Lucy Letby: NHS managers must be held to account, doctor says

Hospital managers should be regulated in a similar way to doctors and nurses, the senior doctor who first raised concerns about Lucy Letby has said.

Dr Stephen Brearey was the lead consultant on the neonatal unit where serial killer Letby worked and raised the alarm in October 2015.

He told BBC Radio 4's Today programme there was "no apparent accountability" for what NHS managers do in trusts.

Letby was handed a whole life sentence on Monday at Manchester Crown Court.

She murdered seven babies and attempted to murder six others in a neonatal unit at the Countess of Chester Hospital, in Cheshire.

The first five murders in all happened between June and October 2015 and - despite months of warnings - the final two were in June 2016.

In an interview, Dr Brearey claimed senior staff at the Countess of Chester Hospital were worried about reputational damage to the organisation.

He said that instead of acting on his warnings he and his colleagues lives were made very difficult - so much so that they felt under attack. "You go to senior colleagues with a problem, and you come away confused and anxious," Dr Brearey explained.

And he claimed his experience was not uncommon in the NHS. Dr Brearey said he had been contacted by clinicians across the UK "in the last three days" who tell him "clinicians raised concerns with senior members of the hospital and their lives were made very difficult by doing that".

"I can't emphasise enough how difficult a position this puts the clinician in," he went on to say. "Carrying out your clinical practice in that environment is very difficult."

The consultant added: "Doctors and nurses all have the regulatory bodies that we have to answer to, and quite often we'll see senior managers who have no apparent accountability for what they do in our trusts and then move to other trusts."

He said he worries about senior managers' future actions, adding that "there doesn't seem to be any system to make them accountable, and for them to justify their actions in a systematic way".

Dr Brearey also said he did not consider himself a whistleblower, but "I was simply trying to escalate concerns that all my colleagues shared, of a spike in mortality, an association with a member of staff, the unusual nature of these events, and the unusual timing of these events.

"We had reviewed all the cases on multiple occasions with an external expert and put all those concerns on paper and I felt really I was following a process rather than speaking out."

In a statement, an NHS spokesperson said: "It is absolutely vital that everyone working in the NHS feels they can raise concerns and that these are acted on and we have reminded NHS leaders about the importance of this following the verdict last week."

They added that every NHS trust is expected to adopt an updated Freedom To Speak Up policy, and ensure the information is easily accessible to staff.

Dr Naru Narayanan, president of the doctors' union the Hospital Consultants and Specialists Association, told Sky News there should "better protection for people who raise concerns".

"But we see time and again that people who do so face retribution, revenge and retaliation, and they fear for their careers," Dr Narayanan added.

This is not the first time there has been a call for the professional regulation of managers.

A series of reviews over the past decade or so have put forward proposals for greater oversight of managers in the health service, including the Francis Review into the Stafford Hospital scandal.

Doctors and nurses have to measure up to fitness to practice standards and must be registered with a regulatory body that aims to ensure they are safe to care for patients.

But NHS managers do not. A code of conduct was established in 2002, asking that managers act in the best interest of patients and listen to concerns when they are raised. However, there is no real national mechanism to ensure the code is applied.

In recent years the government has talked about beefing up regulation, but nothing concrete has happened that has radically changed the approach to NHS management.

Supporters of regulation believe it would also lead to the introduction of consistent training and standards for managers - but there are concerns about cost and introducing more regulation and red-tape. There is already an inspection regime covering all NHS services that is meant to ensure staff including managers are providing safe care and have proper procedures in place to address that when it is not.

On Friday, the government announced an independent inquiry into the events surrounding the Letby case.

Education Secretary Gillian Keegan has said the inquiry should consider whether NHS managers need to be regulated in the same way as doctors.

Dr Brearey has said that given the "magnitude of the events that occurred" and the impact Letby's crimes have had on so many families, the inquiry should be judge led and have statutory powers - so witnesses can be forced to give evidence if needed. It is "clearly what the parents deserve," he added.

Currently, the inquiry that has been announced is non-statutory, meaning it has lesser powers.

Asked whether the inquiry should be statutory, Ms Keegan said that option "is on the table" and "can be discussed".

The inquiry aims to look into the wider circumstances surrounding what happened, including the handling of clinicians' concerns.

Former chief executive of the hospital Tony Chambers and former medical director Ian Harvey, who were in charge at the time Letby was working at the hospital, have said they will co-operate fully with the inquiry.

Alison Kelly, who was the senior manager in charge of nursing at the time, is being investigated, the Nursing and Midwifery Council, or NMC, said on Tuesday.

She had previously been suspended from her current role as director of nursing for Rochdale Care Organisation, part of the Northern Care Alliance, "in light of information" that emerged during the trial.

NMC, the nursing regulator in the UK, said it will investigate Ms Kelly's role as director of nursing at the Countess of Chester Hospital, a position she left in 2021.

Separately, calls are growing for the government to change the law to compel convicts to attend sentencing. Letby refused to turn up in the dock at Manchester Crown Court on Monday.

The judge proceeded without her and addressed her as if she were in the dock.

Letby was given multiple whole-life terms - one for each offence - becoming only the fourth woman in UK history to receive the sentence of whole life order. The trial lasted for more than 10 months and is believed to be the longest murder trial in the UK.

Prime Minister Rishi Sunak said it was "cowardly that people who commit such horrendous crimes do not face their victims".

BBC Panorama and BBC News investigated how Letby was able to murder and harm so many babies for so long. The 33-year-old deliberately injected babies with air, force fed others milk and poisoned two of the infants with insulin.