Mark McDonald, the barrister who has represented Lucy Letby for the past two years, has warned that the public inquiry into her convictions will lead to more blame and suspicion in the NHS, making patients less safe. He argues that a defensive workforce is dangerous for everyone.
McDonald spent thousands of hours reviewing evidence, speaking to experts, and examining what happened to the babies who died or became seriously unwell on the neonatal unit at the Countess of Chester hospital. He worked with nearly 30 experts, including internationally recognised specialists in neonatology, pathology, insulin, statistics and other fields. He remains convinced that Letby is innocent, describing her convictions as one of the most serious miscarriages of justice in modern British legal history. He said she was failed by the police, the NHS, the criminal justice system and a plethora of experts who got it wrong.
Concerns for neonatal staff
McDonald expressed wider concerns about what the lessons drawn from the case will mean for doctors and nurses in neonatal medicine. Neonatal units are among the most demanding environments in the NHS, with tiny, desperately ill babies whose condition can change within minutes. Clinicians make difficult decisions under enormous pressure, often with incomplete information.
He noted that sometimes, despite the best care, babies die. He warned that the case risks creating a culture in which clinicians become frightened to work in these environments. He posed the scenario of a doctor on a night shift whose patient deteriorates and dies despite quick decisions, only to have those decisions reconstructed years later with hindsight, with every action examined and the possibility of a criminal investigation hanging over the process.
Need for a learning culture
The NHS already faces enormous challenges in recruiting and retaining staff, he said. He argued that staff need to feel confident enough to make decisions, to say "I don't know", to admit mistakes, report near misses and challenge colleagues and managers, and above all to tell the truth. He said the NHS has for many years tried to develop a learning or "no-blame" culture, which never meant there should be no accountability, but that the first questions when something goes wrong should be: what happened, why did it happen, and what can we learn?
The public inquiry chaired by Lady Justice Thirlwall delivered its report in mid-September. It placed great emphasis on monitoring and surveillance and specifically stated a need to move away from the no-blame culture. McDonald said these recommendations risk creating a surveillance society within the NHS, where clinicians fear that every adverse outcome may lead to scrutiny and blame. He argued that patient safety depends on openness, trust and learning from mistakes, not a culture of suspicion in which clinical error, systemic failure and deliberate criminal conduct become dangerously blurred.
Past inquiries and responsibility
McDonald noted that Thirlwall's is not the first major inquiry into failures in maternity and neonatal care. Over the past two decades, there have been major investigations into trusts in Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham. Inquiries have repeatedly found problems with leadership, communication, escalation, teamwork and listening, with recommendations made and promises given that the NHS will learn. He asked why it hasn't, and said the answer cannot simply be another set of rules, another layer of monitoring, or another system for identifying individual responsibility.
He was critical of the government, of successive governments, asking who is asking what these changes will feel like to a nurse working a 12-hour shift in an understaffed neonatal intensive care unit, or to a doctor knowing that an unexpected clinical outcome could result in years of scrutiny. He said the government has a responsibility to protect patients but also to protect the workforce on whom patient safety depends, and that the two things are inseparable. He also said trade unions should defend patients but also their members, not defending wrongdoing but defending fairness, ensuring a doctor or nurse is judged in the circumstances in which they actually made a decision rather than with hindsight.
Lack of debate and potential consequences
McDonald said there has been remarkably little public debate about the possibility that the response to Thirlwall's inquiry could create fear among NHS workers, and that no Labour MP has spoken up, a silence he said matters. He warned that the recommendations risk creating an environment in which a disgruntled healthcare professional can point the finger at another, triggering investigations that can quickly become criminal investigations.
He said doctors and nurses caring for vulnerable newborns deserve protection from unfair hindsight, disproportionate suspicion and a culture in which every adverse outcome becomes a potential question of individual blame. If the lesson taken from the Thirlwall inquiry is that we need more blame, more surveillance and more fear, he said, we will have learned the wrong lesson. We will not have made the NHS safer, he concluded; we will simply have made it harder for the NHS to care for the babies who need it most.
