The agony of the death of a child is something most families these days will never suffer. Through illness, accident or even negligence, that loss, and the lifelong pain it causes, is every parent’s greatest fear, but to know someone murdered a defenceless infant must be beyond endurance. How could she?
We will never know what evil or insanity could have induced Lucy Letby to sweep away the lives of seven babies, and attempt the murder of another six. Everyone hearing the case of the worst serial killer of children in modern British history tries, and fails, to imagine the state of mind, the cause and how such a person grew up so apparently normal, her inner murderous impulses unobserved. Her responsibility for new lives inside the Countess of Chester hospital neonatal unit, which should be a sanctuary of the greatest safety, makes this feel like the deepest betrayal.
Coming from a gentle-faced nurse, the sort who might grace recruitment posters for the most trusted among all professions, multiplies the shock. Tradition, culture and a measure of sexism expects nothing but care and kindness from an “angel”. “It can’t be Lucy, not nice Lucy,” the head consultant on the hospital unit said, even as he connected Letby to the series of unexplained baby deaths for the first time.
She doesn’t look the part; her face is not the face of a psychopath from myth or legend. Her ordinariness calls to mind the historian and philosopher Hannah Arendt’s “banality of evil”. The detective inspector investigating her background said there was nothing “outstanding or outrageous” about her, but that “being average allowed her to go under the radar”. If her motive was to garner sympathy, particularly, as was suggested in court, from a doctor she may have been in love with, that’s a painfully banal reason. How many people – all, perhaps – navigate these kinds of choppy waters at some point in their lives without turning murderous?
After this first impulse of revulsion and incomprehension at Letby comes the next strong human instinct: who else is to blame? Why did no one see that pattern of deaths on her shift for a year, and then delay another year before involving the police? Why were early suspicions not acted on immediately? It’s more satisfying to blame others beyond the eternally unknowable murderer herself. Far better if there is something systemic, something rational, some lesson to be learned. It means we can prevent this from ever happening again.
The government has rightly ordered an inquiry: the parents need and deserve it. The facts of exactly who suspected what, who did and didn’t act promptly, will be hashed out, reliving again the death of each child already lengthily exposed in the court case. The instinct often becomes “heads must roll”, a sacrifice as a necessary and satisfying act of contrition. Overburdened NHS staff, managers and social workers know the syndrome well.
Many inquiries are essential: the Covid inquiry needs to tell us not just what was done badly, what lives and funds were needlessly wasted, but also how to defend the country against the next pandemic, which could be due at any moment. But inquiries into the rarest events need only be short and specific: there is no need for some whole new safeguarding panoply to protect against the vanishingly minute risk of another killer nurse.
After the long, 10-month court case trawling over the evidence, let this not become another epic inquiry, costing millions and taking up the precious time of medical professionals and managers. The case did throw up unpleasant truths that should be learned from, such as a manager’s desire to protect the hospital’s reputation. However, the chief executive did order two inquiries, one from the Royal College of Paediatrics and Child Health, which found no definitive explanation for an increase in mortality rates, but identified significant gaps in medical and nursing rotas, poor decision-making and insufficient senior cover; and another from an independent neonatologist, while Care Quality Commission inspectors also failed to identify a killer at work.
Everyday truths about the parlous state of the NHS emerged in court, such as the fact that sewage once flooded the sink in the neonatal unit where staff would wash their hands. The defence claimed it explained one death: it didn’t, but it was a reminder of risks in an underfunded and capital-starved NHS. In Letby’s defence statement, there was a suggestion that the deaths were a product of shortcomings including staff shortages, an issue that was also critiqued in a 2019 CQC inspection report. Would extra pairs of eyes and hands have prevented these unseen murders? With a shortage in England of about 43,000 nurses, units across the NHS are working with perilously low levels of staff. The stress nurses are under is illustrated by their alarming suicide rate: mental health charity the Laura Hyde Foundation said 366 nurses who used its services in 2022 had attempted suicide – that’s one every day. Nurses are one of the professions most at risk of suicide, says Prof Alison Leary, chair of healthcare and workforce modelling at London South Bank University. Throughout the NHS, risks are taken due to staff and funding shortages that would never be tolerated in, say, aviation, she tells me. “There is no overarching healthcare safety regulator,” she adds, to detect the many needless deaths that take place in the NHS every year.
Investigators and commentators should remember this: the Letby case is so shocking because such cases are so rare. There always are abominable aberrations in humanity, throwing up cases beyond our understanding: the Moors murderers Ian Brady and Myra Hindley killed five children, Fred and Rosemary West killed 12 girls and young women, Dennis Nilsen killed 12 young men and boys. The nurse Beverley Allitt killed four babies and attempted to murder more. The GP Harold Shipman was found guilty of murdering 15 women, with many more suspected. There’s a lesson in the response: it took a three-year inquiry for judge Dame Janet Smith to estimate he killed 250. Although he is the only British doctor ever convicted of killing patients, that “never again” instinct caused an array of new regulations to re-license and re-validate all doctors, yet they clearly failed to uncover such freakishness. Worse, it led to the cruel “Shipman effect”, in which doctors dare not prescribe enough morphine to dying patients lest data shows people dying sooner under their care. With every dose checked since then, there’s no knowing what extra suffering is caused to the dying due to that “something must be done” impulse.
That should act as a warning against overreaction to the one-off horror of the Letby case. All these infants were expected to recover, to live and thrive. Instead, their lives are unlived, their parents’ lives blighted. And yet there can never be a “never again” guarantee to defend against such freaks of nature: those around Letby found it impossible to suspect this popular and sociable nurse of such monstrous deeds.
Polly Toynbee is a Guardian columnist
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