Communications lessons from the Thirlwall Inquiry into the crimes of Lucy Letby
The report of the Thirlwall Inquiry into events at the Countess of Chester Hospital is a grim read, but Chapter 15 should be compulsory for all communications professionals.
On 15 September, Lady Justice Thirlwall published the report of her inquiry into events at the Countess of Chester Hospital, which was commissioned following the August 2023 sentencing of nurse Lucy Letby for seven murders and seven attempted murders.
Leaders across the health and care sector will now be digesting the report's findings and recommendations. But it also contains important lessons for communications professionals in the NHS, healthcare and beyond, particularly in Chapter 15.
While the recommendations largely focus on improving systems, processes and oversight, this chapter offers a stark reminder of how organisations behave under pressure, how they communicate with people affected by a crisis, and how concern about reputation can become counterproductive.
Communication with victims and bereaved families
Paragraphs 15.4 to 15.12 describe the distress of bereaved parents who learned through local media that the hospital's neonatal unit was being downgraded and subjected to an external review by the Royal College of Paediatrics and Child Health.
The trust contacted only a small number of families before the news became public, something the report described as “lamentable”. In one case, it attempted a single call to a parent's landline and made no further effort to reach them.
One bereaved mother learned the news through the media before seeking answers from the hospital herself.
For any organisation dealing with death, injury, harm or serious failings, the communications principle is straightforward: those directly affected should be treated as the most important stakeholder group. They should hear significant news from you before they hear it from anyone else.
That requires planning, empathy and persistence. It means preparing for difficult conversations and ensuring people can speak to someone who can answer their concerns honestly and compassionately.
Trying a landline once and moving on is not enough. Most importantly, this is not simply a communications exercise. It is a matter of basic decency.
The Thirlwall inquiry and the reputation trap
The striking irony in Chapter 15 is that these failures occurred despite significant concern within the trust about its reputation.
Paragraphs 15.29 to 15.52 describe how ‘potential damage to reputation of neonatal service and wider trust’ was assessed as a higher risk than ‘apparent increased mortality within the neonatal unit’. The report later notes that even the word ‘apparent’ understated the seriousness of what was taking place.
The conclusion to this chapter is stark: "Where, as here, executives focus on the effect of a situation upon reputation rather than the effect of the situation on patient safety, the strong impression given is that reputation has become more important than patient safety."
The report also quotes parents who believed the trust was more concerned with protecting its reputation than addressing what had happened to their children. This reflects a mistake organisations often make during a crisis: treating reputation as something that can be managed directly, but it can’t.
Organisations can influence reputation, but they do not control it. Ultimately, reputation is shaped by the judgements stakeholders make about an organisation's decisions and actions.
When leaders become preoccupied with protecting reputation, particularly at the expense of people who have suffered harm, they often create exactly the reputational damage they are trying to avoid.
In a crisis, organisations convince themselves they are managing risk when they are simply moving it elsewhere. Legal, political or operational risk may be reduced, but if that comes at the expense of trust, empathy or accountability, the risk has not disappeared. It has simply changed shape and may re-emerge later as reputational damage.
Lessons for organisations beyond the NHS
The report's 17 recommendations include several aimed at strengthening leadership, culture and organisational integrity.
One proposes adding the following commitment to the NHS Leadership and Management Framework Code: “I will make the care and safety of patients my first concern and act to protect them from risk.”
The principle applies far beyond healthcare. The lesson of Chapter 15 is not that reputation does not matter; it is that reputation is largely a consequence of how an organisation treats people.
Organisations that emerge strongest from a crisis are rarely those that focus most intensely on reputation itself. They are the ones that communicate honestly and compassionately, and above all keep affected stakeholders at the centre of their decision-making.
Tim Toulmin is the director of reputation, risk and crisis advisory consultancy Alder.
Further reading
Coping with grief: four books and a podcast that may help
Lucy Letby: A global story and a local police force
Why communicators need to think before they post about criminal cases