Dr Katie Musgrave says the dysfunctional health system enabled Lucy Letby to kill for as long as she did
The truly disturbing and horrifying details that have emerged from Lucy Letby’s case will be on the minds of NHS staff across the country. The scale of Letby’s crimes are clearly unprecedented, and the implications for clinical practice are yet to be determined. For now, we have one monstrous woman – entrusted with enormous responsibilities – who abused the trust of parents and colleagues to harm and kill the most vulnerable babies.
Even if Letby’s motives never become entirely clear, this scandal must raise far bigger questions than one mass murderer. How were systems such that so many unexpected deaths could take place without being acted upon sooner? How could people have had significant suspicions about the potential murder of babies without these being taken seriously? How could managers have moved her to an alternative role while insisting on an apology letter? And why have some of the managers responsible been able to continue in their careers without being held accountable for their part in this awful tragedy?
But I believe the most fundamental question must be whether the NHS makes patient safety enough of a priority and, crucially, what it will do in the wake of this scandal, to do this much, much better.
I was intrigued to read the suggestion from barrister Lord Carlile of Berriew that the forthcoming inquiry must appoint a foreign medical expert to avoid it being influenced by pro-NHS bias. Of course, he is right. For too long, the NHS has been allowed to mark its own homework.
And as history is beginning to tell us (I won’t list the scandals here, there are too many to name), we in the NHS have repeatedly been unable to see the dysfunction that is right before our eyes. We have normalised the abnormal, and every now and again, even more unforgivable acts slip through the cracks.
I think of my time as a junior doctor. Starting out, I was horrified at the level of responsibility I was given from my very first day. Those hundreds of inpatients I was responsible for on call overnight. I didn’t have a clue: I had no support, and I doubtless made countless serious errors due to inexperience. Those ward rounds we did post-take, where surgeons would boast how many patients they could see in a day. It was far, far too many. We were at the bedsides of acutely sick patients for sometimes only a minute, making life and death decisions on the fly. It wasn’t good enough, or safe enough. It isn’t good enough.
We do the same in general practice. Coming in, invariably the registrars complain: ‘There are too many patients, I can’t see them all safely.’ But we indoctrinate them: ‘This is just what general practice is like.’ And: ‘It’s okay, you’ll get used to it.’ They shouldn’t get used to it. It isn’t okay.
As appalling as Letby’s acts were – and I pray a million miles away from how any of us would ever behave – is there something in our healthcare system that is leaving us unable to challenge poor, dangerous, or even criminal, care? Have we become so fixated on delivering the most efficient care that we have forgotten the importance of being human? Have systems been under strain for so long that in their fire-fighting mode, good clinical leaders cannot see a way through the problems?
I’m sadly convinced that Letby’s case is a symptom of deeper malaise. Look closely in every hospital (and probably in plenty of GP surgeries, too) and you will find examples of dysfunctional services. Clinicians who have been overwhelmed by demand for so long that they cannot see a way to make things better. Situations where a callous individual could conceivably get away with crimes like Letby’s because the degree of chaos around them disguises these crimes.
Perhaps Lord Carlile of Berriew is on to something important. Perhaps the NHS needs to invite foreign experts in to inspect all our hospitals, our GP surgeries, our ambulance units, the lot. It’s time that we shone a bright light on what happens in our health service, and ask for broader opinions on what we can do better as well as what needs to urgently change.
A public inquiry into the Letby case is clearly necessary, but this alone will not stop the next scandal.
Dr Katie Musgrave is a GP in Devon and quality improvement fellow for the South West