who have the power to remove staff from their active roles, do not have such accountability.

Calls for a statutory inquiry

Many people, including Dr Brearey are now calling for a judge led statutory inquiry into the events surrounding these murders. The significance of a statutory inquiry is that witnesses can be compelled to give evidence. The Government originally proposed a non-statutory inquiry, but the concern with this is that if key witnesses, including those involved in the management of the trust at the relevant time, are not compelled to give evidence, they may well be reluctant to contribute to the inquiry. Faced with pressure from relatives, the Government is reconsidering its decision.

Corporate manslaughter and gross negligence manslaughter

The police have been urged to consider corporate manslaughter charges against the trust for the alleged failings of management. Corporate manslaughter is a criminal offence where an organisation is found to have caused a person's death. A court would have to be satisfied that the organisation caused a death through a gross breach of duty of care to the deceased.

An organisation obviously cannot be sent to prison, so the penalty for corporate manslaughter is a fine. However, when sentencing, the judge will consider the fact the defendant may be providing a public service and that fining them many millions of pounds could hinder their ability to provide this service. I have seen this rationale applied on previous cases I have worked on. Any fines imposed can therefore be somewhat symbolic.

A person can be charged with gross negligence manslaughter and receive a prison sentence if a court is satisfied that death was a likely outcome of their ‘gross’ negligence. However, convictions for gross negligence manslaughter are often very difficult where the failings may have been committed by several different people at different periods in time.

Hearing of the potential missed opportunities to stop Lucy Letby gives a somewhat depressing feeling of déjà vu, when looking back to the cases surrounding the surgeon Ian Paterson, who was convicted of performing unnecessary surgeries on patients and sentenced to 20 years in prison.

At the time Kashmir Uppal, a partner in Shoosmiths’ serious injury team stated:

“It is important that the medical and regulatory bodies as a whole work together to prevent such events ever occurring again.”

The Letby trial has raised serious questions about hospital management, and it is essential that the events surrounding these tragic deaths are investigated with a statutory inquiry and that the Government looks into the regulation of hospital management in order to increase accountability and, above all else, reassure the public that patient safety is the number one priority.



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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