CEO met ‘a great deal of resistance’ over admitting failures

A former chief executive of the Countess of Chester hospital said she faced “great resistance” over her preparations to admit its mistakes in its handling of concerns about baby deaths and the role of Lucy Letby.

Susan Gilby, who led The Countess of Chester Hospital Foundation Trust from September 2018 until December 2022, gave evidence on Monday to the public inquiry into the events there following Letby’s conviction in 2023.

Letby was convicted of murdering seven babies, and attempting to murder seven more, in 2015 and 2016 while working at the hospital. 

Dr Gilby’s oral evidence is the last to be heard by the inquiry before closing submissions next month. Lady Justice Thirlwall is expected to deliver her report in the autumn.

The CoCH chief executive told the inquiry she had commissioned a report into how the trust had responded to paediatricians’ initial concerns about neonatal deaths, ahead of Letby’s trial.

She said she planned to draw on it when verdicts were reached: “I personally would have stood there and said: ‘We made mistakes, there is learning, we are accountable for this, and we want to be held to account for how we implement that learning.

“But unfortunately, that is not how the NHS operates. There was a great deal of resistance to my intention to openly say that after the verdict. That was my intention, and that was known to be my intention, and it was made clear to me, ’that was not how we dealt with things’.”

She said it echoed a need for NHS providers to be more open about safety failings in general, such as sharing information more proactively about safety incidents.

Dr Gilby said: “I think if we started to be more open, either in person with patients and the population or on our information sites that people can access very readily about where things have gone wrong and what we are doing about it, and the ownership of that, then the patients and the public would have greater trust in the fact that we are doing our best for them.

“Even though those delivering care are humans and sometimes things do go wrong.”

Dr Gilby was not asked who had warned her against that approach, but it is thought she is referring to NHS England officials and the then CoCH chair Ian Haythornthwaite.

Nobody is questioning it

The CEO ultimately left the trust in late 2021, shortly after Letby’s trial began. An employment tribunal this month found she had been unfairly forced out by the trust and Mr Haythornthwaite, because she had raised concerns about his bullying behaviour. He resigned after the verdict.

The work she referred to, commissioned from consultancy Facere Melius, was completed in November 2023 and submitted to the inquiry. 

Richard Barker, the then NHSE North West England regional director, told Dr Gilby’s tribunal in a written statement he was made aware shortly after she left of a “partially completed independent investigation into the events surrounding the Letby matter”.

He said it was not known to NHSE and “appeared to have been commissioned personally by Susan”. It “became a matter of serious concern and, however well intentioned, the way in which the investigation had been commissioned, along with its initial draft findings, required immediate incident management input from NHSE”, he said.

Dr Gilby has said she briefed Mr Barker’s predecessor, Bill McCarthy, on the work.

When Letby was ultimately convicted in 2023, its leaders did not refer to any particular failings in how the case was handled, but the trust’s medical director said in a statement: ”Our staff are devastated by what happened and we are committed to ensuring lessons continue to be learnt… 

“Since Lucy Letby worked at our hospital, we have made significant changes to our services. I want to provide reassurance that every patient who accesses our services can have confidence in the care they will receive.”

Its CEO, medical and nursing leaders prior to Dr Gilby joining have been criticised for poor incident reporting, and how they responded to paediatricians raising concerns about neonatal deaths and their link to Letby.

Dr Gilby also told the inquiry she had seen other senior leaders in trusts forced out of their roles. She said “time and again” trust executives were moved to roles elsewhere – such as at a regulator, NHSE, or an integrated care board – are still being paid by the provider trust and “nobody is questioning it”.

She told the inquiry: “Often, it’s not the fault of the individual. They’ve done nothing wrong, but they’ve just become a thorn in the side of either the organisation or the system, and this is something they are offered as a fait accompli. You know, ‘move or we’ll make life difficult for you. You may lose your job’.

“Most people in that position are providing for families. They can’t afford to challenge that behaviour, or they can’t, in terms of their own personal resilience, go through what they know would be an incredibly difficult and protracted process for standing up for what’s right.”

Letby’s legal team have asked for the Criminal Cases Review Commission to review her case, to permit her another attempt to appeal her convictions.

UPDATED: This article has been updated to reflect that the Facerle Melius work was completed in November 2023 and submitted to the inquiry