The Lucy Letby Case

The Lucy Letby case can be a common topic for interviewers to question students about in the medical school interview. This case was only closed in 2023, therefore it is a current NHS hot topic.

Here is a quick summary of all the key details and the information you should know to prepare yourself for questions surrounding the Lucy Letby case.

Who is Lucy Letby?

Lucy Letby is a former neonatal nurse at the Countess of Chester Hospital, who worked there from June 2015 to June 2016. She was said to be a competent compassionate nurse, however, she then became the subject of multiple news headlines, due to allegations of murdering and harming numerous infants in the neonatal department during this time.

The timeline of the Lucy Letby case:

Here is a timeline of key events in the Lucy Letby case:

• Summer 2015 – 3 infant deaths occurred on the neonatal ward when Lucy Letby was noted to be on duty, however, no suspicion of her involvement was present at that time.
• October 2015 – 2 more deaths have since occurred, Lucy Letby was on duty at both of these times. A neonatal consultant on the ward, Dr Stephen Brearey, along with the support of other consultants fear that there is a potential breach of safety on the ward that is causing these deaths. The medical director was contacted to initiate an investigation for the underlying cause of this. However, no changes to staffing had been made at this point.
• There had been other collapses (’attempted murders’) of infants during the months from June to October.
• February 2016 – an independent neonatologist conducted a review, but no explanation was found for the increased number of deaths and collapses. Despite this, multiple concerns regarding Lucy Letby remained.
• Between February and June – Lucy Letby carries out multiple attempted murders of more infants. The methods she is seen to have been using at this time include dislodging nasogastric (NG) tubes and thrusting the NG tube into an infant’s throat. In some of these cases, the infants go on to recover however in others the babies tragically end up dying.
• By the end of June 2016 – there were 2 more deaths and multiple near deaths. At this point, consultants discuss the ‘inexplicable events’ that occurred and encourage that Letby should be terminated from the hospital due to the lack of patient safety.
• 2017: Doctors are forced to apologize to Lucy Letby due to the ‘stress and upset’ that they have caused her, and her suspension is removed. The doctors then approach the police service with their concerns and Operation Hummingbird is launched, to investigate the cause of the deaths.
• 2018 – 2020 – Lucy Letby was arrested and released multiple times for the murders of the infants. Finally, in 2020 she was charged with 7 counts of murder and 10 counts of attempted murder.
• October 2022 – The Lucy Letby trial begins and Letby pleads not guilty to her charges
• August 2023 – the trial concludes and she is found guilty of 7 murders and 7 attempted murders. This then draws widespread media attention.

Medical Ethics in the Lucy Letby case:

This case can be a common topic for medical schools to question in interviews as there are various medical ethics issues involved in this case.

Here are some of the medical ethics themes at play:

• Trust in the healthcare profession: For the healthcare system to work, there needs to be an established trust between the public and healthcare professionals. However, Letby’s actions have damaged this trust and the doctor-patient relationship, portraying a negative light on healthcare staff.
• Justice: Neonates are a vulnerable population due to their lack of ability to communicate. Lucy Letby deliberately targeted this vulnerable population, violating the medical ethics pillar of justice. Justice refers to the fact that all patients should be treated fairly and equitably. As neonates are a vulnerable group, they must receive additional care that eliminates any disadvantages they may face.
• Whistleblowing: During the events of 2015-2016, numerous healthcare professionals raised concerns about Lucy Letby, but these were not taken seriously enough and were inadequately addressed. It is the duty of healthcare workers to raise concerns when patient safety is at risk. Doctors should feel protected when speaking up, without fear of repercussions on their careers, and all concerns should be addressed thoroughly and taken seriously.
• Institutional Responsibility: If the hospital management did not act timely and thoroughly with their investigation, this could potentially be an ethical violation. This could have potentially led to prolonged harm which could have been prevented. The hospital should have put in measures to ensure patient safety; such as proper checks, and safeguarding practices that would prevent such harm.
• Violation of duty of care: one of the main principles of being a doctor is non-maleficence (the duty to do no harm), Letby’s action in deliberately harming infants is a clear violation of this principle.

Whistleblowing in the NHS

Whistleblowing involves an individual (typically an employee) disclosing information about activities that are unethical, immoral, or illegal. This practice is especially crucial in the medical field as it helps identify and address potential issues before further harm can occur. By raising concerns, whistleblowers can protect patients, catch problems early to prevent escalation, promote accountability, and build trust through transparency.

In the Lucy Letby case, if Dr Breary and his colleagues had not repeatedly raised their concerns with the medical director, the investigation and subsequent actions would not have commenced as early as they did, which could have had even more profound effects.

There is often a stigma and worry around whistleblowing as sometimes the whistleblower is then isolated and put at professional risk. This is why it is important to protect whistleblowers and encourage individuals to speak out if they witness unethical events.

Lucy Letby case medical school interview questions

What are some lessons learned from the Lucy Letby case?

The Lucy Letby case refers to a tragic and unsettling event that occurred between 2015-2016 in a neonatal ward in Chester. Lucy Letby who worked as a nurse at that time on that ward, deliberately murdered and harmed multiple infants, she was then later charged with these convictions in 2023. This case teaches us the importance of whistleblowing and raising concerns through the appropriate channels if warranted. It reiterates the importance of protecting whistleblowers, because if certain consultants hadn’t raised their concerns during the Lucy Letby case then the investigation would not be initiated when it did.

The case also demonstrates the need to implement strong safeguarding measures, especially when caring for vulnerable populations like infants. This would then support the main duty of hospitals and doctors to promote patient safety.

Why is whistleblowing an important act in medicine and how can it be protected?

Whistleblowing is crucial, especially in the medical field, as it can help identify and resolve potential issues before further harm occurs. However, employees may hesitate to whistleblow due to concerns about the impact on their professional development. To address this, it is essential to implement practices that support and protect whistleblowers, ensuring they feel empowered to speak up. Some ways to achieve this include:

• Fostering a speak-up culture, within the department
• Specific training about the importance of speaking up against unethical, illegal actions.
• Ensuring employees are protected by the law when they whistleblow.

The Lucy Letby case had severe damages to the public’s trust in the medical profession, how can this trust be rebuilt?

The relationship between a doctor is extremely important, only with a good trusting relationship can effective care be given to the patient. When people go to see their doctors, they come in a vulnerable position asking for help. This is why trust between doctors and patients is vital. The events that took place in the Lucy Letby case had a detrimental effect on this trust, which is why it is a priority to rebuild this.

There are several ways in which this can be done:

• Strengthening Safeguarding and Accountability Systems – In the Lucy Letby case, the hospital only initiated an investigation after multiple concerns were raised. Taking swift action earlier could have potentially prevented some of the deaths. To improve this, organizations should have a transparent, independent oversight of these processes. This can help reassure the public that action is taking place.
• Rebuilding trust also includes reaffirming the core duties of a doctor – empathy, compassion, and patient-centred care. When doctors promote this practice during consultations, it helps restore the trust that patients once had in the profession.
• Involving patients in the decision-making of their care provides them with autonomy over their health. Encouraging patients to give their feedback and shared decision-making, enhances trust in the medical profession.

Reflection Point:

This case also highlights the importance of mental health support and psychological evaluations for healthcare professionals. Healthcare workers face immense stress daily, so measures should be implemented to promote their well-being.

Other medical school interview questions:

• How can medical schools and healthcare organizations implement safeguarding practices to stop this from occurring again?
• What are some of the key medical ethics issues in the Lucy Letby case?
• How should healthcare institutions respond to allegations of malpractice or harm by a staff member?
• How can hospitals ensure the safety and well-being of patients in light of the Lucy Letby case?
• Describe the events that took place in the Lucy Letby case