Dr MAX PEMBERTON’S lesson from Letby: Rein in NHS bosses who treat doctors as a nuisance
- Managers rule the roost and can intimidate even the most senior consultants
- READ MORE: I love the NHS and have given my life to it but this is why I chose to go private
One of the many shocking things to come out of the devastating case of nurse Lucy Letby, convicted of murdering seven babies and attempting to kill six others, is how it’s exposed the extent to which managers have taken over so much of the NHS.
It used to be that doctors were in charge — but not any more.
As the case shows, managers now rule the roost and can intimidate even the most senior consultants.
It’s very telling that when the consultants who raised concerns about Letby continued to voice their worries, they were threatened with referral to their regulator, the General Medical Council (GMC).
Yet there’s no such regulatory body for management. They are only accountable to their line manager, not patients in the same way as doctors are, and certainly not to a wider set of professional principles.
Lucy Letby was convicted of murdering seven babies and attempting to kill six others
This means there is a perverse incentive to keep critics silent and not shine a spotlight on the service they are running.
Traditionally, doctors have been the thorn in the side of many managers because they are more knowledgeable, better qualified and have clear professional duties to the patient.
But over the years, the power of doctors has diminished in the NHS. Rather than being acknowledged as leaders with more responsibility than other professions, they have been demoted and disempowered.
A flattened hierarchy has been gradually installed whereby doctors are treated as just part of a team, despite them still having to take ultimate clinical responsibility for patients.
Yes, I understand that some doctors can be dismissive and arrogant — but, by and large, their absolute focus is on the wellbeing of the patient. That is what they are trained to do, and that is what their priority is.
But time and time again in the NHS, I’ve seen their positions undermined and their decisions overridden by lesser qualified people who have climbed the management ladder and then feel emboldened to laud it over the consultants.
It’s all too easy for really quite mediocre people to get promoted to high levels of the NHS — and to astonishing power. Worse, many seem to have a chip on their shoulder when it comes to doctors, and actively relish undermining them.
The fact that these people are themselves unaccountable to any professional body yet can threaten doctors with referral to the GMC if they don’t toe the line only makes it all the more scary.
Dr Max Pemberton says his medical colleagues in other countries are baffled by the power that NHS managers have
I’ve seen consultants who are leading experts in their field have clinical decisions overturned by managers.
One friend, a surgeon, has had several vital, time-sensitive operations cancelled by managers — despite her warning that it will endanger lives — so that she could be redeployed to non-emergency clinics with long waiting lists.
This is not about patient welfare: it’s about making sure the service’s numbers look good in terms of targets.
Another, who works in general medicine, is under constant pressure from management to discharge patients, and was even threatened with disciplinary action when he refused to discharge a sick and elderly woman who, it later transpired, had a blood clot on the lung.
The patient could easily have died if he’d given in to the demands of the manager, yet — shockingly — he was still formally reprimanded for disobeying the manager despite him being absolutely correct in his clinical assessment.
I’ve had personal experience of this sort of treatment when, after my emails to managers went unanswered, I formally escalated concerns about the level of care being provided to patients in a service.
All of a sudden, the furious service manager descended and, rather than addressing the issues I’d raised, started to scrutinise my work — the implication being that I was a troublemaker and needed to be silenced.
Medical colleagues in other countries are baffled by the power that NHS managers have.
They simply cannot believe that someone less qualified is able to override clinical decisions made by consultants or threaten, bully or intimidate them. In their jobs, such a thing is simply unheard of.
Nor is it like this in the private sector. The idea that a manager might interfere with a doctor’s work or try to override their decision is anathema when the patient is paying. So why should it be any different in the NHS?
As a life-long supporter of our NHS, it saddens me to say this: but, increasingly, managers don’t seem to be focused on patient welfare.
They seem to see their job solely as protecting the service they work for — thereby allowing a bizarre, adversarial situation to evolve, where patients are seen as hostile agents and doctors as an irritation.
I recall sitting in a meeting to discuss a serious complaint a patient had made and an irate manager, with a completely straight face, said: ‘This service would run so smoothly if it wasn’t for the patients.’
Sadly, this attitude sums up much of the thinking in NHS management these days: those pesky patients and those interfering doctors trying to treat them.
Honestly, what a shameful situation — for which those babies and their families at the Countess of Chester Hospital have paid an unforgivable price.
Parents of children who’ve died from meningitis have urged all students starting university to ensure they are vaccinated.
Freshers are at high risk of becoming infected as they tend to mix with lots of new people.
Around one in eight teens is thought to be missing out on the effective MenACWY vaccine.
Amy was right to set love rules
Amy Nuttall split from her husband for a second time when he failed to adhere to rules including weekly date nights and access to each other’s phones
Former Emmerdale star Amy Nuttall has split from her actor husband for a second time, after he failed to stick to marriage rules she’d set for their reconciliation.
Amy made headlines when, in July, she took Andrew Buchan back after an affair, but made seven rules a condition of him returning.
There’s no suggestion he cheated again but, according to reports, he failed to adhere to rules including weekly date nights, access to each other’s phones and no out of work contact with co-stars.
Personally, I’d struggle to trust and heal after a partner had an affair, but I respect other people who want to give it a go.
The key, as Amy has shown, is ensuring that things really do change — and getting out if they do not.
It’s all too easy to agree, in the heat of the moment, to turn over a new leaf. But how many times have you heard that promise, only for people to relapse into the exact same behaviour as before?
Ultimatums are a good way of making your wishes known, but they only have power if you follow through with them.
Infants who watch screens for four-plus hours a day face problems developing social skills, according to a new study.
Watching screens is a passive process that doesn’t involve interaction. Being bombarded with information means the child doesn’t develop vital skills to cope with frustration or boredom.
However, there’s a sense the horse has bolted — that children are so used to screens we can’t turn the tide. But this isn’t true.
I wanted a TV in my room when I was young, as everyone in my class seemed to have one. But my mum wasn’t happy so she simply said no.
‘No’ seems something today’s parents avoid, in case it traumatises the child. Yet saying no is an act of love, as children don’t always know what’s best.
DR MAX PRESCRIBES
Heartstopper
Heartstopper is perfect for youngsters negotiating their feelings in the modern world
Now in its second season, this sweet, simple love story on Netflix about Charlie and Nick, two young, gay students and their friends, sends a positive message. It’s perfect for youngsters negotiating their feelings in the modern world.
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