Heart of darkness: Lucy Letby

[C69]

That’s horrifying to hear. What’s exactly going wrong?

I just had a quick look at ONS and it’s not like it’s lack of spending. Ever increasing % of GDP



Is it more a rotting culture in it/terrible mismanagement??

err perhaps you really don't understand Health economics and demographics or politics tbh

[Ymx]

I wasn’t after a shit fight on this thread, so if you don’t want to explain, then fine.

[fishfoodie]

I wasn’t after a shit fight on this thread, so if you don’t want to explain, then fine.

Well one reason why people might take offense, is that the chart is massively misleading.

While the overall amount of money being spent is going up, if they showed two lines, one which is the money being spent on the public portion, & one which showed that going to private contractors, you'd see that the amount going to the core NHS has been in continual decline, while the Tories mates are doing very well indeed !

So the NHS is always being asked to do more with less.

[Ymx]

I wasn’t after a shit fight on this thread, so if you don’t want to explain, then fine.

Well one reason why people might take offense, is that the chart is massively misleading.

While the overall amount of money being spent is going up, if they showed two lines, one which is the money being spent on the public portion, & one which showed that going to private contractors, you'd see that the amount going to the core NHS has been in continual decline, while the Tories mates are doing very well indeed !

So the NHS is always being asked to do more with less.

I’ve not seen that chart/data series, can you ping it through so can take a look at what you’re talking about?

[weegie01]

Well one reason why people might take offense, is that the chart is massively misleading.

While the overall amount of money being spent is going up, if they showed two lines, one which is the money being spent on the public portion, & one which showed that going to private contractors, you'd see that the amount going to the core NHS has been in continual decline, while the Tories mates are doing very well indeed !

So the NHS is always being asked to do more with less.

What are the private contractors doing? The issue is surely not who is delivering services, but are enough quality services being delivered at an appropriate price.

It certainly appears that money was wasted during Covid on contracts that did not deliver benefits. But in the general case, if money is being spent on private contractors who are delivering day to day services that would otherwise be delivered by 'core NHS', then I don't see what the issue is, as long as they are doing so on a reasonable value for money basis.

In this country there seems to be a general attitiude that any private participation in healthcare as automatically bad. I have lived and worked in countries with different models of public / private universal health systems. Both were better than the NHS, albeit at a slightly higher cost.

It seems to be that the only solution the UK public is prepared to accept for the NHS is more money and more people. People in the UK seem to equate private participation in health provision with the US model rather than understanding that a mixed public / private health provision works very well in many countries. Anyone who suggests changing the current model is shouted down, when in fact what we need is a fundamental reappraisal of how universal health care is delivered in the UK.

[Sandstorm]

Booo! Shut up!!!!

[inactionman]

Well one reason why people might take offense, is that the chart is massively misleading.

While the overall amount of money being spent is going up, if they showed two lines, one which is the money being spent on the public portion, & one which showed that going to private contractors, you'd see that the amount going to the core NHS has been in continual decline, while the Tories mates are doing very well indeed !

So the NHS is always being asked to do more with less.

What are the private contractors doing? The issue is surely not who is delivering services, but are enough quality services being delivered at an appropriate price.

It certainly appears that money was wasted during Covid on contracts that did not deliver benefits. But in the general case, if money is being spent on private contractors who are delivering day to day services that would otherwise be delivered by 'core NHS', then I don't see what the issue is, as long as they are doing so on a reasonable value for money basis.

In this country there seems to be a general attitiude that any private participation in healthcare as automatically bad. I have lived and worked in countries with different models of public / private universal health systems. Both were better than the NHS, albeit at a slightly higher cost.

It seems to be that the only solution the UK public is prepared to accept for the NHS is more money and more people. People in the UK seem to equate private participation in health provision with the US model rather than understanding that a mixed public / private health provision works very well in many countries. Anyone who suggests changing the current model is shouted down, when in fact what we need is a fundamental reappraisal of how universal health care is delivered in the UK.

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

[Ymx]

Moonlighting as a contractor to cover a shift on your team.

Ffs

[inactionman]

Moonlighting as a contractor to cover a shift on your team.

Ffs

This didn't happen all that much, given it's bloody exhausting and you'd not really want to work your off days.

[Torquemada 1420]

That’s horrifying to hear. What’s exactly going wrong?

I just had a quick look at ONS and it’s not like it’s lack of spending. Ever increasing % of GDP



Is it more a rotting culture in it/terrible mismanagement??

Throwing more money at the NHS is like chucking coke at a crackhead.

[Line6 HXFX]

Lets just jump to the end.. sell off and privatise the NHS, but of course keep having to plough money into it, and beg the new owners (probably a French state run company) to provide a barebones shitty service...like our railways, energy, etc.

Yay. That's what the UK needs right now..another futile, pointless gesture to the gods of the free market, who are rubbing their hands and laughing .....in erm, French..

Or we could you know, tax the true believer, self serving cunts until they have to fuck off, back to where they came..like New York did to the Boris Johnson family.
Anyone really think Rishi Sunak, Nigel Farage, Lizz Truss, Jeremy Hunt etc are planning a longterm future in Britain?

But hey, instead of getting in there first, taxing them until they have to just fuck off..with what remains of their wealth...much better to just let them sell everything the country has owned and invested in for generations and generations..to their mates, out of the back seat of their cars, for 3 cents on the dollar whilst they are escaping to the fucking airport.

Conservatives are not serious people. You get that by now, right?

[dpedin]

Here we go again ...

The Kings Fund regularly publish research on NHS funding and their most recent publication found:

- the cost of changing the current NHS funding model would be hugely exorbitant and very very difficult

- there is no evidence that the funding model adopted is directly related to better healthcare systems, indeed it is the level of funding that makes the difference. Changing to a different funding model would not makes things worse not better.

- self funding models could lead to inequalities in healthcare (ie USA) and any model still needs a taxpayer funded safety net ie the NHS

- no funding model would help address the current problems of lack of beds, staff, diagnostics, etc this would take 10+ years and any shift in funding model would bring about huge disruption to already stretched services and lower services in the short -medium term

Publication is here - https://www.kingsfund.org.uk/publicatio ... ternatives

So we have what we have in the UK for the foreseeable future, how it is funded is a separate issue from how much it is funded and how that funding is used.

The only real solutions are to increase funding to the same % of GDP as comparable EU countries and to invest in capacity ie theatres, beds and diagnostics, workforce planning and training of clinical staff and to change model of social care to avoid hospital beds being used as care homes. We also need to look at funding model for dentists to avoid the ongoing dental armageddon for kids. It will take time - it takes time to grow the workforce and build the capacity but it has been done before - look at the Labour investment in the NHS post 1997 when it brought NHS spend as % of GDP closer to the EU norm.

What we are seeing under the current Gov is an attempt to reduce spend on the NHS in order to make the private sector bigger for their rich chums to cream off the profitable and the easy to deliver. Fine go private and get your cardiac problems solved privately if you can afford it but if it goes wrong then be ready to be blue lighted to the nearest NHS hospital and keep your fingers crossed that there is an NHS ambulance available!

[I like neeps]

That’s horrifying to hear. What’s exactly going wrong?

I just had a quick look at ONS and it’s not like it’s lack of spending. Ever increasing % of GDP



Is it more a rotting culture in it/terrible mismanagement??

Throwing more money at the NHS is like chucking coke at a crackhead.

More money is spent on the NHS annually as we have a growing population (more people to care for) and older population with very poor social care (more demand) and an increasingly unhealthy population (even more demand).

Reform should preventative: be funding social care instead and sugar tax on junk food.

[weegie01]

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

[inactionman]

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

To be honest, it's a hard, hard job with many resultant absences and one that you cannot allow to go overly short-staffed. I don't really know how you plan for it, other than having additional staff capacity above and beyond the minimum required*. The agencies had the NHS over a barrel and knew it.

I'd have thought bodies such as NICE etc could have just issued a diktat there was a rate cap and that is it.

I vaguely recall the NHS setting up its own nurse agency but no idea what's happened there.

* most absences are genuine, but there were professional piss-takers who'd game the system to get maximum time off with full pay - they're being rooted out but maybe not quickly enough. The most egregious was a woman who worked part time and repeatedly signed up for extra shifts, called in sick the whole week and then claimed the extra shifts off against her rota the next week. I think that's actively fraud and she should have been prosecuted. They really, really need to sort out such behaviours, it's awful from a patient safety perspective, it's expensive, and good nurses leave because of overload due to these shitheads.

[weegie01]

Here we go again ...

The Kings Fund regularly publish research on NHS funding and their most recent publication found:

- the cost of changing the current NHS funding model would be hugely exorbitant and very very difficult

- there is no evidence that the funding model adopted is directly related to better healthcare systems, indeed it is the level of funding that makes the difference. Changing to a different funding model would not makes things worse not better.

- self funding models could lead to inequalities in healthcare (ie USA) and any model still needs a taxpayer funded safety net ie the NHS

- no funding model would help address the current problems of lack of beds, staff, diagnostics, etc this would take 10+ years and any shift in funding model would bring about huge disruption to already stretched services and lower services in the short -medium term

Publication is here - https://www.kingsfund.org.uk/publicatio ... ternatives

So we have what we have in the UK for the foreseeable future, how it is funded is a separate issue from how much it is funded and how that funding is used.

The only real solutions are to increase funding to the same % of GDP as comparable EU countries and to invest in capacity ie theatres, beds and diagnostics, workforce planning and training of clinical staff and to change model of social care to avoid hospital beds being used as care homes. We also need to look at funding model for dentists to avoid the ongoing dental armageddon for kids. It will take time - it takes time to grow the workforce and build the capacity but it has been done before - look at the Labour investment in the NHS post 1997 when it brought NHS spend as % of GDP closer to the EU norm.

What we are seeing under the current Gov is an attempt to reduce spend on the NHS in order to make the private sector bigger for their rich chums to cream off the profitable and the easy to deliver. Fine go private and get your cardiac problems solved privately if you can afford it but if it goes wrong then be ready to be blue lighted to the nearest NHS hospital and keep your fingers crossed that there is an NHS ambulance available!

There is an axiom that when people are faced with the need to change, the first thing they do is set to work proving why they do not need to. That report reads like that kind of justification. In addition, that report only looks at funding models, not the service delivery model that has to be looked at in tandem.

It is not just the funding model that is different in other countries, it is also the way healthcare is provided, and then we get back to the horror with which any kind of private provision is treated in the UK as evidenced in your last para.

It seems like the only solution anyone in the UK is prepared to countenance is just throw more money at the NHS. More money may well be part of the solution, but there are many other things that need to be looked at as well to make sure that money is being well spent. How services are delivered varies between countries, and yet private participation in health care works very well elsewhere. It also works poorly elsewhere but to start from the argument that it is always bad hamstrings the debate.

[weegie01]

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

To be honest, it's a hard, hard job with many resultant absences and one that you cannot allow to go overly short-staffed. I don't really know how you plan for it, other than having additional staff capacity above and beyond the minimum required*. The agencies had the NHS over a barrel and knew it.

I'd have thought bodies such as NICE etc could have just issued a diktat there was a rate cap and that is it.

I vaguely recall the NHS setting up its own nurse agency but no idea what's happened there.

* most absences are genuine, but there were professional piss-takers who'd game the system to get maximum time off with full pay - they're being rooted out but maybe not quickly enough. The most egregious was a woman who worked part time and repeatedly signed up for extra shifts, called in sick the whole week and then claimed the extra shifts off against her rota the next week. I think that's actively fraud and she should have been prosecuted. They really, really need to sort out such behaviours, it's awful from a patient safety perspective, it's expensive, and good nurses leave because of overload due to these shitheads.

I don't dispute that in the slightest.

The point is that a certain number of people are needed, they need to come from somewhere. Either the NHS can carry the staff needed to provide flexibility, or they come from the private sector.

One of the things we do very poorly in the UK is regulate the private sector. If the private sector is profiteering then it is not beyond the wit of man to regulate it, but as a country we failed to adequately regulate all sorts of things (power, water etc) and let the private sector take the piss. I don't know if that is happening here, but that is not a fault inherent in private sector provision, just that we do it badly.

As an aside, my wife worked in HMRC for a while; she encountered a similar thing. Staff salaries and temps / contractors came from different budgets. They did not have enough to employ all the permies they needed, so needed more expensive temps. But they could not transfer between budgets and just employ more permies at less cost due to some edict about keeping permanent staff costs low, even though it led to overall higher costs.

[dpedin]

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

To be honest, it's a hard, hard job with many resultant absences and one that you cannot allow to go overly short-staffed. I don't really know how you plan for it, other than having additional staff capacity above and beyond the minimum required*. The agencies had the NHS over a barrel and knew it.

I'd have thought bodies such as NICE etc could have just issued a diktat there was a rate cap and that is it.

I vaguely recall the NHS setting up its own nurse agency but no idea what's happened there.

* most absences are genuine, but there were professional piss-takers who'd game the system to get maximum time off with full pay - they're being rooted out but maybe not quickly enough. The most egregious was a woman who worked part time and repeatedly signed up for extra shifts, called in sick the whole week and then claimed the extra shifts off against her rota the next week. I think that's actively fraud and she should have been prosecuted. They really, really need to sort out such behaviours, it's awful from a patient safety perspective, it's expensive, and good nurses leave because of overload due to these shitheads.

I don't dispute that in the slightest.

The point is that a certain number of people are needed, they need to come from somewhere. Either the NHS can carry the staff needed to provide flexibility, or they come from the private sector.

One of the things we do very poorly in the UK is regulate the private sector. If the private sector is profiteering then it is not beyond the wit of man to regulate it, but as a country we failed to adequately regulate all sorts of things (power, water etc) and let the private sector take the piss. I don't know if that is happening here, but that is not a fault inherent in private sector provision, just that we do it badly.

As an aside, my wife worked in HMRC for a while; she encountered a similar thing. Staff salaries and temps / contractors came from different budgets. They did not have enough to employ all the permies they needed, so needed more expensive temps. But they could not transfer between budgets and just employ more permies at less cost due to some edict about keeping permanent staff costs low, even though it led to overall higher costs.

In Scotland we have staff banks which are for folk who don't want or cannot get a permanent post - it covers mostly nursing but also other staff groups. Bank staff are paid same as permanent staff and get holiday pay, CPD etc. Many are staff who want complete flexibility of when and where they work or are looking for additional hours, including those who may have retired but want to still work but not at the grade with the additional responsibility they once had. In effect it is an internal agency which doesn't carry premium nor pay staff more than permanent staff. However if no staff can be found then employers will turn to agencies to fill the gaps, in most cases these are for specialised staff working in specific areas with very specific skills sets.

Demand for nurse bank and agency staff has rocketed in last year or two - by about 50% - due to covid and need to fill gaps due to high levels of vacancies and absence. Up till then agency nursing use had been pretty minimal and focused in a few specific areas. Medical agency usage is a different issue and NHS in Scotland has been trying to force medics to join staff banks and limit agency use but again covid demand and staff shortages has meant its a sellers market and NHS in invidious situation of either not paying agency rates or closing services. Scotland has a particular problem with smaller or more remote boards in north of country unable to recruit and having to use agency staff to sustain services.

All the info on bank and agency use is publicly available via NHS Education Scotland. Although numbers/costs look big remember the NHS Scotland wage bill is c£7.5b.

PS Remember that Medacs, largest supplier of agency staff to the NHS, has a certain Lord Ashcroft, exTreasurer of the Tory Party and a large donor, as its non-Exec Chair.

[Torquemada 1420]

That’s horrifying to hear. What’s exactly going wrong?

I just had a quick look at ONS and it’s not like it’s lack of spending. Ever increasing % of GDP



Is it more a rotting culture in it/terrible mismanagement??

Throwing more money at the NHS is like chucking coke at a crackhead.

More money is spent on the NHS annually as we have a growing population (more people to care for) and older population with very poor social care (more demand) and an increasingly unhealthy population (even more demand).

Reform should preventative: be funding social care instead and sugar tax on junk food.

That's really not the point I'm making. The NHS is the basket case of basket cases that is the public sector's criminal waste and inefficiency. Sure, you'll make some gains throwing endless more sums at it (which the UK can't afford) but, IMHO, it needs tearing down to basics and starting again.

[Line6 HXFX]

Throwing more money at the NHS is like chucking coke at a crackhead.

More money is spent on the NHS annually as we have a growing population (more people to care for) and older population with very poor social care (more demand) and an increasingly unhealthy population (even more demand).

Reform should preventative: be funding social care instead and sugar tax on junk food.

That's really not the point I'm making. The NHS is the basket case of basket cases that is the public sector's criminal waste and inefficiency. Sure, you'll make some gains throwing endless more sums at it (which the UK can't afford) but, IMHO, it needs tearing down to basics and starting again.

So which services, which haven't already been cut to the bone, or privatised, do you want to tear down?
Do you use the NHS?

We now have some seriously fucking idiotic bored with the world, Dominic Cummings style "disrupters", in society,..that want to tear everything down.

You would have thought Brexit and fucking up the country, sixteen ways from Sunday would have been enough.

[Torquemada 1420]

So which services, which haven't already been cut to the bone, or privatised, do you want to tear down?
Do you use the NHS?

I wouldn't call them services, but I'd fire every single person in management and send him to Rwanda.

[Line6 HXFX]

There are five deliberate, conservative political decisions and policies..that drove the NHS from one of the best health care services in the world with the highest patient satisfaction rating..in 2010..to the brink.



Austerity.
Failed efficiency savings.
Brexit and the Pandemic.
Never ending privatisation.
Passing the buck on Social Care.

https://www.opendemocracy.net/en/nhs-c ... isation/

Instead of tearing it all down, tear the fucking conservative party down.

[dpedin]

Throwing more money at the NHS is like chucking coke at a crackhead.

More money is spent on the NHS annually as we have a growing population (more people to care for) and older population with very poor social care (more demand) and an increasingly unhealthy population (even more demand).

Reform should preventative: be funding social care instead and sugar tax on junk food.

That's really not the point I'm making. The NHS is the basket case of basket cases that is the public sector's criminal waste and inefficiency. Sure, you'll make some gains throwing endless more sums at it (which the UK can't afford) but, IMHO, it needs tearing down to basics and starting again.

Commonwealth Fund has NHS at or close to the top in terms of administrative efficiency when comparing health systems across the developed world. They do know their stuff.

It is an easy throw away line to claim the NHS is inefficient and yes there will be examples of where this is the case but the reality is that compared to the likes of Canada, France, Germany and of course the US it is more efficient. I have worked in industries, private and public, where inefficiency and waste is far more prevalent. No one is suggesting that there is an unlimited sum of money thrown at the NHS but perhaps a sum comparable to the % of GDP spent in comparable developed countries?

As I noted above from the Kings Fund report, another group who know their stuff, tearing down the NHS and starting again is not only irresponsible there is absolutely no guarantee that whatever springs from the ashes would be any better or more efficient and would likely cost more!

Fine, chuck in your own uninformed opinions and a few shouty bits, that's what these type of boards are for but at least try and come up with some facts or figures to support your shouty bits.

[Sandstorm]

Government need to offer free University degrees to all UK students who want to be doctors, nurses, paramedics and dentists. Grow the numbers we need now so that in 10 years we have the staff.

[dpedin]

Government need to offer free University degrees to all UK students who want to be doctors, nurses, paramedics and dentists. Grow the numbers we need now so that in 10 years we have the staff.

The thing that really pisses me off is that the private sector make no financial contribution to the training of medical/clinical staff, all they do is poach already qualified staff from the NHS, paid for by the taxpayer. It is an easy way to staff up their businesses and is in effect subsidised by the taxpayer. I would introduce a training levy on all private healthcare providers to cover their contribution to training staff from undergraduate to becoming fully qualified. It is reported to cost £250k to train a Consultant so I would charge them a % levy based on their utilisation of NHS trained staff. The NHS provides training and support to junior docs, trainee nurses etc and this all costs money, and not all of it is covered by the funding received from Gov.

[inactionman]

Government need to offer free University degrees to all UK students who want to be doctors, nurses, paramedics and dentists. Grow the numbers we need now so that in 10 years we have the staff.

The thing that really pisses me off is that the private sector make no financial contribution to the training of medical/clinical staff, all they do is poach already qualified staff from the NHS, paid for by the taxpayer. It is an easy way to staff up their businesses and is in effect subsidised by the taxpayer. I would introduce a training levy on all private healthcare providers to cover their contribution to training staff from undergraduate to becoming fully qualified. It is reported to cost £250k to train a Consultant so I would charge them a % levy based on their utilisation of NHS trained staff. The NHS provides training and support to junior docs, trainee nurses etc and this all costs money, and not all of it is covered by the funding received from Gov.

Engineering used to do similar with an apprentice levy (note - not the same as the current apprenticeship levy which is for all sectors)

This was more to cover the cots of an employer training apprentices who would move to other employers, rather than from public to private, but the idea was the same.

I can't find much information on it, as google just returns the current 0.5% apprenticeship levy set up in circa 2017, but the general idea as I recall it was the employers could call off against the fund for training apprentices and all engineering companies had to contribute.

[inactionman]

an article in the New Yorker which goes against the grain - raising a fair few queries about the guilt of Letby. I'll re-read it later as I've on ly skim-read it whilst 'working', but thought others might find it interesting.

Snip

Colleagues reportedly called Lucy Letby an “angel of death,” and the Prime Minister condemned her. But, in the rush to judgment, serious questions about the evidence were ignored.

Some of it is a bit weird, almost assuming that someone capable of murder should skulk in shadows and be socially inept:

The public conversation rushed forward without much curiosity about an incongruous aspect of the story: Letby appeared to have been a psychologically healthy and happy person. She had many close friends. Her nursing colleagues spoke highly of her care and dedication. A detective with the Cheshire police, which led the investigation, said, “This is completely unprecedented in that there doesn’t seem to be anything to say” about why Letby would kill babies. “There isn’t really anything we have found in her background that’s anything other than normal.”

another oddity:

One of the last remnants of the postwar social contract, it [NHS] inspires loyalty and awe even as it has increasingly broken down, partly as a result of years of underfunding. In 2015, the infant-mortality rate in England and Wales rose for the first time in a century.

It's so broken that infant mortality dropped for a century until the year in question?

Anyway, as I read it there were a few things that caught me as solid arguments and a few that struck me as the journalist working backwards from a pre-defined position, but I suppose that's unavoidable.

[Uncle fester]

Staff had been raising concerns about her well before the investigation started.

The insulin makes it clear some of those babies were definitely murdered and Letby was the only one with access.

Either Letby murdered them (and a jury was happy with this verdict) or she has been framed for it (improbable).

[Lobby]

Might be worth noting that the New Yorker article can't be published or accessed directly in the UK because Letby is due to be retried in June on a charge of attempted murder as the jury at her first trial failed to reach a verdict on that charge.

UK Media are legally restricted from discussing or reporting anything (including I expect lots of the material included in the New Yorker article) that might prejudice that trial, or indeed any appeal.

[inactionman]

Might be worth noting that the New Yorker article can't be published or accessed directly in the UK because Letby is due to be retried in June on a charge of attempted murder as the jury at her first trial failed to reach a verdict on that charge.

UK Media are legally restricted from discussing or reporting anything (including I expect lots of the material included in the New Yorker article) that might prejudice that trial, or indeed any appeal.

Ah. Link removed

[Uncle fester]

Just finished reading it. It's a decent attempt at her defence but it leaves out a lot such as her nearly getting caught in the act.

At about 9pm on 3 August 2015 a mother arrived on the neonatal unit with expressed breast milk for her five-day-old twin boys, known in court as Child E and Child F. The boys were born 11 weeks premature but had made such good progress they were due to leave Chester for a hospital closer to their home. As their mother arrived, a “horrendous” scream pierced the dimly lit corridor outside nursery one. She rushed in and saw Letby standing near Child E’s incubator. Her son had fresh blood around his mouth and was in extreme distress.

The mother asked Letby what was happening and the nurse, who wore a yellow butterfly sticker on her name badge, reassured her that he was OK and the blood was just from a feeding tube rubbing his throat. She should go back to the postnatal ward and rest, the nurse said. Two hours later the doctors were racing to save Child E’s life. He had lost more than a quarter of his blood and the skin on his tummy had turned purple and white – similar to the discoloration described for three of the nurse’s previous victims.

From the guardian article posted earlier in the thread.

She then tried to poison the other twin with insulin.

[Margin__Walker]

Just finished reading it. It's a decent attempt at her defence but it leaves out a lot such as her nearly getting caught in the act.

At about 9pm on 3 August 2015 a mother arrived on the neonatal unit with expressed breast milk for her five-day-old twin boys, known in court as Child E and Child F. The boys were born 11 weeks premature but had made such good progress they were due to leave Chester for a hospital closer to their home. As their mother arrived, a “horrendous” scream pierced the dimly lit corridor outside nursery one. She rushed in and saw Letby standing near Child E’s incubator. Her son had fresh blood around his mouth and was in extreme distress.

The mother asked Letby what was happening and the nurse, who wore a yellow butterfly sticker on her name badge, reassured her that he was OK and the blood was just from a feeding tube rubbing his throat. She should go back to the postnatal ward and rest, the nurse said. Two hours later the doctors were racing to save Child E’s life. He had lost more than a quarter of his blood and the skin on his tummy had turned purple and white – similar to the discoloration described for three of the nurse’s previous victims.

From the guardian article posted earlier in the thread.

She then tried to poison the other twin with insulin.

It's an interesting article, albeit one with a clear narrative. It's probably strongest when challenging the statistical evidence. The shift chart visualisation looks problematic when taking into account the partial data set. Also the way in which medical expert testimony inherently comes with a conflict of interest to find crimes (unconsciously or not) and potential experts touting for cases, is never particularly satisfactory. IT addresses the insulin evidence at length and I think there are other rebuttals floating around online, but I won't pretend to be qualified to comment. Ultimately you have to go with the evidence presented in court.

The case you quote there of Child E is the most damning for me when it comes to the prosecution case. It puts her directly at the scene of a very odd collapse/haemorrhage. The doctor involved later apologised for not ordering an autopsy in that case and instead attributing it to Necrotising enterocolitis (NEC). I actually know a fair bit about NEC and have seen babies with it first hand, including my own in a NICU. That collapse and haemorrhage, as the doctor later agreed with hindsight, was very atypical without either an issue showing up on the X-ray (Pneumatosis intestinalis - gas in the bowel) done shortly prior or a deterioration over time in vital signs.

[dpedin]

Sorry didnt read article so it may have been covered there. My comments aren't about whether she is guilty or not but more about wider systemic failures. Having had some experience in neonatal care I cannot believe that the pattern of deaths wasn't picked up earlier. I know that in Scotland there is a robust and systematic overview of all neonatal deaths and a huge amount of detailed data is collected on every single one via existing IT systems and internal/external reviews. Any possible anomaly or unexplained pattern of deaths or specific illness is identified early, examined and monitored in great detail. This is done within units, regionally and nationally and every unit has external scrutiny by specialist clinicians. I just find it extraordinary that this pattern of deaths in this unit wasn't picked up a lot lot earlier and examined in minute detail by external experts. Regardless of Letby's actions there has been gross clinical and managerial failure here and it sounds line it has been allowed to be covered up by the criminal prosecution of a single individual.

[Uncle fester]

Just finished reading it. It's a decent attempt at her defence but it leaves out a lot such as her nearly getting caught in the act.

At about 9pm on 3 August 2015 a mother arrived on the neonatal unit with expressed breast milk for her five-day-old twin boys, known in court as Child E and Child F. The boys were born 11 weeks premature but had made such good progress they were due to leave Chester for a hospital closer to their home. As their mother arrived, a “horrendous” scream pierced the dimly lit corridor outside nursery one. She rushed in and saw Letby standing near Child E’s incubator. Her son had fresh blood around his mouth and was in extreme distress.

The mother asked Letby what was happening and the nurse, who wore a yellow butterfly sticker on her name badge, reassured her that he was OK and the blood was just from a feeding tube rubbing his throat. She should go back to the postnatal ward and rest, the nurse said. Two hours later the doctors were racing to save Child E’s life. He had lost more than a quarter of his blood and the skin on his tummy had turned purple and white – similar to the discoloration described for three of the nurse’s previous victims.

From the guardian article posted earlier in the thread.

She then tried to poison the other twin with insulin.

It's an interesting article, albeit one with a clear narrative. It's probably strongest when challenging the statistical evidence. The shift chart visualisation looks problematic when taking into account the partial data set. Also the way in which medical expert testimony inherently comes with a conflict of interest to find crimes (unconsciously or not) and potential experts touting for cases, is never particularly satisfactory. IT addresses the insulin evidence at length and I think there are other rebuttals floating around online, but I won't pretend to be qualified to comment. Ultimately you have to go with the evidence presented in court.

The case you quote there of Child E is the most damning for me when it comes to the prosecution case. It puts her directly at the scene of a very odd collapse/haemorrhage. The doctor involved later apologised for not ordering an autopsy in that case and instead attributing it to Necrotising enterocolitis (NEC). I actually know a fair bit about NEC and have seen babies with it first hand, including my own in a NICU. That collapse and haemorrhage, as the doctor later agreed with hindsight, was very atypical without either an issue showing up on the X-ray (Pneumatosis intestinalis - gas in the bowel) done shortly prior or a deterioration over time in vital signs.

I believe the article is incorrect re secondary testing re the insulin. It was tested and verified by another lab.

[Lobby]

Sorry didnt read article so it may have been covered there. My comments aren't about whether she is guilty or not but more about wider systemic failures. Having had some experience in neonatal care I cannot believe that the pattern of deaths wasn't picked up earlier. I know that in Scotland there is a robust and systematic overview of all neonatal deaths and a huge amount of detailed data is collected on every single one via existing IT systems and internal/external reviews. Any possible anomaly or unexplained pattern of deaths or specific illness is identified early, examined and monitored in great detail. This is done within units, regionally and nationally and every unit has external scrutiny by specialist clinicians. I just find it extraordinary that this pattern of deaths in this unit wasn't picked up a lot lot earlier and examined in minute detail by external experts. Regardless of Letby's actions there has been gross clinical and managerial failure here and it sounds line it has been allowed to be covered up by the criminal prosecution of a single individual.

There is going to be a public inquiry into the case, which is due to start in September. The inquiry's remit is to look into how Letby was able to murder babies in 2015 and 2016, the conduct of others at the Countess of Chester Hospital and the culture in the NHS so the wider failures will be looked at separate from the criminal case.

[C69]

I have talked about whistleblowing with a few of my colleagues and friends who work in the NHS recently.
A number being Consultants and medical directors. No one would be really happy to whistleblow. One had even been bullied and harassed after he reported issues to a Trusts "confidential" freedom to speak up champion.
The Culture of the whole of the NHS is toxic with Clinical staff being increasingly marginalised.

[Blackmac]

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

It's astonishing they can't just offer their staff double time overtime instead of going to agency, but they only offer standard rates for extra shifts.

[Blackmac]

I have talked about whistleblowing with a few of my colleagues and friends who work in the NHS recently.
A number being Consultants and medical directors. No one would be really happy to whistleblow. One had even been bullied and harassed after he reported issues to a Trusts "confidential" freedom to speak up champion.
The Culture of the whole of the NHS is toxic with Clinical staff being increasingly marginalised.

My wife had a torrid experience after she reported a consultant anaesthetist for physically abusing patients and verbally abusing and bullying nurses. The whole thing was aimed at resolving it to his satisfaction and they never gave a shit about the nurses involved or properly investigated the complaints.

[dpedin]

I can only speak for a small part of it , but when my wife was a nurse shift lead she had to pay utterly preposterous rates to agencies to cover for illnesses and absences. At times it was more than 10x a staff nurse rate - to get a nurse who was sometimes one of your own staff moonlighting (although there were many who just lived life as agency nurses as the rates were higher). It was disgraceful, and god alone knows why there wasn't a cap.

This is so typical of Govt depts that it verges on the absurd. That is not a fault of private provision, that is a fault of budget setting within the NHS that results in them paying more in total than they need to.

It's astonishing they can't just offer their staff double time overtime instead of going to agency, but they only offer standard rates for extra shifts.

NHS Scotland has every so often placed a ban on use of nurse Agency staff except in some small highly specialist areas. All the boards run staff banks, equivalent to an internal agency, where staff are paid going rate for the job, can work flexibly and get all the other payments too ie annual leave, CPD, etc but less than what agencies might pay. Many nurses work on bank as they dont want to commit to regular hours of full time job, dont want to work at a senior level or have retired but want to keep working flexibly part time. However it requires the NHS and Gov to hold its nerve to try and drive the staff away from agencies and back into boards either as permanent staff or onto banks by refusing to use agency staff no matter what. This does mean in short term some pain for NHS until agency staff realise that if they want work they need to go into NHS staff bank or contract with NHS. It works but is painful and has usually been scuppered when for example the Gov puts NHS under pressure to meet existing or some new targets - then the NHS is left with dilemma of not hitting Gov target and getting it in the neck or quickly increasing staff by using whatever sources they can ie agency staff. My sympathy also lies with the Senior Nurse desperately trying to staff a rota to 'safe levels' but being told they cant use agency staff as a last resort, however NHS can put processes in place to support this over short term.

Agencies are very flexible, can pay what they want and very good at knowing where the NHS is hurting - they tend to be run by ex NHS staff - and know how to increase NHS dependency on their agency staff and how to attract certain groups of staff away from the NHS. Agencies don't care about NHS services they are only in it for a quick short term gain and increases prices if they know the NHS is struggling. They will always be there but the NHS can and should manage their dependency on them way down and look to change a lot of their working practices ie improve flexible working, annualized hours, etc and better workforce planning to identify key workforce risks in advance which has been done in the past. If the Gov and NHS, which essentially controls all the supply pipelines for key clinical staff, create a situation where workforce demand exceeds workforce supply then they are creating an environment where agencies will thrive and that is where we are at now! It is another apsect of privatizing the NHS I'm afraid!

[dpedin]

I have talked about whistleblowing with a few of my colleagues and friends who work in the NHS recently.
A number being Consultants and medical directors. No one would be really happy to whistleblow. One had even been bullied and harassed after he reported issues to a Trusts "confidential" freedom to speak up champion.
The Culture of the whole of the NHS is toxic with Clinical staff being increasingly marginalised.

My wife had a torrid experience after she reported a consultant anaesthetist for physically abusing patients and verbally abusing and bullying nurses. The whole thing was aimed at resolving it to his satisfaction and they never gave a shit about the nurses involved or properly investigated the complaints.

Traditionally the medics would 'sort these things out' themselves and the management would rather leave them to it than get involved with a very messy HR issue. The medics all know which of their colleague has 'an issue' and will use things like job planning to keep them away from things, man mark them in theatre etc to cover any mistakes they make, make sure they have senior trainees alongside them to do the work, move them into 'teaching' or research or some Royal College role away from patients, etc. This would be discussed and agreed in their consultant meetings, the golf course or when away at a conference. The problem medic would then be allowed to retreat gradually into retirement with no public loss of face. Managers are petrified of cases going 'public' and the HR folk are usually shitting themselves when something like this comes up, they are usually scared shitless of medics, BMA, etc. The press love nothing better than a disgruntled Consultant going public with some sort of 'managers are bullying me' claim or similar whilst the employer can say nothing as a HR process is underway. It's how we end up with medics on 'garden leave' for years at a time, it is very very difficult to 'dismiss' a consultant.

However we now know that the Consultant Anesthetist's behavior you describe is classed as a 'significant patient safety risk' and should be reported and dealt with as such. The traditional ways don't really hold water now and NHS management and HR need to grow a pair quickly. Your wife did the absolutely right thing and I hope she is ok after what sound like shocking treatment.