Within this article, our Founder, Mr. Andy Parr, delves into the intricate dynamics surrounding NHS senior leadership failures and their societal implications. He examines the adoption of ‘just in time’ processes and financial benchmarks, noting their detrimental impact on fostering sound social, environmental, and governance practices.
The disturbing chronicle of Letby’s series of killings and attempted murders, as documented in this timeline, underscores a disconcerting reality: senior leaders within the NHS negligently allowed her to persist in her lethal spree. Alarming instances of whistleblowing emerged from medical professionals on more than one occasion, yet inexplicably, senior leadership remained inert, enabling Letby to perpetrate further fatalities and inflict life-altering injuries on survivors.
Regrettably, this disregard for whistleblowing accounts recurs across both public and private sectors, ostensibly under the banner of operational efficiency, ‘just in time’ management, fiscal prudence, and profit orientation. Patterns of reprehensible conduct persist without reprimand or, worse yet, unabated continuation.
Drawing from my past experience as a law enforcement officer, I resolved to be proactive rather than passive when confronted with hearsay. Armed with evidence and information, my commitment was to hold individuals accountable for their crimes. However, I find myself compelled to speak out today as senior leaders in the NHS failed to act. The heinous nature of Letby’s actions, targeting the most vulnerable of our society, underscores the egregious nature of the leadership’s repeated inaction. These repeated offences, at times in rapid succession, epitomise one of the most appalling forms of incompetence and negligence.
A contemplation of plausible alternative scenarios prompts the question: What factors could have elicited a different outcome? More importantly, what steps were imperative to manifest a more appropriate course of action? It is important to acknowledge that the insights provided in this article do not derive from firsthand courtroom engagement, but rather from media accounts and my extensive background in leading investigations related to serious and organised crime, including my whistleblowing in significant criminal activities in Afghanistan.
The pivotal factor, I believe, resides within organisational culture. Reflecting on my tenure as a police officer, a recurring pattern emerges: individuals in positions of authority often designate successors who mirror their own attributes. This perpetuates cultural norms that are resistant to change unless confronted by a significant disruption or external influence, such as a judicial review mandating transformative measures, frequently accompanied by leadership replacements. Such a transformative event is impending in Chester.
The implications of this cultural norm extend throughout the organisation’s hierarchy. Instituting a framework that prioritises financial prudence, bolstered by ‘just in time’ processes and performance objectives, invariably curtails the inclination for ethical actions. This phenomenon, I have witnessed firsthand in the realms of healthcare, military operations, diplomatic service, and law enforcement, exemplifies a systematic reduction of individual dedication to principled conduct.
The NHS confronts chronic underfunding, but still attracts empathetic individuals driven by a desire to provide care. Monetary gain should take a backseat to vocation in the NHS. Unfortunately, the caregiving spirit wanes as the imperative for fiscal responsibility dominates. This shift leads to scenarios where a lone healthcare provider is confronted with the daunting responsibility of caring for multiple critically ill patients during a solitary night shift. The overarching sentiment becomes one of survival rather than accomplishment, as medical professionals exit their shifts relieved to have navigated them rather than fulfilled by their contributions.
The current reality compels doctors and nurses to conclude their shifts with a sense of gratitude for mere completion, overshadowing any semblance of personal satisfaction derived from meaningful work. The pressing urgencies within such an environment, illustrated by instances like an elderly patient left in soiled bedding due to incontinence or a dying individual languishing in a corridor, amplify the significance of clocking off after a grueling shift.
I am regrettably familiar with these circumstances, as an elderly relative of mine, grappling with dementia, encountered deplorable treatment. Left immobilised in an inverted bed, incapable of mobility, he remained in this position for hours, as staff chose not to engage with him. Subsequently, these same staff members embellished his mental state in a bid to expedite his discharge, sidestepping the necessary steps for proper placement. Such actions entail a need for more time and care, aspects at odds with their choices.
Despite my desire to believe that the caregivers administering treatment to my relative possess a measure of empathy, their resolve has been eroded by the relentless challenges stemming from an alarmingly underfunded and, frankly, mismanaged NHS. However, I remain hopeful that given adequate resources, NHS staff can and will extend compassionate care to patients, approaching each case as an opportunity for recovery.
The pursuit of ‘targets’ governing discharges and other operational benchmarks not only deprives patients of proper care but further reinforces a culture that dehumanises them in favor of financially derived targets. This culture emanates from the leadership echelons of the NHS, attributing the blame to politicians, albeit justifiably to some extent. It is essential to acknowledge that the NHS leadership wields authority over the organisation’s administration, consequently contributing to its lamentable state.
The terrible outcome of Letby’s crimes reflects a repugnant consequence of the NHS’s aversion to accountability and criticism. This disposition will now be confronted by a comprehensive review, one expected to be unequivocally scathing. The leadership within the Countess of Chester Hospital has proven woefully incompetent, setting the stage for Letby’s ‘suspected’ actions to remain unaddressed. Their failure in exhibiting professional curiosity constitutes an incompetent and neglegent lapse.
When confronted with a sequence of infant deaths attributed to factors such as the presence of air where it shouldn’t be within their small bodies or excessive insulin administration, any rational analysis would denote, at the very least, clinical incompetence as the cause. A recurring pattern of such occurrences should trigger an earnest response from senior leadership, who are duty-bound to heed the concerns raised by vigilant clinicians.
It is regrettably evident that a culture of concealment prevails within the NHS, one that prioritises targets over patient welfare and drives staff to the brink of robotic compliance. This cultural dynamic necessitates transformation.
So, what steps should follow?
- An autonomous evaluation of whistleblowing reports, ensuring independence from internal organisational influences.
- Mandate adherence to recommendations from independent whistleblowing reviews within specified timelines.
- Establish an investigative arm within the NHS to spearhead inquiries into reports, reporting to the whistleblowing review team instead of local NHS leadership.
- Empower the investigative team with a comprehensive toolkit of investigative resources, potentially underpinned by legislation granting them authority under the Regulation of Investigatory Powers Act (RIPA). Such empowerment would enable surveillance measures during investigations into significant crimes.
- Institute a mechanism for recruiting senior NHS leaders independently, always including a clinician within the leadership ranks.
- Institute a cultural shift to encourage and facilitate anonymous whistleblowing reports, promoting a culture of reporting.
- Enforce a cultural shift away from target-driven approaches, favoring elevated levels of care.
- At a macro level, promote NHS autonomy akin to the Bank of England, insulated from political influences. This entails cross-party management with equitable representation on committees governing performance and finances.
- Empower the Parliamentary committee to advocate for the financial needs of the NHS, reversing the current dynamic of governmental control.
- Task the Parliamentary committee with driving innovation and research to curtail costs, transcending target-driven motives.
It is crucial to acknowledge that these recommendations merely scratch the surface of those anticipated from a judicial review. Armed with comprehensive insights, the impending review, ideally, will deliver meticulous findings and robust recommendations.
The NHS must internalise the resounding message: transformation is imperative, not solely in Chester but holistically throughout the organisation.
Comprehensive evaluations of management and leadership are required across major NHS divisions to cultivate a culture of openness and learning, transcending the present climate of secrecy.
Emerging from this, our nation is presented with a pivotal juncture for catalysing positive change. The aspiration remains that we must grasp this opportunity…