Lucy Letby case proves fear of ‘bullying’ deters whistleblowers, warns union

Lucy Letby sentenced to whole-life order

Doctors are frequently deterred from complaining about concerns in the workplace by the threat of bullying and victimisation, a union leader has warned, after the sentencing of killer nurse Lucy Letby.

Letby was jailed for life at Manchester Crown Court on Monday for the murder of seven babies and the attempted murder of six more in 2015 and 2016, while working on the neonatal unit of the Countess of Chester Hospital.

Afterwards, doctors there revealed the intransigence and outright hostility they faced from senior executives as a result of voicing suspicions about Letby following a spate of suspicious deaths.

At one point two consultants were even ordered to write letters of apology to the Hereford-born 33-year-old, one of them, Dr Stephen Brearey, said.

Consultant anaesthetist Dr Claudia Paoloni, the former President and current executive member of doctors’ union the Hospital Consultants and Specialists Association (HCSA), told systems were in place for reporting concerns – but people were frequently put off using them for various reasons.

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She said: “Either they’ve tried to use them in the past and there’s been no outcome from them or they’ve tried to utilise them and it takes so long to get an outcome which then doesn’t have any appropriate action at the back of it so that they become disenfranchised with the system.

“And thirdly, in some cases, people who raise concerns can be victimised for doing so.

“So because of raising a care concern, which then has potential consequences and actions that are required, it seems that, especially if there’s already been relationship breakdowns with individuals and managers, you can end up with a series of situations which end up in the victimisation and bullying of the individuals who have raised the concern.”

The Francis Report, named after Sir Robert Francis and published in 2013 after allegations of patient neglect at Stafford Hospital, in turn led to the Freedom to Speak Up review two years later, which established a framework for whistleblowers, Dr Paoloni said.

She continued: “Even then at that point, he made the recommendation for protections for individuals raising concerns, which is how the Freedom to Speak Up system, which was initially called the Whistleblowing Support Scheme, got created.

“But that was 2013 and it’s 10 years ago, and while the systems are in place, they’re clearly not all working well in trusts.”

The union usually got involved with its members as a result of employment disputes and relationship breakdowns between employers and individuals rather than those centred on clinical practice, Dr Paoloni stressed.

However, she continued: “For many of our individuals, what started as a raising the concern over something clinical ends up with being a disciplinary action which then ends up with employment issues which we then deal with.

“So you can see that what happens with the individual is that for raising a concern, it goes down a route which ends up with an employment issue against the individual raising the concern.”

Doctors faced conflicting pressures when it came to reporting potential wrong doing in the workplace, Dr Paoloni pointed out.

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On the one hand, the General Medical Council (GMC) requires them to do so – but on the other hand, if they did there was a possibility it being met with “hostility” or implications for their careers including possible disciplinary action, she explained.

She added: “And then the big one as well is the human factor on those individuals because there is a wellbeing issue that comes out of this.

“For individuals who raise concerns and the concerns then aren’t actually taken seriously or acted upon that results in those individuals feeling unvalued, unable to keep patients safe, they feel guilty.

“And in some cases, especially when it comes to months of unemployment because they’ve been dragged through an investigation to their activity as to whether they’re actually the ones that are causing the problem then they end up being suicidal.

In the case of Letby, police were not contacted until 2017, after which Paul Hughes, a senior investigating officer at Cheshire Constabulary, met with Dr Brearey and Dr Ravi Jayaram, another consultant to discuss their concerns. She was eventually arrested for the first time in July 2018.

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For Dr Paoloni, the situation underlines the difficulties facing healthcare professionals.

She said: “If it’s clear criminal activity, then that’s an easy one to say, ‘well you go to the police, wouldn’t you’?

“But as with most medical cases, nothing’s ever clear cut especially when you’re dealing with vulnerable patients or sick patients.

“To know with absolute conviction, that there is some criminal activity is happening is really very difficult and to make that accusation is actually quite a hard one.

“The fact that they ended up doing it in the end would suggest that they were really at the end of the tether and they were relying on the normal standard processes that should work to stop the action from continuing because they wouldn’t have known that it was deliberate to start with either.”

In the Letby case there was very little in the way of hard evidence, with hospital managers initially seeking to dismiss as coincidence the fact that she was working on every shift during which a baby died or became ill in unexplained circumstances.

Dr Paoloni said: “It’s very difficult, which is why there are all these governance systems within organisations so you do have the critical incident and serious incident reporting systems, which is the first thing that you do.

“You do have policies in place that you follow that you raise concerns in a certain pattern or certainly follow the policy.

“And then if you’re not getting anywhere with that, or you don’t think it’s appropriate for that you can go to the Freedom to Speak up Guardians. So those governance processes exist, but what’s clear is, it’s pretty ad hoc as to how effective they are.

Asked to outline what needed to happen next, with the Government already having confirmed plans for an independent review in the case of the Countess of Chester, Dr Paoloni concluded: “I think the first thing immediate thing that firstly happens every single trust needs to review their existing systems and make sure they’re robust and effective.

“Secondly, we as an organisation feel that an independent statutory national body should be created to which is outside the NHS, where such potential actual whistleblowers can register themselves at the point of disclosure, and be protected against recriminations, where that body can actually monitor that investigation, the allegations and the actions being taken, and the outcomes.

“And then thirdly, also, to make it a criminal offence to cause detriment to people who have made a sensitive disclosure. There needs to be a consequence for that, because as a union, we see people’s careers destroyed because they’ve raised a concern, which has ended up in a disciplinary which, even if that disciplinary goes to tribunal, and they win, means their careers have been ruined over years, and there’s no recourse for that.”

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