It is always a disorienting moment when a cult with a large following is exposed as an empty superstition and collapses. So it is with the NHS, the nearest thing this country had to a state religion since the Church of England abdicated that role to become a therapy service for the progressive cause. Today, however, the clatter of saucepans on doorsteps, summoning to worship on Thursday evenings, has fallen silent. The collective fetish is as overthrown as Stonehenge.

And where, as the megaliths tumble, is the chief druid? Where is Amanda Pritchard, CEO of NHS England, at a cost to the taxpayer of £260,000 a year? We asked this question last Monday and it remains unanswered. This abdication of responsibility by the highest NHS executive of all epitomises the evasion of accountability that is the hallmark of NHS management, as we have seen, with such tragic consequences, at the Countess of Chester Hospital where Lucy Letby conducted a campaign of mass murder, denounced by her clinician colleagues, but given the green light to continue by management.

No wonder the scales have fallen from the public’s eyes and they worship no more at the shrine of a mythicised NHS. This Götterdämmerung was long overdue. Dysfunctional is too mild a term to describe the current state of the NHS. The waiting list in England and Wales has soared to 7.5 million – 12.5 per cent of the population – and the 18-week waiting limit has not been met since 2016. This is a Third World healthcare system. Yet it is one of the biggest employers in the world, with a staff of 1.5 million, of whom 524,000 are doctors and nurses. That figure excludes many people directly employed in clinical support, such as radiographers and laboratory technicians. There are additionally 35,500 management staff.

So, there is one manager for every 14 doctors and nurses. Some people might think that smacks of micromanagement. But the real criticism is that it is mismanagement, as drastically demonstrated by the Lucy Letby case. The details that have emerged from that lethal failure by management are the most damning indictment imaginable of a key public service run by totally inadequate, yet entitled, people. The tragedy is that the culture of cowardice and incompetence, masked by ideological conformity, that currently infects all public sector institutions and many private enterprises, has now claimed the lives of vulnerable children.

At this moment, which is surely the nadir of the 75-year history of the NHS, it is necessary to qualify public condemnation in certain areas. There are still many dedicated and brilliant clinicians within NHS ranks. Their service in containing, so far as was possible without vaccines or even adequate PPE in the early stages, a devastating pandemic in which many hospital staff lost their lives will not be forgotten. If strikes by nurses and junior hospital doctors have since partially dimmed that lustre, there is still, at the core of the NHS, a solid body of clinicians who continue to personify the highest ideals of their profession.

But it is the people who have infiltrated the managerial commanding heights of that profession who are abusing these valuable public servants. The conduct of the management at the Countess of Chester Hospital where Lucy Letby committed mass murder was little short of criminal. Indeed, since it resulted in so many deaths, some of which had been pre-warned against, it is difficult to see how some of those involved can escape criminal charges for facilitating preventable child murders.

Consider the facts so far exposed. Dr Stephen Brearey, lead consultant on the neonatal unit at the Countess of Chester Hospital, raised the alarm concerning Lucy Letby in October 2015. Instead of acting on his warnings, he alleges that his life and those of other colleagues who voiced concerns were made difficult by management. Two of the murders occurred after the consultants had warned the hospital management and been repulsed.

Any responsible manager, warned about a possible threat to the lives of children under his care, should have taken immediate action, on the precautionary principle. Letby should discreetly have been taken off the ward temporarily and assigned to other duties while investigations were carried out. Instead, experienced and conscientious paediatricians were forced to write a letter of apology to a mass murderer.

Allison Pearson wrote a hard-hitting piece in the Telegraph arguing persuasively that management deficiencies were attributable to a warped HR culture (Lucy Letby had to be “valued” – unfortunately the same did not apply to her victims) and that over-promoted nurses in management posts relished disciplining doctors. If a chippy culture of “We are the masters now” is causing underqualified nurses-turned-bureaucrats to dismiss the superior clinical expertise of consultants, then that is toxic for the welfare of patients.

Tony Chambers, the £160,000 a year CEO of the hospital, left in 2018 with a pension pot worth £1.08m and a golden handshake of £80,000, and subsequently became interim chief executive at the Royal Cornwall Hospitals NHS Trust, reportedly earning a further £90,000 between August 2021 and January 2022. And he has held a string of similarly lucrative appointments since leaving the killing ground he had allowed to develop at the Countess of Chester.

His successor there, Susan Gilby, took the concerns over Letby seriously and, with the Trust’s then chairman, Sir Duncan Nichol, established an independent review. It has never been published and she is suing the Trust for constructive dismissal, alleging she was forced out and that the current chairman Ian Haythornthwaite “bullied, harassed and undermined” her.

Others of the managerial elite with questions to answer are Alison Kelly, former director of nursing at the Countess of Chester, who told concerned doctors to “see what happens”. Tragically, they did. Ian Harvey, medical director on a salary of £175,000 a year, dismissed the paediatricians’ evidence as “limited” and “circumstantial”. The police took a different view. Karen Rees, head of nursing for urgent care, asked by Dr Brearey when he requested that Letby be taken off the ward and she refused, “Would you be happy if something happened to any of the babies the following day?” replied “Yes.” That conversation was repeated in sworn evidence in court.

As Dr Brearey and many of his colleagues have argued, it is intolerable that NHS managers are not subject to the same accountability as clinicians. That must immediately be remedied, by setting up a rigorous regulatory regime. We also need a full judge-led public inquiry with power to compel witnesses to give evidence. Anything less would be a farce and an insult to the murder victims and their families.

On a much broader scale, now is the moment when a root-and-branch reform of the whole dysfunctional National Health Service must be carried out. It no longer commands the knee-jerk veneration it formerly did: people are waking up to the concerning reality of a badly broken healthcare system. It is time for a royal commission to carry out the exhaustive investigations that are needed and to recommend the necessary reforms, heedless of the discredited cult that formerly cloaked inadequacy in quasi-religious awe. Nothing less will serve.

Perhaps it might also be able to discover the whereabouts of Amanda Pritchard, phantom CEO of our Heath-Robinson healthcare apparatus, falling apart on her watch. The lights are on, but all the responsible agents seem to have left the building.

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