There’s no need for an inquiry into the Lucy Letby killings

Sunday/Monday/Tuesday blog

Here we go again. Another massive scandal in an organisation which is meant to serve us – this time it’s the NHS. Our rulers will, as usual, dodge any repsonsibility for anything by launching an ‘inquiry’ often led by a retired judge or some other establishment stalwart. This great inquiry will no doubt promise that ‘no stone will be left unturned’ while actually dragging out any investigation for years till the original scandal is either all but forgotten or else superseded by a new even worse scandal in the same or some other public-sector body. Then, after millions or even tens of millions have been spent making a bunch of lawyers richer than any ordinary person could imagine, the inquiry will eventually conclude that it was ‘the system’ not any individual which was to blame and reassure us that ‘important lessons have been learnt’ and ‘this can never happen again’. Meanwhile all those who have been (sometimes criminally) negligent will have either been promoted out of trouble while being given even higher salaries and pensions at taxpayers’ expense or else allowed to retire, often with large pay-offs, and always with their generous pensions intact which gives our rulers the excuse to claim it’s too late to take any action against them.

But here, as with most other public-sector scandals, there is absolutely no need for any inquiry. Why? Because we already know what has gone wrong. There are three constants in any bureaucracy that is supposed to serve us, whether it be the NHS, the military, the Home Office, HMRC, the police or even any of our major charities:

• Parkinson’s Law
• The Peter Principle
• Givers and Takers

The first two of these – Parkinson’s Law and The Peter Principle – are well-known, so I’ll just briefly summarise these. Then we can look in more detail at the one which is key in the Lucy Letby scandal – the idea that there are two main types of person in any organisation set up to serve the public – Givers and Takers.

Parkinson’s Law

Named after historian C. Northcote Parkinson, states that work creates more work, usually to the point of filling the time available for its completion. That is, Parkinson believed that bureaucracies always grow—typically 6% annually. Managers wish to appear busy, so they increase their workload by creating paper and rules, filling out evaluations and forms, and filing. Then they hire more assistants, who in turn require more managerial time for supervision. Moreover, many bureaucratic budgets rely on the “use it or lose it” principle, meaning the current year’s expenditures determines the following year’s budget. This provides a deep incentive to spend (even waste) as much money as possible to guarantee an ever‐increasing budget.

Perhaps amusingly, under New Labour from 1997 to 2007, while the number of NHS staff increased by about 20%, the number of managers increased from around 25,000 to about 43,000 – a compounded annual rise of just over 6% annually – just as Parkinson’s Law predicted. Over the same period, the number of hospital beds fell from around 250,000 to less than 180,000 – resulting in a fall in managerial efficiency from 10 beds/manager to just 4 beds/manager.

Peter Principle

Named after sociologist Laurence Peter, states that employees in a bureaucracy are promoted to the level of their incompetence. In other words, competent managers continually receive promotions until they attain a position in which they are incompetent. And they usually remain in this position until they retire or die. Of course, there are (possibly?) many competent managers in the NHS. But when people are over-promoted and out of their depth, they tend to spend much of their time and effort justifying their positions and become hyper-defensive every time they feel threatened by some problem for which they might be held responsible.

Givers and Takers

One less well-known idea of how organisations develop is the concept that there are two main types of employee in any organisation set up to serve the public. There are the Givers – people who focus their time and effort on fulfilling the stated goals of the organisation – looking after patients in the NHS, assisting the deprived for social workers, trying to alleviate poverty for charity workers and so on. Some other people in the organisation are Takers. They are less interested in the goals of the organisation. Instead they see the organisation – whether it is the NHS, a government department, a local council or a charity – as a means for self-advancement, for accumulating power and for reaping financial and other rewards such as social status and maybe even a few awards, gongs and other honours.

As the Givers will spend much of their time and energy trying to serve those the organisation was set up to serve, the Takers tend to rise to positions of power because they have the time, the energy and the ambition to play organisational politics in order clamber up the hierarchy.

When something goes badly wrong in an organisation, the Givers – like the paediatric doctors in the Lucy Letby case – will try to alert management to get action to fix the issues which worry them. The Takers, on the other hand, see any problems as a threat to their positions, ambitions and reputations. Therefore they will try to suppress any bad news, will threaten any concerned Givers or whistleblowers and will cover up any potential scandals. We saw in the Lucy Letby case how hospital managers tried to silence any concerned physicians, made threats against them and forced them to write a letter of apology to Letby.

I have twice come across Takers in management positions in the NHS.

Takers experience 1: In 2007  I co-wrote and published a book ‘WHO CARES?’ by Midlands housewife Amanda Steane describing how her husband Paul was discharged from hospital just before suffering kidney failure. A blood test done on the day of discharge showed that Paul Steane’s creatinine levels were off the scale – an indicator of imminent kidney failure. But the doctor discharging Paul hadn’t looked at the blood test results. Following this Paul had a number of operations including amputation of a leg which led to him becoming a helpless cripple. Unable to walk or breathe properly, he commited suicide. As for the blood test results, these mysteriously ‘got lost’. Amanda wouldn’t have known about the hospital’s blunder. But a nurse, appalled at the way the family was being lied to, sent Amanda a copy of the ‘missing’ blood tests. Then followed years of litigation until hospital managers finally admitted responsibility. The hospital chief executive was, of course, promoted and moved to a different NHS hospital trust.

Takers experience 2: A few years ago I was made an elected governor of my local NHS trust. Probably because of the type of books I wrote, a whistleblower contected me claiming the construction company which had recently built the hospital’s multi-storey car park had overcharged the hospital by over £1 million by using what was called ‘cover pricing’ – when construction companies decide among themselves which firm will get which contract and conspire to put in higher than necessary bids so the chosen firm wins the work at a much elevated price. I did some research and found out that the cost per parking space in the hospital’s multi-storey car park was much higher than similar car parks built for commercial shopping centres. When I informed the NHS trust chief executive of my concerns, I got a very dismissive lettter explaining to me that the role of an elected governor was to represent to hospital in the local community and not to get involved in managerial issues. It seems to me that saving face and protecting well-paid, well-pensioned careers for hospital management was more important than whether the hospital could claim over £1 million back from the cheating construction company.

No need for an inquiry

So, in my humble opinion, there is absolutely no need for a fatuous and expensive inquiry into what happened at the Countess of Chester Hospital. We know what happened. Givers raised the alarm about excessive baby deaths, but Takers were  running the hospital and did everything in their power to crush any warnings of problems to protect their own positions, reputations, salaries and pensions. It’s not more complicated than that. So, instead of a pointless inquiry which will conclude that ‘important lessons have been learnt’ and ‘this can never happen again’ perhaps we should have firings and criminal prosecutions of the self-serving Takers who allowed Letby’s killing spree to take place?