NHS bosses in North Somerset and the surrounding areas have said they are committed to doing “everything possible” to prevent a repeat of Lucy Letby-type murders happening locally.
The serial killer nurse received a whole life sentence for the murder of seven babies while working on the neonatal unit at a hospital in Chester.
But Eugine Yafele, chief executive of the local NHS trust covering Weston General and Bristol’s hospitals, warned: “It could absolutely happen anywhere.”
Speaking at an Integrated Care Board meeting on September 7, he said: “We’ve got to have a healthy approach to being inquisitive and asking the questions in all directions.”
The board draws together top bosses from NHS organisations and local authorities across North Somerset, Bristol, and South Gloucestershire to work together on local issues.
Board member Jaya Chakrabarti said: “Sharing data and knowledge is where we are at as a system, so if we do have movements of potential serial killers between our system parts that’s probably where the conversation starts.”
But fellow board member Steve West warned that the different NHS organisations had failed to learn from each other in the past.
He said: “One organisation has an incident, investigates it — and in this case clearly it was a court case — and there’s a lot of learning that comes from it.
“We used to see exactly the same thing in mental health homicides where I would chair those end meetings, where everyone would say we would learn from the lessons.
“Yet every time, I was seeing the same thing over and over and over again. So we are not learning as a system.
“So I think that’s where we come in. How do we make sure that the system is learning from each other and not assuming ‘that was that organisation, it will never happen in mine’.”
Chief Nursing Officer Rosi Shepherd said they could not wait for the findings of the independent inquiry to finish before taking action.
She said: “It’s really striking that some of the features that come out of this, that have come out of previous patient safety issues in relation to actually listening and hearing properly from the people that use our services and our workforce.
“We don’t know the facts yet, but that is the sense that we get is we have another situation where people were trying to raise concern, either the parents of the children or our workforce, and that wasn’t heard effectively and wasn’t acted on.
“So there is work we will need to do collectively and individually inside our own organisations to really think about our own culture and our own ‘freedom to speak up systems’ to make sure they are really working in service of the safety of our citizens and our workforce.”
However, she added that things in the NHS had changed since Lucy Letby committed the murders in 2015 and 2016.
She said that every maternal or neonatal death was looked at through their quality safety committee and the Local Maternity and Neonatal System, a partnership of organisations working on improving care.
A new ‘Patient Safety Incident Response Framework’ is also being introduced across the NHS nationally this autumn, which is designed to ensure NHS organisations focus on understanding why incidents happen.
Locally, chief nurses will also run a seminar in autumn about ensuring the right questions are being asked.
Ms Shepherd said: “This is about our culture. This is about us hearing and listening properly and acting quickly and being prepared to believe the unbelievable.”
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