Intended for healthcare professionals


Letby’s killing spree raises questions over NHS governance

BMJ 2023; 382 doi: (Published 22 August 2023) Cite this as: BMJ 2023;382:p1931

Linked Opinion

Lessons not learned

  1. Clare Dyer
  1. The BMJ

Lucy Letby, an outwardly unremarkable neonatal nurse found guilty last week of killing seven babies and attempting to kill six others, will spend the rest of her life in jail for a “cruel, calculated and cynical campaign of child murder,” in the words of Mr Justice Goss, who sentenced her to life imprisonment without the possibility of parole after a 10 month trial.

As Letby, 33, begins her life behind bars—only the fourth woman in UK history to receive a whole life tariff—the healthcare system is just beginning to grapple with a question: how was she allowed to get away with her killing spree in plain sight for so long, from June 2015 to June 2016?

That question will be at the heart of an independent inquiry promised by England’s health and social care secretary, Steve Barclay, immediately after the verdict was given. He announced a non-statutory inquiry without the power to compel witnesses and the production of evidence, but pressure is growing from families, doctors, politicians, and lawyers to convert it into a full statutory inquiry.

Consultant paediatricians told Manchester Crown Court that they had alerted the management at the Countess of Chester Hospital to the fact that Letby was the only nurse on duty for all the incidents, but the management ignored the consultants’ concerns for months and even made them apologise to Letby for “inappropriate statements” about her after she registered a grievance accusing them of bullying her. Doctors were told that Letby’s parents had threatened to refer them to the General Medical Council.

Letby was finally removed from the neonatal unit and given an administrative post in early July 2016, but managers were considering allowing her back on duty. Doctors pressed for months for the police to become involved, but it was not until May 2017 …

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