30 August 2023

The shocking case of Lucy Letby has given me pause for thought about the standing of the medical profession. Like the case of Harold Shipman many years ago, there has been a lot of attention on the motivations and how the crimes remained undetected.

There is the usual circular firing squad of finger-pointing, but this is another example of the decision-makers being driven by the wrong targets. It seems that several consultants tried to draw attention to suspicious deaths but were ignored or disciplined themselves. So much, it would appear, for the NHS whistleblowing policies, which are supposed to encourage professionals to raise such issues without risk of prejudice.

We have come to accept that the power and authority in our employing organisations sit with senior managers and executives, not senior clinical staff.

As Alison Leary correctly points out in her BMJ opinion piece, Lessons not learned, the need for a whistleblowing policy implies a poor safety culture in the first place and Trust Boards seem to exist in a parallel universe, caring more about financial performance and reputation management than quality of care.

I doubt anyone can do much to prevent a determined and clever individual from causing death if that is their aim. However, the tragic events in Chester are symptomatic of a wider issue around safety.

Over the last few years, we have all witnessed and, to a degree, normalised a deterioration in standards of patient care. Do we have an option to whistleblow about ongoing staff shortages or delays in investigations and treatment? At the moment, we’d be sitting constantly in the whistled version of the Last Night of the Proms.

Rightly or wrongly, I still lay the blame for our current malaise on the doorstep of central government. The need for an open debate on what level of healthcare the NHS can realistically afford to deliver has never been more pressing.

Before the COVID pandemic, the BSH Global Haematology Special Interest Group had planned to visit Zambia to assess and assist with the development of a newborn sickle screening programme.

It’s taken a while to get this trip off the ground again. But a couple of weeks ago, I was part of a small team of two haematologists and a senior laboratory scientist who visited Lusaka and Ndola.

A colleague commented to me, “It’s a jolly. You’ll probably just spend your time on the beach.” So, it’s worth noting for the geographically challenged that Zambia is landlocked, and both cities get very few tourists. Indeed, when you put “10 best things to do in Ndola” into TripAdvisor, it can only manage to come up with five. One of which is a taxi company.

It was a fascinating and inspiring trip. The screening programme is just off the starting blocks, with many challenges ahead. The Zambian Clinical and Laboratory teams are committed to seeing this through but operating in testing circumstances.

Haematology as a specialty is underdeveloped, with an evident demand for the upskilling of laboratory teams and the development of postgraduate education in haematology. Zambia has a track record of stable government and a growing economy aided by its ample mineral resources. The need to develop better services for non-communicable diseases is a national priority.

I hope the BSH will be able to build on the links we have established, developing ongoing training and education, initially concentrating on sickle care and newborn screening, but in time extending into other subspecialist areas. I believe such a link will provide development opportunities for staff in both countries.

My colleagues and I were overwhelmed by the response to the call for a BSH Workforce Research Fellow to work with our colleagues at London South Bank University. We received a large number of applications, universally of a high standard, and almost every one of them appointable. That made for a challenging selection process, and in the end, we were able to appoint two people to share the role.

Congratulations to Dr Nicola Ransom and Dr Jon Massie.

Nicola is a Consultant Clinical Scientist in haematology based in Hull. She was one of the first HSSTs in haematology to complete the training programme and provides a unique role in delivering direct care to patients as well as leading the laboratory services.

Jon is an ST5 haematology registrar training in Bristol. He has a particular interest in workforce planning and has also published on the use and misuse of workplace-based assessments in training.

I have no doubt their complementary skills will be of great value to the project, and I wish them every success.