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The GMC’s Good Medical Practice guidance is clear on what it means to be a good doctor. It says that as a good doctor you will:
“Make the care of your patient your first concern
Be competent and keep your professional knowledge and skills up to date
Take prompt action if you think patient safety is being compromised”
On 18th August 2023, Lucy Letby was found guilty of murdering seven babies, and attempting to murder at least six more, whilst employed at the Countess of Chester Hospital in Northwest England. This case exemplifies the consequences of healthcare concerns not being escalated by those suspecting poor clinical practice, or the lack of action by those to whom the concerns have been raised.
This highlights the complexities that health professionals sometimes face, even when equipped with guidance, when reporting substandard care in their place of work. It suggests a scenario where some professionals believe that senior managers might not be acting in the best interest of patients, despite being informed of potential harm within the institution. A variety of reasons, including concerns about potential reputational damage, might have influenced the perceived inaction.
So, the question arises: what additional steps could health professionals have taken when faced with such dilemmas? There are several external avenues available for intervention when internal channels seem ineffective:
- NHS Entities. Contacting the Clinical Commissioning Group (CCG, now known as ICB), NHS Region, or NHS England can offer alternative solutions.
- Government Bodies. Local MPs or the Department of Health and Social Care (DHSC) are potential points of contact.
- Inspection Authorities. The Care Quality Commission (CQC) serves as an independent regulator for health services.
- Professional Associations. Organisations like the GMC for doctors or the RCN for nurses can offer guidance or intervention.
- Whistle-blowing Mechanisms. Even though historically these systems might not have been as robust, they serve as a channel to raise concerns. It’s worth noting that these systems, at times, report to the Executive team, which might be perceived as part of the issue. This would also include Freedom to Speak Up Guardians in healthcare facilities.
- Law Enforcement. If the circumstances warrant, contacting the police is an option, as they are not solely reliant on managerial discretion.
- Media. Whilst it’s a more unconventional route, the press can be approached if other channels fail to yield results and if public awareness is deemed necessary.
Conclusion
As more information regarding the case is released, many more staff will come under scrutiny from law enforcement, to examine the systemic failures that allowed Letby’s crimes to go unchecked. Indeed, there are growing calls for managers in NHS organisations to shoulder the same level of responsibility as healthcare professionals when it comes to actioning requests for investigations into clinical concerns.
Hindsight though, as they say, is 20/20. Evaluating past events can offer clarity. As health professionals, continuous reflection on prior challenges, such as the Shipman and North Staffs incidents, is crucial. The objective is not just to remember but to ensure that valuable lessons from these events inform future actions.
There is an ongoing commitment by doctors and nurses to take the necessary steps, especially when concerns appear to be side-lined. The case serves as a reminder that we are all, patients and healthcare professionals alike, responsible for speaking up when things go wrong.
As always, best wishes from myHSN!
