Managers should ‘embrace’ regulation, says Letby trust CEO

Jane Tomkinson, who has led the Countess of Chester Hospital Foundation Trust since December 2022, was giving evidence at the public inquiry into events surrounding Letby’s murders.

Neonatal nurse Letby was convicted in 2023 of murdering seven babies, and attempting to murder seven more, in 2015 and 2016, while working at the hospital.

The inquiry has asked several witnesses for their views on professional regulation of senior NHS managers, which government is now proposing to introduce.

Ms Tomkinson said current rules were “really inconsistent”, with a lack of “set standards” and “core values” for managers.

She told the inquiry: “Given the history, and certainly the learnings through this case and the inquiry, it feels that the time is right [for professional regulation]. I don’t accept criticism that this could have a chilling effect on stopping people from taking these roles up.

“They should absolutely welcome and embrace a regulatory framework that makes things safer for patients.”

Ms Tomkinson – a finance director by background and previously CEO of Liverpool Heart and Chest Hospital FT since 2013 – also defended the NHS targets regime.

Last week, former health and social care secretary Jeremy Hunt told the inquiry about his view that an excessive number of central targets led to local NHS leaders neglecting safety and quality, and a culture of covering up failure.

Asked about national targets, Ms Tomkinson said: “I think it gives focus… what I always say is a target is about the quality of care and how long people wait for that care, so we shouldn’t have a problem.”

Lip service to ‘speaking up’

Ms Tomkinson was asked to reflect on how the leadership of the trust handled concerns about raised neonatal mortality, and doctors’ warnings that Letby might be responsible around the time of the murders.

The inquiry was shown evidence of the trust’s risk assurance “matrix” three months after the deaths of two babies, and after neonatal mortality concerns had been raised.

Inquiry counsel Rachel Langdale KC highlighted how it said the trust was concerned about damage to the reputation of its neonatal service.

Ms Tomkinson said: “I would be exceedingly unhappy to have been presented with a risk register that looked like that. We do review them very frequently at the Countess now…

“Reputational risk is just nothing compared to the risk of harm to patients. I would not have scored it in that way. I wasn’t in the position at the time, but that is pretty shocking to me.”

Asked if it told her anything, she added: “It tells me that the culture is focused on something other than the primary job of keeping patients safe.

“It says to me that there is an element of spin in the issue and that the governance processes that led to a scoring and risk descriptor like that are absolutely out of kilter with the reality of what was happening…

“[There was] spin about reputational damage. Words like ‘apparent’, when it wasn’t apparent, there was increased mortality. It’s been written in a way to convey a message which, for me, is not the reality of what was going on.”

Ms Tomkinson told the Thirwall Inquiry hearing that much of the failings appeared to be attributable to culture rather than policies and processes.

She said: “Policies and processes were there, they weren’t followed. In my view, this is a relationship and cultural issue which absolutely undermined what should have been really robust ways of escalating issues.”

She said “lip service was paid out to Speak Out Safely” at the trust, while the board was “dominated by the views of a number of individuals”.

“It was not a unitary board, and people were potentially threatened with punitive action if they didn’t toe a particular line,” she said.