A senior NHS leader has claimed Lucy Letby was scapegoated by incompetent and over-confident doctors who were unwilling to consider that their failing neonatal unit had harmed babies.

The 36-year-old nurse is serving 15 whole life terms in prison after being convicted of murdering seven infants in her care and attempting to murder seven more at the Countess of Chester Hospital in 2015 and 2016.

This week, the Thirlwall inquiry concluded that a failure in safeguarding and poor systems prevented her being stopped earlier.

But a senior NHS boss, with 30 years’ experience, has contacted The Telegraph to say he believes Letby is innocent, and to argue that the Thirlwall recommendations will not prevent further harm.

Writing for The Telegraph, below, he has chosen to remain anonymous for fear of reprisals, but his identity has been verified by this newspaper.

“I do not believe Lucy Letby murdered those babies,” he said. “Having spent 30 years watching how hospitals fail, I can see another narrative that explains what happened in Chester without a murderer in it.

“It is a narrative that is uncomfortable, ordinary and, I think, far more likely. Healthcare harms patients. Globally, every day of every year. That is an uncomfortable fact, but it is a fact.

“What I see is a unit caring for babies who were sicker than the teams working there were competent to manage. I see a team too confident in its own standing to admit that. I see a trust that was not curious enough, soon enough, to recognise the impact on outcomes and downgrade the unit.”

The manager said that medical schools taught doctors to believe they were more important than other hospital staff, which tended to lead to arrogant displays of “groupthink”.

It was consultants at the Countess of Chester who first accused Letby of harming babies, noting that she was present at the majority of the collapses and deaths.

But a panel of international experts working for her defence team concluded many of the babies suffered poor care at the hands of doctors, and there were a number of medical mishaps during the period.

In 2015, an inquest found that baby Noah Robinson had died after doctors at the Countess of Chester wrongly put a breathing tube into his gullet. And since Letby’s convictions, several families have come forward to talk about poor care at the hospital.

The manager said many doctors were unwilling to question their own competence, and looked for others to blame.

“This system produces many compassionate and competent clinicians,” he added. “It also produces too many who are entitled, competitive and combative, and who see themselves as separate from, and above, the teams around them.

“A group of doctors, confident in their own judgment and used to being deferred to, begins to see a pattern. They confer with each other and not with anyone outside the group. Each conversation makes the pattern more certain.

“Alternative explanations, particularly those that would implicate the group’s own competence or the unit’s capacity, are not seriously entertained, because entertaining them would be a loss of face.”

He added that medical culture “remains an underdiagnosed sickness within the NHS”, with consultants often boasting of “owning patients” and “being the name at the end of the bed”.

The manager also blamed frequent changes in strategic direction driven by government policy, targets and performance structures for placing patients at further risk.

“Put those two factors together and the Countess of Chester looks very different from the story we have been told,” he said.

“Consultants at Chester are widely regarded as having done the right thing: they saw something wrong and they said so.

“I do not doubt their sincerity. But sincerity is not the same as being right.”

The Countess of Chester’s neonatal unit was downgraded in June 2016, meaning it could no longer take such vulnerable babies as before.

At the same time, the spike in deaths and attacks on babies stopped, but the downgrade also coincided with Letby being removed from the unit, and the prosecution claimed the decrease was because the nurse was no longer working with the babies.

The senior manager said it was likely that death rates improved once admissions “matched to the competence of the teams caring for them”.

Letby’s case is being reviewed by the Criminal Cases Review Commission (CCRC), which deals with potential miscarriages of justice. It is expected to report back before Christmas.

Cheshire Constabulary and the Crown Prosecution Service continue to stand by the original verdicts, arguing that two juries convicted Letby, and three Court of Appeal judges refused to grant leave to appeal after examining the evidence.

---

I can see a narrative for baby deaths without a murderer in it

By Anonymous

Death has a devastating impact on a person’s loved ones. I am a healthcare professional with 30 years of experience, and I currently hold a very senior leadership role in the NHS.

I have lost count of the number of patients I have been with in the last minutes of their lives. But, as with every healthcare professional, there are some I will never forget: deaths that have reserved a space in my consciousness because of the impact they had on me then, and have had in every year since.

Those memories are visceral. I can see them in colour; I can hear them. The process of death is, by definition, the same. The cardiovascular and respiratory systems cease to function, and the cascade of organ failure follows. Some deaths are traumatic, some are peaceful, but in every case that lives with me it is the pain of the loved one – the partner, the parent, the child – that I remember.

Foremost among them are the cruel, sudden and unexpected deaths of children: the screams of a mother, the deep sobs of a grandparent I held in the resuscitation room.

I start with this because I need you, the reader, to understand that I know the pain, the need for answers, the need for accountability, and even the need for blame that comes from grieving families when someone dies, especially a child. I understand it.

But the parents of the babies who died at the Countess of Chester will ultimately find no comfort if the lessons of their children’s deaths go unlearnt.

I do not believe Lucy Letby murdered those babies. I am not going to pull the evidence apart here. Others, better placed than me, have identified gaps in it that, at the very least, make the conviction unsafe, and the proper place for that argument is a courtroom. It needs to get there, and it needs to get there with haste.

My contribution is different. Having spent 30 years watching how hospitals fail, I can see another narrative that explains what happened in Chester without a murderer in it. It is a narrative that is uncomfortable, ordinary and, I think, far more likely.

And unless we – as a society, as politicians and as clinicians – are prepared to confront it, we will go on seeing avoidable deaths, in Chester and everywhere else.

Healthcare harms patients. Globally, every day of every year. That is an uncomfortable fact, but it is a fact. Most of that harm is minor and transient. In too many cases, it is permanent or fatal. The literature on healthcare-associated harm is vast, and I will not rehearse it here.

What I want to do instead is name the modifiable factors I see in the Countess of Chester case. They are the same factors I see causing harm elsewhere in the NHS, right now. They are the factors I hear too little discussion about.

And they are the factors the Thirlwall Inquiry was never going to find, because it began from the assumption that this was a case of murder rather than a case of failure.

The first is medical culture. It remains an underdiagnosed sickness within the NHS. It begins in medical school, where five years of undergraduate training prepares doctors for the foundation programme – the first two years of medical practice – and immerses them, for those same five years, in medical culture: how to behave, what to value and what to expect.

This system produces many compassionate and competent clinicians. It also produces too many who are entitled, competitive and combative, and who see themselves as separate from, and above, the teams around them.

That sense of separateness is reinforced at every turn by the different ways in which doctors are treated: in professional development, in disciplinary processes, in pay and reward.

Consultants talk of “owning” patients, of being “the name at the end of the bed”, of “bringing in the income”, without recognising that they are members of multidisciplinary teams and employees of the organisations in which they work.

The consequence is not simply bad manners. It is a specific failure mode, and I have watched it play out many times. A group of doctors, confident in their own judgment and used to being deferred to, begins to see a pattern. They confer with each other and not with anyone outside the group. Each conversation makes the pattern more certain.

Alternative explanations, particularly those that would implicate the group’s own competence or the unit’s capacity, are not seriously entertained, because entertaining them would be a loss of face. By the time anyone outside the room hears about it, the conclusion has hardened into a conviction, and anyone who questions it is treated as an obstacle to patient safety.

It is not a mob. It is a closed circle, and closed circles do not self-correct.

The second factor is the structure of the NHS itself. It is complex, and I will not attempt to map it here. But the frequent changes in strategic direction driven by government policy, the payment mechanisms, the performance management framework and the regulatory environment together create risk for patients.

These structures shape what leaders and organisations do. They drive decisions about services, staffing, equipment and priorities, and those decisions land directly on the care patients receive. When the incentives point at financial and operational targets, that is what organisations manage to. Outcomes come second.

Put those two factors together and the Countess of Chester looks very different from the story we have been told. What I see is a unit caring for babies who were sicker than the teams working there were competent to manage. I see a team too confident in its own standing to admit that. I see a trust that was not curious enough, soon enough, to recognise the impact on outcomes and downgrade the unit.

And I see that once that decision was finally made, and the acuity of the babies admitted was matched to the competence of the teams caring for them, mortality improved.

I know that the consultants at Chester are widely regarded as having done the right thing: they saw something wrong and they said so. I do not doubt their sincerity. But sincerity is not the same as being right, and the behaviours I have described above – the closed circle, the certainty, the reluctance to look inward – are exactly the behaviours that turn a sincere concern into a wrong conclusion. That, I believe, is what happened.

None of this is exotic. It is ordinary. That is precisely why it matters. A good outcome from Thirlwall would have been recommendations on medical education and medical culture, on the quality of medical leadership, on recognition, from Government, that stability of policy is itself a safety intervention, on stabilising payment mechanisms, and on incentives that pull leadership and organisational decisions towards outcomes rather than solely towards financial and operational targets.

Instead, we have a report that will gather dust, and a nurse who may spend the rest of her life in prison for a crime I do not believe she committed.

I recognise how hard that is for grieving parents searching for closure, and I do not say it lightly. But I do not think the offence here was murder.

It was a managed decline in our commitment to free and universal healthcare, and a long failure to modernise the medical profession. Those are the things that harmed those babies, and they will go on harming patients until we are honest enough to say so.

The author is a senior NHS leader with more than 30 years’ experience