Lucy Letby does not represent nursing, members of the profession have firmly stated as they reflect on the impact of her horrific crimes and the steps that must be taken following her conviction.
As well as the shock and sadness they felt as nurses, they told Nursing Times the case posed fresh questions about raising concerns and regulation.
Letby, 33, was sentenced to life in prison on 21 August for the murder of seven babies and the attempted murder of six others – crimes she committed between June 2015 and June 2016, while working as a neonatal nurse at the Countess of Chester Hospital NHS Foundation Trust.
During the 10-month trial, held at Manchester Crown Court, it was revealed how Letby used various methods to harm the babies, including injecting air into the bloodstream, overfeeding with milk, physical assaults and poisoning with insulin.
The police investigation into Letby, from Hereford, is ongoing to determine whether there are other victims, who have not yet been identified.
Letby is currently suspended from the nursing register and, now criminal proceedings are over, the Nursing and Midwifery Council (NMC) will seek to strike her off.
Alison Kelly, the nursing director in place at the trust at the time of Letby’s crimes, has also been referred to the regulator.
A public inquiry is set to take place to determine how Letby’s crimes were able to happen.
The government, having bowed to pressure from families and others to upgrade the inquiry from an independent to statutory one, said the probe would “ensure vital lessons are learned”.
A key part of the inquiry will look at how concerns raised about Letby were handled, as it has emerged that clinicians sounded the alarm months before she was removed from the neonatal unit.
It was not until May 2017 that she was reported to police – almost two years after the first murder of which she was convicted.
The case has sent shock waves through the nursing profession.
Dr Amanda Lee, a former advanced neonatal nurse practitioner with significant clinical and academic experience, said that Letby “does not represent us”.
“I was shocked and abhorred by her actions – anyone would be – but, as a nurse, I feel so let down,” she told Nursing Times.
“I couldn’t understand how or why someone could get away with this for so long. Our nursing ethic is, first and foremost, to do no harm.
“Yet this outlier, this woman – I won’t call her nurse – has directly contravened that stance.”
Dr Lee, currently a senior nurse lecturer at Manchester Metropolitan University, expressed remorse and sympathy, not only for the families affected by Letby’s crimes, but also for the nurses and other clinical staff who would be “scarred” by the case, particularly those who had worked alongside Letby.
Reflecting on her own career as a neonatal nurse, Dr Lee said she had sat by countless bedsides of babies watching for, and acting on, the slightest cues of a change in their condition, and explained how the relationship she had with their parents was “crucial”.
“My time in neonatal care was phenomenal and the [Letby] case has somewhat damaged those precious memories,” she said.
“But we must make sure we recognise her for what she is – a significant outlier. She does not represent the rest of us hardworking, competent nursing professionals.”
After the verdict, the Neonatal Nurses Association (NNA), which represents neonatal nurses across the UK, released a statement recognising that the case would have affected and “challenged” all neonatal nurses and the wider profession, and would have “shaken” the fundamental foundation of trust between families and nurses.
Pledging to back any recommendations that followed the case, the NNA also urged nurses to seek support where needed. It stressed to them: “Your work – day in and day out – is essential, valued and is making a positive difference to babies and families.”
Meanwhile, Dr Lee noted that “open, honest conversations” involving staff, leaders and families would be required, as the next stage of the process – namely, to recover and learn from the tragedy – gets under way.
“Now, more than ever, we need to draw on our powers of reflective practice, to understand how the situation has impacted everyone and to ensure managers give us the time and space to debrief, to work through what has happened,” she said.
“We must re-establish trust, not only from patients’ families – we must be able to trust the system to listen to the nursing voice when we raise concerns.”
Ann Keen, chair of the Patients Association and voluntary nursing adviser to the Labour Party, said her reaction to the case was “absolute anger as to how it had been allowed to continue”.
She said unexpected deaths and collapses of babies were “never events” and “red flags” that should lead to thorough investigation and action.
Ms Keen, herself a nurse, was a health minister between 2007 and 2010, when the care scandal at Mid Staffordshire NHS Foundation Trust involving poor care and patient deaths came to light.
While recognising that the Letby case was different as it centred on one individual who set out to kill, Ms Keen said a common theme with NHS scandals in the last few decades was that the organisation’s “culture was not appropriate”.
It was clear that lessons had not been learnt from the past, she warned, adding: “The Countess of Chester did not seem like it [had] a culture where people could speak freely.”
In the wake of the Letby case, calls have been made for a system of regulation to be introduced for NHS managers, like those in place for nurses and doctors.
Ms Keen said she “absolutely” backed these calls, adding that managers needed to “be answerable because, at the moment, it’s only the nurse who may be answerable, or the doctor”.
Ms Keen also raised a question posed by other senior nurses about the role played by Letby’s race and ethnicity in the way she was viewed and treated.
She said: “Had that nurse been Black, Brown or Asian, it would have been picked up very, very quickly.
“Now, how can I say that? Because my friends who are Black and Asian, and who are in nursing or were in nursing, have said it to me.
“And I know that’s true, and it’s so desperately concerning.”
Neomi Bennett, a registered nurse from London and founder of campaign group Equality 4 Black Nurses, also believed Letby would have been caught earlier if she was Black.
She told Nursing Times: “The moment suspicion is raised about a Black nurse, [hospital leaders] don’t take any risks.
“The systems, processes and rules that enabled Lucy Letby to kill and get away with murder undetected for so long are the same processes used to execute, and disproportionately target and profile, Black nurses’ lives daily.”
While the NMC stressed that decisions in relation to Letby’s fitness-to-practise case had been made based on facts and evidence, on the issue of race it added: “That’s not to say that bias doesn’t exist.
“We see it in the disproportionate fitness-to-practise referrals of Black professionals, for example, and we are committed to targeted work with employers to address these disparities.”
Registered nurse and National Guardian for the NHS, Dr Jayne Chidgey-Clark, is in charge of the Freedom to Speak Up Guardians scheme in England, which aims to support health workers to raise concerns when they feel unable to do so through more-formal channels.
The scheme was set up in 2016 in the wake of Mid Staffs and a subsequent whistleblowing review by Sir Robert Francis, both of which unveiled a culture of fear and secrecy in the NHS that needed to be addressed.
Speaking to Nursing Times, Dr Chidgey-Clark said the crimes committed by Letby had shocked her “to the core”.
“My thoughts are with everyone whose lives have been affected by the actions of Lucy Letby – both families and colleagues,” she said.
“I became a nurse to care and support people at their most vulnerable. That someone would abuse the trust the families had put in them to care for their babies goes against everything that nurses stand for, and I am sure nurses across the country are feeling as I do right now.”
She said the case should “focus minds” on the importance of nurses and healthcare workers being able to speak up, and for managers and leaders to listen and take “timely and proportionate action”.
Going forward, she said her office would work with regulators and the Department of Health and Social Care to see whether any changes needed to be made to policy and procedures in response to the case.
“When people speak up, they are giving you the gift of information that could help to avert a crisis, save a life,” she added.
“For all those leaders who think ‘this is rare, it couldn’t happen here’ – I want to challenge them to think ‘how would I respond to uncomfortable concerns – would I be defensive, or would I take action?’”