The Nursing and Midwifery Council (NMC) has accepted that it “could and should” have done more and acted faster after it was made aware of concerns about Lucy Letby.
On Thursday, the regulator made its opening statements to the Thirlwall Inquiry, which is investigating how Letby was able to murder seven babies, and harm seven others, while working as a neonatal nurse at the Countess of Chester Hospital between June 2015 and June 2016.
“It is important for me to say the NMC has reflected on the steps it could and should have taken”
Samantha Jones
Letby, 34, was sentenced to multiple life-in-prison orders last summer. The public inquiry was called shortly after by the government.
This first week of the inquiry has been dedicated to the opening statements of the core participants, including the Department of Health and Social Care, the Royal College of Paediatrics and Child Health, Countess of Chester Hospital NHS Foundation Trust, the families of the children and the NMC.
Earlier in the week, counsel to the inquiry Nicholas de la Poer KC described a “seemingly high threshold” for referring Letby to the NMC among those aware of concerns about her potential involvement with high mortality rates at Countess of Chester’s neonatal unit.
Letby was eventually referred in 2018, more than three years after the first murder took place and around two years after paediatric consultants first raised concerns within the trust and nursing director Alison Kelly flagged a potential worry about Letby to the NMC.
Representing the NMC was barrister Samantha Jones, who spoke at length about the “reflections” and changes which had been made within the organisation in the time since Letby harmed and murdered the children.
In her opening remarks, Ms Jones said that these reflections include an acknowledgement that more “could and should” have been done on the part of the NMC – as well as the trust – to investigate Letby.
“It is important for me to say the NMC has reflected on the steps it could and should have taken [in 2016],” she said. “We have identified a number of areas of improvement.”
Ms Jones spoke about the response to Ms Kelly’s initial contact with the NMC in July 2016, in which the nursing director told the regulator, via its employer link service, that there had been concerns about Letby raised at the trust.
However, the inquiry heard how Ms Kelly told the regulator there was “no evidence available” at the time to support concerns that Letby may pose a threat to public safety, and that the executive team of the trust was to meet that day to decide whether to report her to the police.
Ms Jones said Ms Kelly left out that a discussion about Letby by senior trust figures had already taken place in June.
“[The NMC was] not provided with crucial documentation we now know the hospital possessed,” the lawyer said.
“We were not told of the meetings that had been taking place between senior management… as a result, our employer link service advisor advised Alison Kelly that we needed to know both the trust board’s decision whether to report to the police, and any subsequent action taken by the police.”
Ms Jones acknowledged, on questioning from the inquiry chair, that there should have been more “curiosity” from the NMC about the Letby case in July 2016.
This was echoed by Richard Baker KC, representing some of the families of the children murdered by Letby. In his opening remarks earlier that morning, he said a “greater curiosity” about the early incidents could have helped to prevent further babies being harmed.
Ms Jones then detailed the timeline of communication between Ms Kelly and the NMC. The nursing director gave further updates to the NMC in August and November 2016 stating that there was “no grounds” for referring Letby.
The inquiry heard that the NMC found out about a police investigation into neonatal deaths at the hospital via a Countess of Chester trust press release in May 2017, and that Ms Kelly told the regulator’s advisor that Letby was placed on restrictive duties, had not been arrested and that she was just a witness, like other staff were at the time.
It took until July 2018 for Ms Kelly to make a fitness-to-practise referral to the NMC, on request of the regulator after it had learned through “media monitoring” of Letby’s arrest.
Ms Jones said: “We fully accept we should have been more proactive in this period.”
Noting how the NMC had “learned” from the case, she added: “We needed to be more proactive when employers raised concerns with us to find out what happened, steps they are taking locally to address the issues.
“We should have proactively scrutinised the information provided to us by Alison Kelly and we could and should have contacted the General Medical Council and the Care Quality Commission to discuss the concerns.”
Another issue raised at the inquiry was why an interim suspension order was not placed on Letby at an earlier stage; one was only issued in November 2020, after Letby was charged with murder.
Ms Jones noted that the NMC was powerless to apply for an interim order, and to therefore impose restrictions of practice for Letby, without a referral.
However, she reiterated that the regulator accepts it could have helped expedite a referral against Letby being made and that the NMC acted too slowly after it received one.
“We accept it was not right for the NMC to wait to apply for an interim order until Lucy Letby was charged,” she said.
“We consider that, in this case, the facts of the arrest could have been sufficient to justify an interim order application given the serious nature of the concerns.”
Ms Jones said that, at the time, its internal guidance on when to apply for an interim suspension order was not “sufficiently clear” to allow its staff to act on an such an “extraordinary case”.
Further, she discussed the fact no member of the trust’s medical team attempted to refer Letby to the NMC.
“We do not seek to criticise them in any way,” said Ms Jones. “We have already identified that we should and could have advised Alison Kelly to ask the consultants who had raised concerns to contact us directly so we could have discussed the concerns with them.
“But…. we would like to understand what, if any, barriers consultants faced in making a direct referral to us at the time and whether there is anything further the NMC can do to ensure anyone with a concern in the future feels able to contact us directly to initiate a referral.”
Ms Jones said that the NMC’s reflections so far had led to new guidance being published for its case workers and advisors on a “culture of curiosity” and new guidance on interim suspension orders.
She also mentioned, though not wholly related to the Letby case, other changes it was making following the NMC culture review earlier this year which included reforms to the “pace and quality” of its fitness to practise process.
On the same day Ms Jones delivered her opening statements, the inquiry also heard from Andrew Kennedy KC, representing Countess of Chester, and Peter Skelton KC, who represented other families of the children hurt or killed by Letby.
Mr Kennedy outlined the internal reflections of the trust, and the acceptance of the impact failings in acting and communicating had on the families, while Mr Skelton reiterated the incredible impact “continuing denials and deflections” from senior trust figures has had on those affected by Letby.