It is clear that what is required is an accredited register for non-clinical managers, write Kevin Dent KC and Alecsandra Manning-Rees for The Times

Lucy Letby is one of Britain’s most notorious serial killers and in light of her conviction in August of the murder of seven babies, a public inquiry will be opened into how the neonatal nurse was able to get away with the attacks for so long.

Sometimes such inquiries uncover truths that lead to real consequences for medical professionals. Doctors and nurses can be referred to regulators and have their future careers on the line.

It is clear that in public service settings such as the NHS – and other employment spheres such as schools and local authorities – staff can find themselves caught in the crossfire of individual responsibility versus direction from higher management. Employees can get caught between doing what their manager tells them to — and what they feel they should by virtue of professional codes of conduct. The question must be: what about the higher managers — who do they answer to?

The worst that can happen to non-clinical managers – who may not be regulated by a professional body such as the General Medical Council – is employment proceedings and criticism from inquests and public inquiries. To many in the general public, this can feel too little and too late. Resignations arising from such proceedings only create space for new unregulated non-clinical managers to take up vacant roles and the cycle continues.

This is not the first time this issue has been raised. In 2018, the Kark review called for increased regulation of board-level directors in NHS trusts. The terms of the Thirlwall Inquiry into the Letby case included considering: whether recommendations from previous inquiries into the NHS have been implemented, and whether any concerns with the conduct could be addressed through changes in NHS culture, management, governance and professional regulation.

It is clear that previous recommendations have been ineffective and that what is required is an accredited register for non-clinical managers, involving their regulation within the NHS. This will bolster patient safety by ensuring consistency in training, a uniformity of decision making and increased accountability for risk assessments.

Any such register needs to have teeth, meaning that managers cannot simply move on to new positions without demonstrating that they are safe and competent to undertake these roles and, if they are not, they should be prevented from working in that area until they are.

Perhaps there is change afoot, with this latest apparent failure to protect the most vulnerable demonstrating the need for NHS managers to be accountable. Likewise clinical professionals within a hospital should be encouraged to document everything and be supported when raising concerns, hopefully saving lives as a result.

The Thirlwall Inquiry could play an important role by bolstering regulation and accountability.

Kevin Dent KC is a highly persuasive advocate with a calm, measured, yet robust courtroom manner. Kevin took silk in 2019, building upon his heavyweight practice in the fields of financial crime and serious crime and is ranked in the Legal 500 for Fraud: Crime. Kevin has an established practice within the field of professional discipline, with particular emphasis on cases involving probity and fraud, drawing upon his ample experience of criminal cases involving medical professionals. 

Alecsandra Manning-Rees has extensive experience of Regulatory and Professional discipline cases and is ranked within the Legal 500 and is also recognised in Chambers and Partners in the field of Regulatory and Professional Discipline. Her practice in regulatory and professional discipline extends to both prosecuting and defending registrants. She is noted for sensitive witness handling, ably navigating paper-heavy caseloads and highly effective cross-examination.

The original article was published in The Times on 2 November 2023 and can be accessed here (subscription required to access).