Top doctor who helped convict serial baby killer backs call for NHS managers to be regulated

Martin Shipton

The Welsh doctor who established that the babies killed by nurse Lucy Letby were victims of crime has backed a proposal to introduce a regulatory body for NHS managers.

Dewi Evans, a retired consultant paediatrician from Carmarthen, was one of two clinical experts who provided detailed medical evidence to Cheshire Police that resulted in Letby’s conviction for seven murders and six attempted murders at the Countess of Chester Hospital. He has been critical of NHS managers’ involvement in the case.

Now Dr Evans is supporting Plaid Cymru MS Mabon ap Gwynfor’s bid to regulate NHS managers by a new body similar to the General Medical Council (GMC) for doctors or the Education Workforce Council (EWC) for teachers.

Mr ap Gwynfor argued that while other healthcare professionals are held to rigorous ethical standards, the managers who oversee them and shape the culture of the NHS currently operate in a regulatory vacuum, potentially jeopardising patient safety and public trust. A pre-legislative vote on the proposal in the Senedd was passed by 28 votes ro nil, with 22 Labour MSs abstaining.

Cover up

Dr Evans said he thought the proposal was excellent and deserved to become law. He said: “What I’ve learned over the last 20 or 30 years doing medical legal work is that what NHS managers always do if there’s any concern is to engage in a cover-up. That’s the default. They seem to be a law unto themselves and don’t seem to be accountable to the public or to the patients. Therefore we need a regulatory body for NHS managers, that is the chief executive, the medical director, the nursing director and the health board – both the chair of the health board and the non-executive directors, all of whom are political appointments.

“What we have is a system that is more in keeping with an authoritarian regime than a democratic one, in Wales and in England. You have the chair of the health board appointed by the Health Minister. The chair then, in association with the politician, appoints the non-executive directors, who are politically acceptable. The political appointees appoint a chief executive, who clearly has to be politically acceptable. They’re usually ‘talk the talk’ kind of people, who walk in, spend three years in the job and then go away again, after making a mess.

“There is no accountability. The general public have no access, are unable to appoint anyone to a position of executive power within the NHS. This is not a criticism of only the Labour Party or the Tory Party. I’m a member of Plaid Cymru, and Plaid Cymru has not yet moved to a position where it supports the democratic election of people on health boards in the same way as we elect Police Commissioners and local councillors. I’ve been banging on about this within Plaid Cymru for a long time and not getting any traction – but I think this should happen.

“What concerns me far more is that health board people are not accountable to any kind of regulatory body or disciplinary body equivalent to the GMC or the General Nursing Council. There should be one that is independent of the politicians and certainly independent of NHS management. Such a body would stop NHS managers bullying consultants and bullying nurses.

“I could name a number of doctors who have lost their jobs in Cardiff, in Swansea and Carmarthen, not because of clinical incompetence but because they confronted the management about failings within the health board and therefore got kicked out – usually on the allegation of intimidation and bullying of management. It’s very much what you would expect in the old Soviet Union or in an authoritarian state. If you had a regulatory body to which anyone working in the NHS could file a report or a complaint, they would investigate it on the record, in public, I think it would discourage them from making wrong decisions in the first place.”

Duty of care

Dr Evans said he also believed that NHS managers should have to sign an equivalent of the Hippocratic Oath annually, declaring that their primary responsibility is to the patient and the public, and not to the institution, to remind them of their duty of care.

He said: “Health boards are not accountable to the public in any way, and our Senedd has followed the example of England in getting rid of community health councils [which acted as local health watchdogs]. I think that’s totally the wrong decision.

“Another thing that the Westminster government did about 10 years ago was to abolish legal aid for people who had concerns regarding alleged medical negligence. So it’s virtually impossible for people to issue a writ alleging medical negligence without running a risk of tens of thousands of pounds worth of costs. It’s therefore easier now than it was 10 years ago for health boards to get away with inadequate care.”