On 18 August 2023, Lucy Letby was convicted of the murder of seven babies and the attempted murder of six. This makes her the most prolific child killer in the modern history of the United Kingdom (UK). In the wake of this conviction, this blog will discuss the case’s legal impacts on the UK’s National Health Service (NHS).
By Dennis Turner, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=14063725.
Lucy Letby was a neonatal nurse at the Countess of Chester NHS Trust. She was arrested three times from July 2018 to November 2020, but was bailed twice pending further enquiries. While several reports had been filed since 2015 of a suspicious increase in the number of baby deaths and non-fatal collapses in the hospital, they were ignored or dismissed by the senior management at the hospital. This highlights issues with whistleblowing and patient safety in the NHS, mainly attributed to the power imbalance between staff and senior management.
More than 500 consultants were interviewed for the ‘After Lucy Letby: Silence on the Wards?’ ITV documentary. 71% of these consultants said their careers would be harmed if they raised any patient safety concerns. Reasons for this included bullying accusations, the threat of unfavourable regulator (General Medical Council) referrals, and potentially losing their jobs. Dr Ravi Jayaram, a consultant paediatrician at the Countess of Chester NHS Trust, called for a shift in NHS culture to facilitate greater accountability of staff behaviours. For example, developing a collaborative environment based on patient input and revising the appraisal process for senior NHS managers.
In response to the Letby case, the Department of Health and Social Care implemented an inquiry led by senior judge Dame Kate Thirlwall. Inquiries involve investigations, into issues of public concern, for accountability or improvement purposes. Legal principles and considerations are scrutinised, particularly ‘lawful decision making, fairness, and due process’. The inquiry into the Letby case covers three areas: the experiences of all the affected parents, the conduct of hospital staff and managers, and NHS culture.
It was announced on 30th August 2023 that the inquiry had shifted from a non-statutory status to become statutory. Statutory inquiries have legal powers to ‘compel witnesses to give evidence’ and require evidence to be heard in public. This change aims to gain more effective access to the truth of the Letby murders.
The UK Government has committed to introducing legislation concerning a new death certification process involving medical examiners, which takes effect in April 2024. This legislation will ensure that deaths in all medical settings will be independently investigated, even if they are not examined by the coroner. The review of medical records, examination of the Medical Certificate of Cause of Death, and interactions with the bereaved will be extended to primary care.
Lucy Letby refused to attend her sentencing at the Manchester Crown Court during the criminal prosecution. This caused public outrage. The Lord Chancellor and Secretary of State for Justice, Alex Chalk, has declared his intention to amend the law to make it mandatory for perpetrators to attend their sentencing hearing.
Under Section 46 of the Youth Justice and Criminal Evidence Act 1999, medical professionals involved as witnesses in the Letby case will receive ‘lifetime anonymity’. This is to prevent the ‘mental distress and health problems related to giving evidence, stress during trial, [and] concern about being identified by the public’. This is important as it encourages better quality evidence and reduces losing the focus of the case.
In a statement delivered on 4 September 2023 by the then Health and Social Care Secretary, Steve Barclay, several ‘forward-facing’ initiatives were introduced.
The ‘Getting It Right First Time’ programme, which focuses on improving the treatment and care of NHS patients, will launch a ‘centralised and regularly updated dataset to monitor the safety and quality of national neonatal services’.
The Government plans to implement ‘Martha’s Rule’, a three-step process drawing inspiration from the ‘Ryan’s Rule’ system in Queensland, Australia. Martha’s Rule will involve a clinical review of patient cases that are deteriorating or do not seem to be improving by a critical care outreach team. All NHS staff and patients, their families, carers, and advocates will have access to this 24/7 review.
The ‘Freedom to Speak Up’ policy, which supports NHS staff in raising concerns, will be amended to make routes to speaking up more accessible to staff. For instance, through Freedom to Speak Up Guardians. This policy has been implemented since January 2024 across all trusts and we are yet to see its impact.
Moreover, NHS England is considering the regulation of non-clinical NHS managers. This includes exploring recommendations posed in the Kark Review regarding disbarring senior managers in the case of misconduct. Dr Henrietta Hughes, the Patient Safety Commissioner for England, supports using an Accredited Register to conduct a regulatory check on senior managers. Reforms are needed to ensure consistent competency standards across trusts, considering the Care Quality Commission's inaccurate report in 2016 of ‘good leadership and communication’ in the Countess of Chester NHS Trust despite the senior management’s dismissal of and delayed responses to staff concerns about Lucy Letby.
The Lucy Letby case exposed flaws in the UK’s healthcare system regarding whistleblowing and patient safety. In response, a statutory inquiry is being conducted, and the UK Government has proposed several measures to address these issues. While they intend to promote greater accountability in the NHS, many measures do not appear to target reforms of NHS culture directly. However, if these improvements are complied with, and further measures to shift NHS culture are established, they should be effective in pre-empting another harrowing case like the one of Lucy Letby.
By Marion Mah, LLB Law Student