I was planning to comment on the arrest of three NHS managers on charges of manslaughter in connection with the supposed murder of children by Lucy Letby today, but then I noticed what Roy Lilley had to say on the issue, and thought it both pithy and wholly appropriate:
The Lucy Letby drama took a new twist yesterday. Three of the bosses at her former hospital were arrested on suspicion of gross-negligence, manslaughter.
Arresting managers is a highly unusual step.
I think most fair minded people would say Letby's convictions, based on what we now know are at best, unsafe and deserve another look.
If Lucy Letby didn't kill those babies, then what exactly are we accusing the managers of failing to stop?
Arresting people for not preventing a crime that may not have happened isn't justice, it's theatre.
The evidence against Lucy Letby now looks to be utterly threadbare, at best. Many medics from across the world say it lacks any credibility.
The baby unit at the hospital at which she worked failed because it was treating neonatal babies that it was underqualified to care for, did not have the expertise to manage, and was ill-equipped to manage. When the ages of babies that it was allowed to treat was increased, their death rate returned to normal.
But, to maintain the farce that there was not a systems failure in the NHS, due to cuts, politicians are maintaining the line that Lucy Letby killed babies, and is now accusing managers of letting her do so.
As Roy Lilley says, this is not about justice, it is about theatre. But there are dangerous side effects.
Who will want to be a neonatologist in the environment we now have in the UK?
Who will want to be a neonatal nurse?
Who will want to be a hospital manager?
All now face the risk of such extreme scrutiny that an already hard and extremely demanding job will become totally unattractive when there are better options available.
And who will look after premature babies in that case? It will not be the private sector. They will not have the skills when everyone in this sector is trained in the NHS. Nor will they want to take the risk. So, presumably, these babies will die.
And that will be because over-zealous politicians and incompetent police, aided and abetted as ever by lawyers who have not the slightest comprehension of statistics, coupled with the deeply flawed expert witness system of evidence used in this trial, means that an almost certainly innocent woman is in jail and others look as thought they might be headed that way. And apparently, there is nothing in our legal system that will even prevent this miscarriage of justice from going on. An Act of Parliament might be required to free her.
I think the state works well most of the time. When it goes wrong, it goes horribly wrong. This is a case where it has done just that.
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I gather that assuming the babies were not killed by Lucy Lethby there are significant issues about what happened at that unit.
There are in addition of course to funding issues about management ‘competence’ across all sectors in the UK and these need to be urgently adressed.
We teach children to be honest, to care about the truth, to value each other, and be open, accountable, transparent, and responsible.
Then we have the Establishment and Governments, who mislead, lie, overthrow other country’s democratically elected representatives, provide arms to genocidal countries, sell off our assets so that the well-off can benefit further, and exploit the public. The judiciary is not any better.
Agreed.
There is something rotten in this whole thing giving off a terrible odour – there’s something not right about it, but I remember supporting a legal opinion on the 38 Degrees Platform that Andrew Lansley’s (was it he?) bill actually severed any responsibility by Parliament for NHS failures – it was a cynical precursor move by Tories to wash their hands of the consequences of keeping NHS funding at previous levels and under funding it from 2010. The legal opinion I supported was prescient in my view and this is what we’ve got now.
So, the Tories legitimised harm to its citizens. The question for me then is what does a society do about a form of rule that actually poses an existential threat to it? Where is the recourse? The accountability? The justice?
I know what I think.
I campaigned against Lansley’s reforms. A report at the time said I as the fourth most active opponent on social media. But the realty was, the Act that severed control was ineffective: of course politicians stayed in charge in reality. Words become meaningless when nonsesne is turned into law.
That is the sort of reality based response I would expect from you Richard.
But just as much as too many of our ‘poxy-ticians’ choose to believe that the BoE is truly ‘independent’, that only markets can deliver solutions, that BREXIT will work out OK, that taxes pay for everything and that the government has no money of its own, then choosing to believe that Parliament has no accountability for wrecking society’s health by undermining its healthcare will not stop bad things from happening.
The problem is the power behind these assumptions. It means that the problems persist. It is going to be really interesting seeing how the top down destruction of the NHS is unpicked by an enquiry or a court – if at all.
I’m sorry, but Richard began this – quite rightly – as an examination of the general failure of the State and its calamitous consequences (and let me be clear, I am not going to pontificate on Lucy Letby, because I know virtually nothing about the case, and certainly not enough to judge the case outcome). Richard is right to contemplate the principle of State failure, because it happens quite often, and should be faced squarely whenever it arises.
I am only commenting here (reluctantly) because PSR has somehow managed to turn Richard’s critique of State failure into this question begging aside: “the BoE is truly ‘independent’, that only markets can deliver solutions, that BREXIT will work out OK”. Really, PSR? I mean, really? This is about Private Sector failure, after all? In my opinion this is exactly what happens, when ideology leads thinking. Sorry, but there it is.
Just a quick note to Mr Warren, below? Or above whatever. I’ma bit discombulated.
You do realise that I’m stating what state politicians choose to believe – that I’m not advocating the private sector myself, but they – politicians – all too often do?
It is private sector thinking imported unthinkingly into the state sector (as I think you say yourself when talking about ideology) where a lot of the states problem is now – I mean look at the issue over money creation and tax – dominated by a private sector point of view.
You cannot talk of state failure in my view these days without talking about the private sector. And, you cannot talk about a successful economy without the private sector either. Whether failing or succeeding the two sectors are fated to be together. I ‘d rather have the latter, but it is private greed that upsets the apple cart.
I thought my comment was as plain as a pikestaff. Whatever politicians do or say, however insidiously the private sector insinuates itself into the public sector to extract soft, easy monopoly profits from guaranteed, over-priced contracts; you simply cannot turn every single failure of the State in the public sector into a failure of the private sector, because it satisfies a neat ideological position. You are in effect passing the buck, or washing the State’s hands of responsibility for its serious executive failure.
The private sector will offer little more than the contract specifies (if anything at all – ever); and everyone understands the private sector is not ever the remedy of last resort, from the outset. Such tasks remain the sole responsibility of the State, and the State remains the remedy of last resort; and its failure is worse, where it fails to resource or manage the regulator to ensure the regulations or legislation are executed according to law. It is a prime duty of the State to protect its people from harm, and it has enormous legislative, and executive sovereign power to execute that responsibility; not only to protect people from abuse in the private sector, but against the failure of the State itself.
We need only think of the problematic building regulations (the fire hazard cladding scandal – it is no excuse for the State to blame the private sector – the legislation and regulations are in the State’s hands, and there the responsibility, and power to act remains); or supervising the use of blood in transfusions (the blood scandal); or executing the State’s responsibility to supervise an ancient State institution, the Post Office* (for all the puff, hand-wringing and promises, many of the cheated postmasters – by the State – are still not compensated by the State, which was responsible through its executive failures); or ensuring the State maintains its £1Bn of PPE stocks in usable condition for an expected pandemic; or the condition of the prisons, public or private, remain a State responsibility; and so the long list goes on, and on, and on (these examples were written without even needing to think about it).
* Part of the problem was – I suspect – the hubris of the Post Office, BECAUSE it was an ancient and very powerful State Institution, with exceptional powers in law that are not typical of the private sector.
“You cannot talk of state failure in my view these days without talking about the private sector”. Only the private sector fails? This by implication is a variation of the old priciple of English law: ‘Rex non potest peccare’ (The King can do no wrong). It is the State’s escape clause, from failing its own people.
I admit that I am a little lost, John.
What are you saying?
Is it simply that the state can fail, which is of course true, because all human organisaqtions do, and we do not need to differentiate state or private sector organisations to discover that? Or is there something deeper, because if there is I too am a little confused as to what else it is that you are saying. I am afraid you are not being as plain as a pikestaff. Sorry.
“Is it simply that the state can fail, which is of course true, because all human organisations do, and we do not need to differentiate state or private sector organisations to discover that?”.
Yes, I am saying that; and it is as plain as a pikestaff. Clearly it isn’t simple. Because PSR sees State failure as, in reality private sector failure. That also is clear.
But we can also go further. ‘Rex non potest peccare’ was fundamental to English law, and spread to the US. It establishes sovereign immunity. My point is, whether or not the State encourages the incursions of the private sector into State operations, State power means that it is in a special position of responsibility and power that does not absolve it of final responsibility for failure, even where part of the responsibility for the problem mat be the influence of private sector interests. Grenfell and Building Regulations is an example. The Regulatory machinery failed, and the State was unequivocally responsible for that. But in addition the State has used Sovereign Immunity to avoid its responsibilities, even when it has been directly responsible. The State, however can no longer simply invoke immunity with no regard for anyone, in a Parliamentary democracy (Crown Proceedings Act 1947 means the Crown can be sued in contract), but it appears the Crown remains immune from criminal proceedings; so the State wraps up its resort to immunity in endless fog (Postmasters compensation delays), or the lack of money excuse (Blood scandal). But it invokes its Sovereign Immunity, one way or another; and someone else commonly pays the full price of that prerogative.
Note also the absolute immunity granted the US President.
Thanks for the clarification.
“But, to maintain the farce that there was not a systems failure in the NHS, due to cuts, politicians are maintaining the line that Lucy Letby killed babies, ”
This falls into the “look a squirrel” class. The problem was money, the cause, politicos wedded to the fantasy of the maxed-out-credit card.
In a normal society, the politicos would be put to the question – but they arn’t & the UK meeja are happy to continue their role as cheerleaders for govs of any neolibtard stripe.
As for Letby, wrong place, wrong time, but the politicians needed a cuplrit. Ta-da. UK political culture is DEPRAVED – from top to bottom, with, for the most part, the judges going along with it both for the Letby’s of this world or those on zoom calls discussing protests & let’s not forget the plods – who “just follow orders” (ref the managers). Nothing quite like “dead babies” to generate headlines is there? be it in the Uk or other places. In fairness – it does keep UK peasants occupied.
This sort of scandal is exactly why the NHS isn’t fit for the modern age and should be replace by an insurance-based scheme, designed to provide the highest quality of care.
Obviously some form of minimum care would be provided for those unable to afford anything at all.
Politely, don’t be a pratt.
Just look at the disasters in healthcare in the USA and go away.
I remember this from some time ago.
The UK health system costs 10% of GDP.
The USA health industry costs 18% of GDP
Note that one of the reasons that the USA industry went over seas was because the cost of health care made it uncompetitive.
The totally neoliberal Irish government sent a delegation over to the USA to see the the American health system and decided that it would destroy the Irish industry.
It never ceases to amaze me – even after following Richard’s blog for more than a decade – that whenever some twat want’s to post a glib but supposedly clever comment, counter to the argument being put, they ALWAYS use some equally twattish name to present there twattery (and yes, both words have two ‘t’s).
Just after World War II when Britain was quite broke, it not only founded the welfare state, including the NHS, nationalised the railways, and started building 4.5-million homes (80% affordable housing), the country worked quite well for most people.
Since Thatcher, governments have been privatising as much of the public sector as it can, resulting in the poor levels of service we see today.
US healthcare shows us what medical insurance would be like: 400,000 people go bankrupt every year, and they are the one WITH insurance.
What would happen if the UK went with the same model? I dread to think.
How remarkable.
Only this week I read that in spite of receiving a record majority vote, thanks to FPTP, Attlee lost the 1951 general election to the Tories, who won a majority of 17.
Apparently, it was changes by the Boundary Commission wot won it!
“This sort of scandal is exactly why the NHS isn’t fit for the modern age”
Are you an andrologist? Because you are certainly talking utter balls.
“by an insurance-based scheme, designed to provide the highest quality of care.”
@Judge Dread
If one has the financial resources to pay the insurance premiums.
25% of the cost of premiums will be spent on administration and profit ROI payouts. Less money will be spent on actual deliver of high quality medical services. Insurance companies turn a profit by NOT paying for services.
I KNOW all about this as I live in the USA with an insurance-based scheme which fails MANY privately insured people.
I’ll never understand the Right wing fixation with private insurance schemes when medical bankruptcy does for so many small business owners and self employed people in the US
Precisely why my daughter quit and took a crash in income after 11 years on a prem baby ICU with diminishing funds and inadequate staffing (not to mention parking charges and fines). Just how precarious things are is illustrated by two very religious parents accusing the unit of letting their child die, a child born with most organs external.
Why do poorer people only deserve “minimum care” ?
Ops! Should be ‘their’ twattery not ‘there’.
We all do them
I agree that the evidence looks threadbare in Letby’s conviction.
The police are investigating other incidents.
From the BBC this morning:
Police have submitted a “full file of evidence” to prosecutors to consider further charges in relation to the deaths and non-fatal collapses of babies at hospitals where neonatal nurse Lucy Letby worked.
The Crown Prosecution Service (CPS) said it had received a file from Cheshire Police, asking it to consider further allegations in relation to incidents at the Countess of Chester Hospital and Liverpool Women’s Hospital.
Neither Cheshire Police nor the CPS said they could confirm the identity of any suspect or suspects.”
and
“Cheshire Police has been investigating other incidents going back to 2012, including in Liverpool where Letby trained.”
This stinks of the hospitals having deaths which are poorly explained now taking the opportunity to pin them on Letby. Thereby getting themselves off the hook.
Is is possible that our Mr Plod does not understand that very premature babies are at high risk of dying? Indeed, I would argue it would be better for everyone if a lot more did. If they survive with massive medical intervention they tend to do so with multiple long term medical problems needing care for the rest of their impoverished lives.
That’s a might difficult one. I know. My wife did serveral years in neonates before becoming a GP. The ethical challenges are enormous. The number of sleepless nights of worry when not on shift are high.
What’s really needed is structural reform of the entire NHS to restore it to its founding mission. So, 1. Depoliticise oversight. 2. Prioritise prevention. 3. Embed accountability. And that would sort out Wes Streeting too.
No, we must ensure there is political oversight. The alternative is privatisation. We have depoliticised leadership now.
Apologies. Didn’t explain properly. What I have in mind is establishing a cross-party NHS body to set long term national health strategy goals, covering workforce planning, digital systems, infrastructure, and public health priorities, all insulated from short-term political cycles.
So Ministers would retain control of funding but not micromanagement of service design.
Getting cross-party consensus would be tricky, but not impossible if driven by Citizens Assemblies, mobilising professional opinion, a regional trial or two, and so on. Everyone needs to realise the NHS belongs to us, and start acting accordingly.
No
Not cross party
Why give neoliberals a say. That is what that will mean. It is status quo supporting.
Yesterday when visiting my Mum in hospital, I noticed a door in the ward with 9 name plaques on it. 4 were Business Managers, 4 were Service Managers (all 8 for Division of Medicine) and 1 Secretary (Speciality Medicine).
I’m pretty sure I was in a hospital not a startup incubator!
Can you imagine how complex running a hospital is? The NHS has incredibly low admin spends. Wh6 knock people doing intensely difficult jobs?
So all nine administrators squeezed into a single office? That sounds like under-resourcing more than anything else.
I think there are shifts. I think there are weekends. And even days off.
If the hospital management were complicit in blaming shortcomings on one individual, i.e. Lucy Letby, and they have allowed an innocent nurse to be sentenced to 15 life sentences without speaking out, then I am sorry but they need arresting. But unfortunately that does not seem to be what they are charged with.
Kudos too to Private Eye which highlighted the inadequacies in the Letby case a long time before most other news outlets.
(1) Letby will join the lengthening list of State-created scandals. Give it a few years more.
(2) Where I live, there is compulsory medical insurance. Insurers are prohibited from medical underwriting, and must set their premiums annually to recover only actual costs over the previous 18 months by municipality (calculated six months before the annual renewal date, always 1st January). Insurers reinsure against complex cases. They can profit only from surcharges for private hospital accommodation and such like. Costs are regulated by government, including local governments, who have power to subsidise premiums generally if they wish.
The result is a high standard of healthcare, relatively short waiting lists, lower taxation, and lower rents and house prices in the retirement locations.
MD (Dr Phil Hammond) in Private Eye has long detailed the mechanisms whereby Letby’s conviction was sustained (e.g not counting the deaths when she wasn’t there, ignoring evidence from actual experts, etc). It now appears Cheshire Police are not only going to attribute more deaths to her but are delving into her previous employments (scraping) to buttress their initial miscarriage. My daughter (ex prem ICU) has said from the outset you could probably convict a fair proportion of neonatal staff using these techniques. She also made the points that the better the nurse is, the more difficult and risky the cases she takes responsibility for, and that consultants and admin will deflect and cover their arses by accusing those less able to defend themselves.
Your daughter is spot on.
I’m just going to riff a bit more about how we try to make the stupid ignorant bastards who go into politics a bit more accountable and how hard that is to do.
We all know about the Grenfell disaster. But one of things that has emerged was the Building Safety Act 2022 (BSA). This act has got a lot of good things going for it but let us remember that it was previous politicians bonfire of the regulations that led to those horrific events, and the creation of the BSA in the first place.
The BSA works with the Construction Design Management (CDM) Regulations 2015, and calls for (amongst other things) detailed recording of the decisions made behind what creates a building, change control etc.
The thing is, for all the perceived benefits, it is very onerous indeed on the people delivering projects – to me it seems to place the onus on people like me to determine if the market is supplying us with decent kit – the Act pushed all the risk onto to those who do the work, the builder, the Building Control Officer, designers (architects, engineers), project managers (who have to certify these) like me.
Now, transpose that onto the NHS? An over stressed organisation that should be giving people care – just like they did to teachers who now more likely judged on whether they have lesson plans and are at the school gates at the end of the school day, never mind have enough time to actually teach. So who in (say) a post Letby NHS will be filling in the checklists to cover their arses, whilst the poxy-ticians under-budget the NHS, fail to regulate suppliers and markets and think low wages are the key to controlling inflation?
So in other words, there seems no recourse for citizens to hold these numpties to account. Not only can they make you life harder, they can avoid responsibility for it as well by using the law to put your arse on the line. Again.
It’s your job in construction to ensure that you don’t use combustible materials – but the poxy-iticans might well not stop the market from making it available in the first place.
Now, tell me folks, how twisted is that?
Sorry to come back again on the cross-party oversight thing. I’m a bit woolly today. I think the clear danger of neoliberal dominance can be overcome if the Citizens Assembly, with its professional support, is a permanent fixture with real authority, at least akin to a select committee. And the cross-party oversight group would need to formally recommit to the founding principles of the NHS.
Given the party political landscape, clearly all this can only happen if there’s something akin to a national uprising! But that’s really where we are. That’s what needs to happen if we are to save the NHS.
Citizens Aseembiles can never be involved in decision making.
They are:
a) Not democratic
b) Subject to massive selection bias as most people would not serve
c) Capable of capture
Cliff
If you want to make politicians accountable to real people, to restore democracy, then the only way to do it is be Alexandrian about it and cleave what is the Gordian knot of private political funding of the parties you vote for and nationalise elections and election funding. That must be the first place to start.
You’re absolutely right, PSR, but these reforms, vital though they are, won’t happen any time soon.
I think there are ways to structure Citizens Assemblies that would deal with the risks Richard has set out. And there have been some successful outcomes, perhaps especially in Ireland – on abortion, same sex marriage and climate change – that give some cause for hope.
Given the current paralysis in mainstream politics – especially around issues like NHS reform, climate, and constitutional renewal – they might offer a structured, thoughtful, and publicly engaged alternative. So I’d say don’t rule them out. Anyway, I’d better belt up now on this topic. I’m trying Richard’s patience a bit I think.
What was the evidence you saw that swung your opinion on serial murderer Lucy Letby to one of probable innocence?
Only recently you thought that the multiple child killer nurse deserved an appeal, but you were sat on the fence about what the outcome should be.
If you have not read the evidence of experts who have reviewed the case, why not?