Lucy Letby – a warning for NHS culture

The tragic loss of life and heartache caused by Lucy Letby is beyond imagination. Our hearts go out to all those affected.

Undoubtedly, mistakes were made that look even worse with the power and accuracy of the ‘retrospectoscope’.

Patient safety was not put first, nor was the dogged pursuit of the truth of what happened in each case. It seems these were trumped by reputational concerns and a desire not to upset the feelings of the individual involved.

The precautionary principle was not applied.

However, I find the official NHS response disingenuous.

There are good whistle-blowing policies in place, we are all in a governance structure, and an accountability framework, and all staff do (or should) have appraisals. But these policies ‘sit on a shelf’. At the same time, day by day, there is enormous pressure from above that gives a very different message – ‘do not complain, do not cause a scandal, meet the targets, do everything – regardless of resource, regardless of staff shortages – and do this while also delivering this year’s cost savings’. Even though this is patently impossible.

This is an unequal fight between a good, well-written policy and the daily pressure, whose message is in many ways the opposite – ‘deliver, and do whatever is needed to deliver’. The government, NHS England, CEOs, and Trust Boards don’t always want to hear the truth.

The government’s primary concern is re-election, and the avoidance of, and limitation of, reputational damage. This culture is cascaded down through the system, not least through Trust CEOs, whose jobs are on the line if they are deemed responsible for reputational damage and the ensuing political fallout. With an average tenure of only three years for an NHS CEO, this is a very well-grounded fear!

There is often no honest conversation.

Indeed, a candid conversation is often discouraged in practice (despite what is said). The system doesn’t want to hear about the daily shortages and shortfalls. There is neither the political courage nor will for the honest conversation that recognises that, at this time, with these resources, and with these limitations, we can do ‘this’, but not ‘everything’. It feels like plausible deniability has become an NHS art form.

I would suggest this is responsible for a highly politicised and corrosive culture coming from the top, which is, at least in part, the culture that allowed the dreadful events of the Lucy Letby case to continue when they should have been stopped much earlier.

It is a culture in which reputation and massaging the truth for the best political spin are more important than the truth or patient care.

Which leads us to prayerfully reflect on our role as Christians. What is God calling us to do, or perhaps more importantly, calling us to be?

To pray certainly, but also to be champions of multiple, honest conversations in the corridors of power and locally in wards, surgeries, and departments throughout the country, day by day.

Honest conversations in support of our colleagues (often more junior) on an impossible night shift or an under-staffed ward, but also with our CEOs and Directors of Finance and Execs who make impossible decisions every day with the constant threat of the sack hanging over them.

And then, of course, to support each other as Christians working in healthcare and healthcare leadership roles throughout the NHS, as we seek daily to have those honest, supportive conversations. We support our juniors and nurses when they are put in impossible clinical situations, and we also support our CEOs and managers who have to make impossible decisions. To support each other as we seek to do this in a godly way. The Christian Medical Fellowship’s Christians in Healthcare Leadership Network (CHLN) has been started to do just this – a supportive network where those who live and breathe the challenges of getting stuff done in the NHS can thoughtfully and prayerfully consider how to apply our faith day to day and support each other in that.

In today’s NHS, true honesty is not always a welcome message. It is a hard message to give against the pressure to be quiet and not rock the boat. It has not ended well for most whistle-blowers in the NHS, in the same way as it did not end well for many of the prophets of the Old Testament. Yet, God did and still does call us to champion the truth and to speak up for the voiceless, as he called Jeremiah to speak to King Zedekiah, or Nathan to King David, or Moses to Pharaoh.

The GMC’s newly-updated Good Medical Practice is with us on this, giving:

formal recognition of the role we all hold in shaping workplace culture regardless of seniority or specialty. Clinical leaders are especially important in modelling and enabling the values and behaviours which support and encourage environments where concerns can be raised, questions asked and everyone feels valued.

God’s call on our lives is the same today as it was 2,500 years ago; God calls us to get involved in the messy, complex business of the secular world and to make a difference.

Chris Holcombe is a recently retired surgeon who has held multiple leadership roles in the NHS. He now heads up CMF’s Christians in Healthcare Leadership Network (CHLN)