Lucy Letby: child murder case highlights need to regulate managers and improve whistleblowing procedures

• Two medical consultants, Dr Stephen Brearey and Dr Ravi Jayaram, both raised concerns about unexplained infant deaths as early as July 2015.
• Common sense would dictate that if a senior doctor raised concerns with managers, even informally, it would be taken seriously.
• This highlights an urgent need to change the structure of the NHS to ensure managers and executives are held to account for the decisions they make.

Refusal to act

• In hospitals such as the Countess of Chester, most routine decisions are made by middle management.
• Brearey and Jayaram suggested that executives were attempting to minimise any reputational damage to the unit and, by extension, the hospital.
• The decisions of hospital executives will be investigated as part of a public inquiry.

Freedom to Speak Up

• This is what led to the Freedom to Speak Up review, which investigated how organisations dealt with concerns raised by NHS staff.
• The results of the report led to the Freedom to Speak Up policy, which provides guidance for NHS staff on how they can raise patient safety concerns.
• A Freedom to Speak Up Guardian is also now present in every NHS Trust to ensure issues raised are responded to.
• Even with the Freedom to Speak Up Policy, the British Medical Association reports that staff are still being victimised for raising concerns.
• Clearly, the policy needs to be improved and legislation passed that would protect staff from dismissal if they do speak up.