Lucy Letby: Royal Preston and Chorley hospitals act to protect patients in wake of killings

Lancashire Teaching Hospitals NHS Foundation Trust (LTH), like its counterparts across the country, has been considering the lessons that it can learn following Letby’s conviction for the murder of seven babies and the attempted murder of six others at the Countess of Chester Hospital.

Peter White, LTH’s chair, said that an initial plan drawn up in response to Letby’s crimes should ”give assurance to the public [about] the actions that have been taken by the trust to minimise [the chance of] anything like this happening here”.

A report presented to an LTH board meeting set out the systems already in place to protect patients and detailed the areas that the trust would now seek to strengthen.

Several of the latter hinge on a more comprehensive use - or “triangulation” - of different sources of data, specifically to identify “themes” that may help indicate when an issue brought before the trust’s Raising Concerns Group requires escalation and remedial action.

The identification of concerning trends at both an individual and organisational level is a theme in itself in the steps that are set to be taken to root out risks.

These include reviewing patient safety reports with an eye to uncovering “a weak safety culture and [the] normalisation of low expectations or apathy” in particular areas of the hospitals.

The promotion and reinforcing of the so-called “Freedom to Speak Up” (FTSU) amongst staff - via which they should be able to raise concerns without fear of ramifications - is another key component of the plan.

Divisional management teams are also now to be provided with monthly reports of FTSU concerns so that they are fully aware of the issues being brought up in the areas for which they are responsible. That information should include a “descriptive narrative” which - once again - highlights potential concerns arising from any “repeated themes [and] reference to individuals/teams/services”.

Chief nursing officer Sarah Cullen told the meeting that there was a need to be able to identify “multiple, low-level concerns about individuals that may indicate that there is an issue that needs to be addressed”.

FTSU data will also be married up with other information – such as prevalence of grievances and patient safety incidents – to help manage the concerns raised.

Although fears about Letby were raised by senior medics, Mr. White said that it was vital that staff in “lower-ranking, lower-paid jobs” could “get their voice heard [by] the more senior people within the organisation”, so that colleagues at all levels within LTH felt comfortable “speaking truth to power”.

“It’s about how we make those processes easier and better understood…for people in the organisation, [who], maybe at the moment, feel that it is not for them to say something.”

He added: “There are bad people out there who will seek employment in organisations like this and in occupations and vocations that are part of the NHS… in order to do harm to others - so we’ve always got to be aware of that.”

Sarah Cullen said that there would always remain “a risk that there may be a perpetrator within our environment”, but that the mechanisms being put in place would help identify issues “at the earliest opportunity”.

Progress on the agreed measures will be reported to future meetings of the board in a twice-yearly Freedom to Speak Up presentation which is to be reintroduced after previously being dropped.