‘Letby case shows why NHS must empower nurses to speak up’
Children’s nurse of 40 years whose own baby grandson was cared for by the serial killer says layers of hierarchy in the NHS are used to stifle complaints
An experienced children’s nurse whose grandson was in the care of Lucy Letby has called for changes to the NHS hierarchy to make it easier to raise concerns.
Speaking exclusively to Nursing Standard – and choosing to remain anonymous – the nurse argued that chains of command serve ‘to protect the wrong people’, often making it harder for staff to speak up.
‘We must somehow break the hierarchy that means because you’re a band 5 nurse, or a healthcare assistant, or a parent, you cannot raise concerns at senior levels. We’re forgetting about allowing people to speak out if they have a gut feeling something is wrong,’ she said.
‘When there is a problem there is no autonomy to act. The decision is shelved to the next layer, the next layer, the next layer. It’s also very difficult when chief executives have the power to squash things and keep them internal.’
Whistleblowing at Countess of Chester Hospital
In Letby’s case, consultants raised concerns about her association with a number of baby deaths and collapses at the Countess of Chester Hospital in Cheshire as early as June 2015. But the then head of nursing Alison Kelly, along with other hospital managers, did not remove Letby from nursing duties at that time. It took a full year for this to happen, after multiple complaints from the consultants.
Following Letby’s sentencing for the murders of seven babies and attempted murders of a further six, an inquiry was announced. Part of its scope will be to examine how clinicians’ whistleblowing was handled. And on 30 August, England’s health and social care secretary Steve Barclay revealed the inquiry would have statutory status – with power to compel witnesses to give evidence under oath.
Move to strengthen freedom to speak up policies across NHS England
The government has also vowed to strengthen NHS freedom to speak up policies in light of the case. Mr Barclay told the Commons on 4 September all trusts in England will have strengthened policies in place by January to bring consistency across organisations, ‘supporting staff to feel more confident to speak up and raise any concerns’.
The children’s nurse welcomed the announcement of a statutory inquiry as an opportunity for the voices of those involved in the case to be heard.
She told Nursing Standard her grandson was on the Countess of Chester neonatal intensive care unit in 2015 and his case notes show Letby spent four hours with him.
The baby beside her grandson died and she and her family believe the infant was one of Letby’s victims. These children have not been named publicly.
Expert reviews have been unable to determine whether Letby also tried to harm the woman’s grandson. She said her family has been left plagued by doubt, haunted by unanswered questions, and now lack faith in health services.
‘Nurses lack autonomy to take action when they see a problem’
Sadly, her view of the profession she has been part of for 40 years has changed.
‘It’s made clear to me that communication is now totally missing. We've seen it all the way through with Lucy Letby and we had it with Beverley Allitt too,’ she said.
‘People are not talking to each other, and when there is a problem there is no autonomy to act.’
The nurse fears without change to make it easier for staff to raise concerns, patient safety will be put at further risk.More on the Lucy Letby case
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