Letby case: lack of parity in oversight or response

We agree with Dyer that the crimes committed by Lucy Letby raise important questions about how we respond to concerns and variations in clinical outcomes.1 This is particularly pertinent as routine checks and balances did not identify that the mortality exceedance in the neonatal unit was of very high statistical significance.This case shines a spotlight on the lack of parity in oversight of and response to local variations in clinical outcomes for non-communicable or non-infectious diseases compared with communicable disease.2 If the unexpected deaths on the unit were thought to be caused by an infectious disease—methicillin resistant Staphylococcus aureus, Clostridium difficile, or covid-19, for example—health protection colleagues would have become aware through notifications or routine surveillance. A response would have been initiated in June 2015, and a multi-agency incident investigation instigated.3 Resources would have been mobilised, and a standardised, legislated,45 consensus of what constitutes an outbreak (including investigative steps and…
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