Senior managers in the NHS should be independently regulated and struck off for poor performance, Lucy Letby inquiry hears 

Senior managers in the NHS should be independently regulated and struck off for poor performance, the inquiry into serial killer Lucy Letby heard today.

Top lawyer Sir Robert Francis KC, who has overseen several inquiries into NHS scandals, said better accountability was needed to stop the merry-go-round of bad leaders moving from one NHS hospital or Trust to another.

And he called for a professional body, similar to the General Medical Council, which regulates doctors, to be set up so performance can be scrutinised and those found to be failing disqualified from holding top posts again.

Sir Robert, who was giving evidence to the public inquiry into Letby’s crimes, said there is currently no effective way of testing whether NHS chief executives or senior directors are ‘fit and proper’ for those posts.

Although the health inspectorate, the Care Quality Commission, is supposed to oversee a fit and proper person test, the CQC has never investigated any individual and the system ‘hasn’t worked,’ he said.

Lucy Letby, 34, was convicted of murdering seven babies and attempting to murder six others, in August last year, before being convicted of another count of attempted murder, in July, following a re-trial

An NHS hospital (stock image). Top lawyer Sir Robert Francis KC, who has overseen several inquiries into NHS scandals, said better accountability was needed to stop the merry-go-round of bad leaders moving from one NHS hospital or Trust to another

Letby, 34, was convicted of murdering seven babies and attempting to murder six others, in August last year, before being convicted of another count of attempted murder, in July, following a re-trial.

Following her first trial, Dr Stephen Brearey, the lead consultant at the Countess of Chester Hospital, where she worked, also called for a regulatory body for hospital managers. He and his colleagues claim that when they went to senior executives with concerns about Letby that they were dismissed and she was allowed to carry on working.

Read More

NHS is not set up to catch 'bad apples' due to 'no blame' culture, expert tells Lucy Letby inquiry

Sir Francis told the inquiry, sitting at Liverpool Town Hall, that such a body was needed.

‘In my opinion there have been some pretty egregious cases recently of evidence of a chief executive or chair criticising whistleblowers and nothing much happened,’ he said.

‘If a doctor is not thought to be fit or proper then the General Medical Council will investigate and, if it sees fit, it refers a case to the Medical Practitioner’s Tribunal Service, which is an independent adjudicator, who decides on the fitness of that person to continue in practise. There’s no equivalent for non-clinical managers and there should be.’

He said this organisation should be able to ‘disqualify’ senior managers if they are found to be failing.

‘The sad thing is, if a doctor is brave enough to become the chief executive of a Trust and acts in a way contrary to the patients’ interests the GMC can, and occasionally, has acted,’ Sir Robert added. ‘There’s no such procedure for non-clinical managers and the result I’m afraid is that people who haven’t done terribly well may leave one job and then pop up in another.

Dr Stephen Brearey, the lead consultant at the Countess of Chester Hospital (pictured), where she worked, also called for a regulatory body for hospital managers. He and his colleagues claim that when they went to senior executives with concerns about Letby that they were dismissed and she was allowed to carry on working 

Families of Letby’s victims have told inquiry chair Lady Justice Thirlwall that senior management at the Countess were ‘complicit’ in Letby’s killing spree, between June 2015 and June 2016 

‘So I am in favour of there being a system of regulation. There ought to be a means of disqualifying someone from being the chief officer or senior director of an NHS organisation.’

Read More

Key expert in Lucy Letby trial gave 25 further suspicious incidents to police

Sir Robert, who oversaw the public inquiry into poor care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 said that, in his experience, there was ‘remarkably little competition’ for top jobs in the NHS. He gave the example of Mid-Staffs where a ‘frankly unsuitable person’ got the job of chief executive because ‘there was no-one else.’

Sir Robert’s inquiry, published in 2013, uncovered the neglect of hundreds of patients who died at Stafford Hospital and made sweeping recommendations for change.

Families of Letby’s victims have told inquiry chair Lady Justice Thirlwall that senior management at the Countess were ‘complicit’ in Letby’s killing spree, between June 2015 and June 2016, and have also accused them of ‘facilitating a murder’ by ignoring the consultants’ concerns.

However, senior managers have claimed they were not informed until late June 2016 about suspicions that Letby was deliberately harming babies in the neonatal unit. She was removed from frontline nursing weeks later to a non-patient role, although police were not called in by the hospital until May 2017.

Letby, from Hereford, is serving a whole life tariff and has been refused leave to appeal her convictions, meaning she will never be freed on parole and will die in jail.

The inquiry is expected to sit until early next year, with findings published by late autumn 2025.

Sir Robert suggested the leaders of NHS hospitals needed the same qualities as those running a FTSE 100 company, albeit they are expected to work under the same pressure for a much lower wage.

Lady Justice Thirlwall commented: ‘What you are looking for is a tip top leader who has an ethos of public service who is prepared to work at a different rate than you might expect to get at a FTSE 100 company and, from what you say, there are very few people like that running big hospital Trusts.’

Sir Robert said a specialist NHS residential training college ought to be set up, similar to police training colleges, which could identify potential hospital leaders much earlier in their careers and equip them for running large Trusts in the future.

‘I recommend a training college...where you bring together people who are potential candidates for these higher positions long before they get there and give them intensive training to assess their competence, how good they are with team work, their behaviours and so on.

Chair of the inquiry Lady Justice Thirlwall heard Sir Robert suggestions that the leaders of NHS hospitals needed the same qualities as those running a FTSE 100 company, albeit they are expected to work under the same pressure for a much lower wage

‘It will allow people to see who is going to make the grade or not.’

He said ‘bad things happen’ in the NHS when staff ‘forget’ to put patients first or keep them at the ‘forefront of their minds’.

Too often the duty of candour - a legal requirement that requires NHS bodies to be open and honest with patients and their families when something goes wrong with their care - is treated ‘a bureaucratic process and defence mechanism’ rather than an opportunity to involve them when something has gone wrong, Sir Robert said.

Families ought to be part of the ‘search for answers,’ he added.

‘Any investigation that doesn’t take patients (or their families) along with them has failed.’

Peter Skelton KC, who represents some of the parents of Letby’s victims, said it was an issue for the inquiry that families had concerns which were never articulated but ‘mirrored concerns of clinicians’ at the Countess.

Sir Robert agreed families of patients often ‘had things to contribute’ and were the ‘experts of the wellbeing of their child’ and NHS staff ‘must listen to them.’