After the second triplet died, he phoned a hospital executive and demanded that Letby be removed from the ward. The executive said there was no clear evidence against the nurse and insisted she was safe to work with, Brearey later told a court.
It would be another week before Letby, now considered the most prolific killer of children in modern British history, was moved to clerical duties, and months before the hospital’s senior managers contacted police.
She was finally convicted last week of killing those boys by injecting air into their bodies, murdering five other babies and attempting to murder six others in her care.
The harrowing case has not only horrified the nation but also raised profound questions about the workplace culture that allowed her to continue working, even after doctors raised alarms.
Since the trial, clinicians who worked alongside Letby have spoken out, describing a culture of hostility toward whistleblowers and a fear of scandal that they say meant their alerts were ignored.
The hospital delayed contacting police
In England, hospitals that are part of the National Health Service, or NHS, are operated by individual trusts that have their own management teams. The Countess of Chester Hospital Foundation Trust did not contact the Cheshire Constabulary, the police force responsible for the area, until early May 2017, a year and a half after doctors first began reporting their suspicions.
During the trial, the court heard that a number of paediatricians who worked alongside Letby, 33, including Brearey, had repeatedly alerted hospital executives to their concerns about the nurse.
Dr John Gibbs, who worked in the department, told Channel 4 news that there had been “resistance on the senior management side to involving the police, but I don’t know quite why.” He added, “We paediatricians were certainly concerned that someone — and suspicions fell on Lucy Letby — could have been harming and perhaps killing patients on the unit.”
After Letby left the unit, she began a grievance case against the hospital, claiming she was being victimised. In January 2017, some of the doctors were made to apologise to the nurse and asked to attend mediation sessions, including Brearey and Dr Ravi Jayaram, a paediatrician at the hospital for nearly two decades.
Jayaram had spoken up about Letby as early as October 2015 and recently told ITV he believed “babies could have been saved” if the situation had been reported to police earlier.
“There are things that need to come out about why it took several months from concerns being raised to the top brass before any action was taken to protect babies,” Jayaram said in a statement on Facebook on Friday, “and why from that time it then took almost a year for those highly paid senior managers to allow the police to be involved.” He declined an interview request from The New York Times.
The case highlights a problematic culture in the health service, experts say
Medical professionals say the fact that the trust failed to involve police sooner underlines a broader failing in the NHS. Rob Behrens, an ombudsperson who investigates complaints about government departments and the health service in England, said the trial revealed how, for too long, nobody listened despite repeated alarms.
Behrens was clear that the type of intentional killing seen in Letby’s case was extremely rare in the health service. But he said that senior managers’ ignoring warnings was “depressingly familiar.”
“I see this time and time again in the cases I investigate,” he said, noting that a number of independent reports in recent years pointed to a defensive culture and hostility to those who disclosed safety issues.
Dr Claudia Paoloni, an executive member of the hospital doctors union in Britain, said that the case followed a longtime pattern in which whistleblower clinicians were ignored or victimised.
“Every single trust should be reviewing their existing systems to make sure they are robust and effective,” she said.
Jayaram said in his Facebook statement that there was a long history of whistleblowers in the NHS “not only being ignored but then being portrayed as the problem, sometimes to the point of their careers being destroyed.”
“What happened here was history repeating itself,” he wrote, “but the patient-safety issue that was ignored was beyond anything that the NHS has tried previously to cover up.”
The case has prompted calls for change
Tamlin Bolton, a lawyer at Switalskis Solicitors, is representing the families of seven babies who were victims of Letby in civil claims against the Countess of Chester trust.
“We really need to look at what was known and what the trust knew during that timeline, to know what they could have done and what they should have done with what was presented,” Bolton said.
Immediately after the Letby verdict, the British government ordered an independent inquiry “to ensure vital lessons are learned and to provide answers to the parents and families impacted.”
But many experts, and representatives of the victims’ families, said this type of inquiry would not go far enough.
Behrens, the ombudsperson, sent a letter to the health secretary Wednesday calling for the government to set up a statutory inquiry, which would compel those involved to give evidence, rather than the weaker independent inquiry, which will allow people to opt out. He also requested better protection for whistleblowers.
“This is a critical, pivotal moment in the history of our health service,” Behrens said. “And we need to understand why patient safety is not considered as important as the reputation of the trust.”
This article originally appeared in The New York Times.
Written by: Megan Specia
©2023 THE NEW YORK TIMES
