LL Part 25: Level 1, Level 2, Is this the only issue?

Or was it just one of several confounding factors

Following on from our previous article in the Letby series here.

I have been asked in the last 24 hours about the issue of the neonatal unit at Countess of Chester Hospital (CoCH) being Level 2 during the 18 months when we are told by prosecutors and the mainstream media that there were elevated deaths, and whether this can be characterised (and evidenced) as the cause of the issue. It was pointed out that in a previous post I had strongly intimated in this general direction. However, I believe I was actually pointing to the fact that when the prosecution claim the numbers of deaths returned to normal coincided not with one event as they alleged - the removal of Lucy Letby, but two events - the removal of Lucy letby AND the CoCH voluntarily downgrading themselves back to Level 1 on the heels of the scathing RCPCH Report.

Similarly, when looking at the start of the so-called elevated period (and let me be clear, as stated in my interview with Professor Norman Fenton, the claimed increase in deaths per year during 2015-16 when considered with information for the 3-4 years prior to 2015 and the 3-4 years post 2015 does not reach a level of statistical significance), there too appear to be confounding factors that coincide to provide an easier explanation than Baby Killer Nurse (TM).

First, is the question of when CoCH made themselves, or became, a Level 2 neonatal unit accepting babies as premature as 27 weeks or as tiny or growth restricted as 800 grams. Yes, we know this change pre-dates the 2015 period, but when the actual change occured and for how long it had been in place seems to be a matter of some speculation and contention online. In fact, there is evidence showing CoCH was already a Level 2 unit in early 2013 - a full two years before the 2015/16 period.

We know from the now famous (or infamous, given the questions that now arise regarding its accuracy) FOIA request that there were 6 neonatal deaths (3 early neonatal, 1 late neonatal deaths and 2 post neonatal deaths) during 2013, along with 4 late foetal loss deaths and 8 recorded stillbirths. There were four neonatal deaths reported in 2014 and 9 in 2015. So the summary data goes something like this:

We should note the discrepancies (in red) between the MBRRACE crude rates for both neonatal death and stillbirth, and those calculated using the CoCH FOIA information. How is it that MBRRACE gets these numbers correct in only three out of ten instances (30% - in black)? What explains the discrepancies for a full 70% of these numbers?

Is it perhaps that the data MBRRACE received was different to the data disclosed by CoCH in the FOIA?

This is certainly something that several people online consider given that Letby was found guilty of murdering Baby E on August 4th, 2015, yet there were no FOIA-reported neonatal deaths in August 2015 (the number 2 represents two stillbirths which, if accurate, should normally have been recorded by midwives or obstetricians in the antenatal or delivery suites).

Letby was found guilty of murdering three neonates in June (Babies A, C and D) - which were all of the FOIA-disclosed neonatal deaths for that month. She was not charged with or prosecuted for the single early neonatal death in July. She was also not charged with murdering either of the two neonatal deaths reported in September. However, she was found guilty of murdering Baby I on October 23, 2015 - yet again we see no neonatal deaths were disclosed on the FOIA in October.

It doesn’t require a leap of logic to understand now why questions are being raised about the factual disposition of every piece of evidence that arises from the Letby prosecution.

If the neonatal mortality data for possibly the most scruitinised period at CoCH is itself unreliable, if the temporal printouts they gave police are also intermingled and unreliable (remember that information about patient events on February 16 and 18 got mixed in with February 17 and the mistake was only admitted during the Baby K trial), if the way in which key pieces of evidence were explained to or by police (door swipes on the outside to get in, rather than the inside to get out, and medical evidence that many in the profession now acknowledge doesn’t make sense) then I ask you, what, if any, of the evidence and records from CoCH can we actually believe at this point?

However, let’s leave that aside for the moment and return to the matter at hand…

Second, is the question of whether, as suggested by Peter Elston and Michael McConville in a recent podcast episode, CoCH made a group of neonatally-qualified and more expensive Band 6 neonatal nurses redundant in the period leading up to the events described by Letby - wherein she described the experience of constantly having to be shadowed by and training new grad or non-neonatally trained Band 5 nurses (and bank/agency staff) and the additional stress and negative impact this had on her ability to perform her duties. Is this the reason there appear to be very few, some say only two, permanent neonatally-qualified nurses left on the CoCH neonatal unit?

Third, is the question not just of adequate staffing numbers, but adequate numbers of competent staff sufficient to properly supervise junior or neonatally inexperienced practitioners. This aspect speaks not just to the nursing staff but, as discussed in the RCPCH report, the medical staff as well. How should we characterise junior and trainee doctors with no training in the neonatal specialty using these premature and poorly neonates as little more than training appliances to perform repeated invasive and risky procedures, sometimes up to seven in one go? How should we characterise the few qualified neonatal nurses having to bounce between almost every patient and practitioner on the unit to provide care, training, support and oversight rather than simply being able to focus on providing the primary care to their designated patients?

This is perhaps the most significant reason why we cannot dispense with the elevation from Level 1 to Level 2, even if it occured two or more years earlier. If it is true that CoCH no longer had sufficient neonatal nurses - whether because they left, because CoCH wouldn’t pay to send those they did have for training, or because CoCH made them redundant and hired a whole bunch of inexperienced new graduate nurses - then this together with the fact that CoCH was currently, and inappropriately, running as a Level 2 centre better explains the events of 2015/16. The unit was overwhelmed, understaffed, lacked sufficient appropriately qualified individuals and accordingly, those that were there were insufficiently supervised. It was a convergence of these things and the fact that these neonates had statistically lower chances of survival, rather than a Baby Killer Nurse, that led to their unfortunate demise.

As with any highly contended situation… cooler heads must be called to prevail.

The next part in our Letby Series can be found here.