A Government trade advisor and Conservative donor, who won Covid contracts worth £164 million after being referred to the ‘VIP Lane’ by his long-term political ally Michael Gove has admitted deleting emails from the account through which he conducted the deals, a court has been told.

David Meller, who donated tens of thousands of pounds to Mr Gove and the Conservative Party before his beauty firm Meller Designs was awarded six large Government contracts to supply personal protective equipment (PPE) at the height of the pandemic, was revealed in a commercial litigation case he has brought against a former business associate to have a “penchant to...delete emails”.

Solicitors for Meller – who has a vast network of political connections that include senior Conservative politicians Nadhim Zahawi and Business Secretary Kemi Badenoch, who last year appointed Meller to the UK Board of Trade where he advises the Government on trade strategy – said: “In the usual course of business, Mr Meller had a practice of deleting his emails after they had been actioned.”

The emails in question relate both to Meller’s personal email address as well as to his Meller Designs email account, and cover everything prior to March 2023.

It includes the period Meller successfully negotiated the mass supply of PPE with the Cabinet Office, which is responsible for Government procurement and in which Gove was at the time a minister.

In addition to the practice of deleting his emails, Meller also openly concedes he has agreed several high-value contracts, including one with the Defendant, T&P Real Estate, which is said to exceed £1.4 million, on the back of “oral agreements” and a WhatsApp message.

Defending, Jonathan Davey KC, for property developer T&P Real Estate, said in a case management hearing on Friday: “This is a remarkable position. For the defendant, being sued in relation to an oral contract, that sets alarm bells ringing.”

Niall McCullough, for Meller, said his client had been advised while seeking legal advice ahead of the case to “preserve relevant documents”.

Mr McCullough said: “We didn’t say [Meller] destroyed all documents; we said [he] destroyed some documents. This is not a case where [he has] destroyed everything.

“This [email deletion] was pre-litigation conduct [which began in March 2023].”

Mr McCullough conceded it was not known how likely it was that Meller’s emails could be retrieved.

“We are making enquiries with [Meller’s] IT provider as to the possibility and cost of retrieving emails deleted from his [business] account,” he said. 

“Our preliminary enquiries…suggest it is unlikely that it will be possible to retrieve deleted items from [Meller’s personal account].”

A Government spokesperson said: "Ministers had no involvement in these procurement decisions.

"In the height of the pandemic, we had to act swiftly to procure PPE, competing in a global market where demand massively outstripped supply.

"Potential suppliers often passed on offers of PPE to MPs, civil servants and ministers – and these offers were then passed onto professional procurement specialists for assessment, with due diligence carried out on all companies in advance of procurement and every company subjected to the same checks."

A Network of Interests

Meller's case concerns a 2019 multi-million property redevelopment deal he is alleged to have provided funding towards in association with former Goldman Sachs vice- chairman Michael Sherwood - one of several Meller and Mr Sherwood did together - which has seen Meller’s business practices come under scrutiny.

Nicknamed ‘Woody’, Sherwood was once one of the City’s highest-paid bankers with a wealth of £185 million, but the 58-year-old quit the firm in 2016 after failing to disclose a request for a £40 million loan from controversial British retailer Sir Philip Green, with whom he had a close friendship and a shared partiality to expensive yachts.

Aside from his deletion of emails, Meller - who was awarded a CBE in 2018 and was on the Department for Education's board of directors when Gove was Secretary of State for Education, before he resigned in 2018 over a sexual harassment scandal surrounding The Presidents Club, of which he was joint chairman - was revealed in court not to have “worked from” a laptop or desktop computer during the late 2019 period the litigation relates to.

This was around six months before Meller’s company was awarded the first two of its Government PPE contracts, worth a combined £66.9 million, in May 2020. It is not known in what fashion Meller negotiated those deals in the two months after the pandemic began in March 2020. 

The businessman - who, despite having admitted borrowing £600,000 from Sherwood to finance the deal because “he did not have the cash funds” is described in court filings as a “high net worth individual” - admitted he agreed his financial backing to the T&P Real Estate Ltd project following a handful of unminuted phone calls and “in person” meetings between himself, Sherwood, and T&P’s then director Joshua Garside. 

A single WhatsApp message, sent by Mr Garside to Meller, is said to be the only written proof in existence pertaining to any part of the negotiations, the terms of which are disputed by both parties. 

Meller claims £880,000 of his funding was to be in the form of money “roll[ed] over” from, several named companies he had an interest in, one of which at the time of the alleged loan had been dissolved (Secure Sleep Properties LLP), and another that was in administration and is now insolvent (Wellington Old Co. Ltd).

Another company named by Meller that he claims to have rolled money over from, Berkshire Assets (West London) Ltd, collapsed last year. The latest administrator’s report showed the company’s investors had lost more than £30 million, and HMRC was owed £186,000.

After the failure of the deal, the businessman decided to take legal action against T&P Real Estate Ltd in an attempt to recoup money he says he invested. 

Meller is seeking all of his money back from T&P Real Estate Ltd, plus interest and an exit fee, claiming any money he placed into the £14.5 million redevelopment in Sutton, Surrey, was only ever a loan.

In response, T&P Real Estate Ltd have launched a counterclaim against Meller.

They say that the money advanced under the alleged loan arrangement between Sherwood and Meller did not beneficially belong to Meller, that none of the £880,000 “roll over” money promised was ever received, and that Meller failed to bring in a further £1.4 million investment from Marron Capital LLC as they say he had promised to.

They claim Meller’s son, Jonathan, who is a minor shareholder in one of his father’s investment companies, and who is said to have conducted business on his father’s behalf, had assured them he had had a pre-existing relationship with the US-based investment firm.

Meller, who has declined to detail the arrangements of the loan from Sherwood but claims he paid it back a year later in November 2020, argues that it should have been the responsibility of Garside - who was a director of a number of companies Meller had an interest in - to enact the “roll over” of funds from their other businesses.

Meller says it should effectively have been Garside’s responsibility report on the finances of the companies the pair were jointly involved in, and to look after arrangements for the “rolling over” of funding from those companies.

T&P argue there is no proof that such an arrangement between Meller and Garside existed and, even if it did, such an action lacked “legal legitimacy”. They add that “it would be commercially nonsensical for T&P to accept a ‘rolled-over’ ‘investment’” which ultimately would not amount to any new money being advanced to the company, and instead would be taking on an assumed debt. 

Meller also says he never agreed it was his obligation to seek investment from Marron Capital LLC, and that he was in fact told by T&P that no funding from Marron Capital LLP was required.

Byline Times will continue to cover the case, which will go to trial in November. 

Primary care doctors in England are feeling “despondent” and feel unable to provide adequate care given the current pressures on workloads and funding, Byline Times has been told. 

GPs and emergency doctors are picking up the pieces amid long waits for operations, as well as a crisis of mental health underfunding, according to testimony shared with this newspaper.

And a significant number of GPs are leaving permanent positions for locum roles (filling in for those ill or on leave), or leaving clinical careers altogether amid unsustainable workloads and heavy admin burdens.

Dr Kath Fielder, a GP in the north-east, told an EveryDoctor survey for Byline Times: “Everyone I know who is a GP is very tired, despondent and weary. I actually think the predominant emotion is sadness. Nothing works like it should and it’s truly heartbreaking seeing patients receiving substandard care from the entire NHS. 

“We in primary care have become a holding bay: for people waiting years instead of months for urgent procedures; managing people with significant mental health problems because they aren’t 'bad enough’ to reach the threshold for a massively under-funded CAMHS [Child and Adolescent Mental Health Services]; writing appeals for PIP [Personal Independence Payment] because so many people are losing their benefits.” 

She compared the situation to “handing someone a thimbleful of water when their house is on fire”. 

“I rarely send patients to hospital but, when I do, I am truly shocked at how many are sent straight home again," she added. "And this is not criticism of the hospital staff. I know they will be under incredible pressure not to admit anyone and there won’t be any beds for them to lie in. Whilst this is happening we are having increasing restrictions in what we can prescribe; where we can refer and impossible targets to attain.”

Dr Kath Fielder: “Everyone I know who is a GP is very tired, despondent and weary...Nothing works like it should."

Some GPs are now “unable to work” given the conditions, and many more are swapping permanent posts for temporary or ad hoc work.

Asked what the biggest challenges for her practice are right now, she added: “Not being able to give the care we want. It’s that simple.” 

Dr Nicholas Souter, a GP based in the south-west, said GP practices had increasingly been incentivised to hire less-qualified Associate Physicians or Advanced Nurse Practitioners (ANPs) over GPs as they were cheaper to employ. 

It comes as a new British Medical Association survey of 18,000 doctors found that 55% of respondents said the employment of PAs (physician associates) and AAs (anaesthesia associates) in their workplace had increased their workloads, rather than reduced them. 

Just 21% of doctors responding to the survey said the presence of these staff had reduced their workload.

Along with complaints over increased workload, the BMA’s survey also highlighted serious concerns about the use of PAs and AAs regarding patient safety.

Among doctors working in primary care (typically GPs and A&E doctors), 90% told the BMA the way that PAs were being employed in the NHS was a risk to patient safety, with 82% believing PAs frequently or often worked beyond their capabilities. 

Dr Souter pointed to a recent case of two ANPs analysing a patient’s bloods, which they said “showed a build up of toxic substances''. One told the elderly patient that her life was under threat and she must go to hospital. 

Dr Souter said: “I looked up old bloods and noted this lady had chronic kidney disease.” Her blood toxin levels were always that high – in fact, they were usually higher. “She did not have acute renal failure… So this ANP-to-ANP discussion was all a misunderstanding – the Advanced Nurse Practitioners was reviewing bloods taken by another ANP and neither knew the difference between chronic renal failure and acute renal failure.

"The poor woman was stressed, her family was stressed, an unnecessary ambulance had been sent, an OOH physician had been kept busy.” 

The GP said practices should “never” be allowed to have less-trained ANPs outnumbering GPs “but of course, while the Government is under-funding GP practices there is no way to resolve this”.

However, one GP said that recruitment of Physician Associates – which was ramped up following the 2019 Government contract with GPs – followed “years of practices struggling to recruit salaried doctors”. 

Another added: “The GP contract has generally speaking buggered up our practice as the funding has not matched the demand. That said, so many factors are making GP a nightmare to work in (and manage) that pulling out one strand is very difficult. PAs in the surgery are very hit and miss. We have had two that have been utter disasters, making more work by wanting constant intervention on the part of their supervisor for the days, having a long list of things they won't do, and referring all kinds of things that don't need referring. 

“We have, however, had one who is an absolute legend and has been a pleasure to work with – we wouldn't lose her for the world. The problem is that you don't know what kind you are going to get.”

Six other GPs who spoke to EveryDoctor, and who wished to remain anonymous to speak more freely, echoed these concerns – noting GP practices are struggling to recruit salaried doctors, leading many trainees to choose locum positions for a better work-life balance. This has left full-time partners working extensive hours with additional unpaid admin work.

GPs also pointed to the Government’s 2019 contract with GPs, which they claim has not matched funding with demand. 

Several GPs said the current workloads were destroying morale: “On top of my daily appointments, home visits, supervisions, quick reviews, [and] prescribing for the team, I regularly have five to eight sick note requests to action, 50 [test] results and 20 to 30 letters to look at. District nurses tend to send me messages multiple times a day too.

“There has been a huge exodus of GPs in our area so anyone I’m working with is usually newly-qualified. They can’t seem to work at pace, having been trained in the pandemic. I’m frequently having to mop them up too when exhausted or upset over vexatious complaints. Our biggest challenge is retaining GPs because of the above. One has just resigned and is going abroad.

“Morale is terrible. I’m lucky because I have been at my practice for nearly 10 years so most patients are appreciative. But the general public view is we’re rubbish but at the same time want us to do everything/fix everything… and so do secondary [specialist] care.” 

In another practice, a doctor described how they have seen a large rise in turnover of GPs: “We have managed to recruit several GPs to replace them… but not in full capacity, because we cannot afford to recruit as many as we need. The new GPs are very recently qualified and so need peer support.” 

And they claimed that the recent 6% pay rise for NHS staff in England is not being fully funded by NHS: “[It does] not cover our costs by a long way. Someone at NHS England decided staff costs are about 40% of income. [It’s] more like 60 to 70%. As a result, you are left with a huge dilemma. Our hard-working staff deserve a pay rise but we can't afford it without losing staff to pay for it?” 

A&E specialist doctor Dr Huw Evans, based in the West Midlands, said workloads in NHS hospitals meant care expectations had fallen through the floor. His department is constantly under-staffed, with significant vacancies among specialists, he said.

The failure to invest in infrastructure after years of austerity is also visible, with Dr Evans noting: “There are numerous buckets under holes in the roof” of the hospital. 

Dr Huw Evans says buckets fill with water from leaks in his hospital due to crumbling infrastructure

“Patients are missing out on the professional relationships that used to be commonplace in the community. As a result, they come to [Emergency Departments] – we never close – where problems that could be dealt with in a few minutes take many hours to sort out."

The breakdown in primary care, including huge delays to get GP appointments, in turn slows down care for those who really need emergency help, he said: “The sight of queued ambulances is the most visible aspect of this. We are not able to offer the level of care that we would wish and have given up on the 'Gold Standard’ aspirations. It used to be that a four-hour breach would cause castigation. Now, any patient who is not a 12-hour breach is a cause for celebration.

“I have worked for the NHS for over 30 years. The NHS is sinking like the Titanic, holed by the iceberg of under-investment. Captain Sunak [is] putting his telescope to his blind eye, telling us he only sees clear water ahead.”

Dr Julia Grace Patterson, EveryDoctor's chief executive, told Byline Times that the Government's "political actions" had "decimated" the NHS.

“NHS GPs are absorbing an enormous amount of pressure currently," she said. "They are doing everything they can to keep patients safe, but this becomes more and more challenging as the situation evolves. The Government is not supporting the current GP workforce, they are often scapegoated for problems that they have not caused, and there is now a move to flood the NHS with non-doctor clinical decision-makers, which is exacerbating the situation. 

“Every healthcare professional has a role, and within a fully-functioning NHS with abundant resources, physician associates would be a welcome addition to clinical teams. We definitely hear about some places in the NHS where they are highly valued. However, in many NHS facilities, the burden of responsibility for supervision of their work falls to doctors. This is hugely labour-intensive and even dangerous, given the pressure on the NHS, the rate at which staff must work, and the potential for diagnoses to be missed and patient safety problems to be caused. 

“Morale amongst GPs is very low, and the situation must be urgently tackled. The Government must listen to frontline GPs and healthcare leaders to rectify the situation. Politicians are profoundly failing NHS staff and the patients they are devoted to caring for.” 

Commenting on concerns over the roll-out of Physician Associates, a Department of Health and Social Care spokesperson said: “The role of Physician Associates is to support doctors, not replace them, and they make a significant contribution to the NHS. PAs work alongside doctors providing medical care as an integral part of the multi-disciplinary team. They carry out clinical duties such as taking medical histories, carrying out physical examinations, and developing and delivering treatment and management plans.

“Regulation of these roles has cross party support and will boost patient safety, with the General Medical Council operating strict fitness-to-practice procedures and setting education and training standards.”

The Government’s Long Term Workforce Plan aims to increase the Physician Associate workforce in England to 10,000 by 2036 to 2037, and the similar Anaesthetic Associate workforce to 2,000 over the same period. 

Officials say new regulations will give the General Medical Council responsibility and oversight of doctors, PAs and AAs, allowing it to take a “holistic approach” to the education, training and standards of the roles. 

The testimony from GPs and patients was gathered by EveryDoctor

Do you have a story that needs highlighting? Get in touch by emailing josiah@bylinetimes.com

Hundreds of health care workers are launching legal action against NHS Trusts and other public bodies over their alleged failure to protect them from infection during the COVID-19 pandemic.

Law firm Bond Turner is already working with over 250 UK-based healthcare professionals who are living with life-altering physical, psychological and cognitive injuries, and who say they contracted the SARS-CoV-2 virus at work while caring for patients throughout the pandemic. Many more are expected to join the action in the coming weeks.

The action is being spearheaded by the Long Covid Doctors for Action Group (LCD4A). Although initiated by doctors, the action is open to all health care workers injured by COVID at work, in all four nations.

A 2023 BMA survey of over 600 doctors with Long Covid found that nearly one in five (18%) reported that they were now unable to work due to their resulting ill-health. There was also a reduction in the number of doctors with Long Covid symptoms working full-time. Less than a third (31%) of respondents now work full-time, down from 57% before their infection.

Campaigners believe a significant number of NHS England workers may also be in a position to join the legal action if they contracted COVID at work, and to seek damages for the loss they have suffered.

“Some have lost their jobs and their homes; they are in financial ruin. Their illnesses have had far-reaching consequences in all areas of their lives,” said Sara Stanger, Director and Head of Clinical Negligence and Serious Injury Claims at Bond Turner.

Dr Kelly Fearnley is the chair of Long Covid Doctors for Action and is a Junior Doctor. She has spoken out about the “devastating” health issues she has suffered with after contracting COVID-19 at work.

“From the start of this pandemic, UK healthcare workers have been risking their lives and health caring for COVID patients without adequate protection. A significant number are now disabled following preventable occupational exposure to SARS-CoV-2 and are being managed out of the door with no support system in place and without means to financially support themselves and their families," Dr Fearnley said.

"Not only have they lost their health and independence, they have lost their careers and livelihoods, with many now facing financial destitution.”

The campaigner and medic claimed that an increasing number of employers are “choosing to terminate contracts” of health workers who have Long Covid, adding: “We feel betrayed and completely abandoned."

And Dr Fearnley called for healthcare workers to be provided with respiratory protection for the airborne disease which continues to circulate in health settings. 

Also joining the action is Nathalie MacDermott, a paediatric infectious diseases doctor and undertakes research into outbreak diseases, specifically Ebola virus disease. From March 2020 she was working on the frontline of the pandemic in the NHS, caring for children with a variety of infectious and immunological conditions. 

LCD4A note she contracted COVID at the end of March 2020 when exposed to a colleague at work. She recovered and returned to work 10 days later. But at the end of May 2020 she contracted COVID for the second time while caring for children affected by conditions related to COVID-19, ‘without adequate PPE’. “This second infection resulted in damage to her spinal cord resulting in long term disability and mobility problems, among other symptoms,” a spokesperson for LCD4A said. 

Bond Turner’s Sara Stanger added: “As the nation stood at their doors clapping, our frontline NHS workers risked their lives while caring for patients, without proper protection. Thousands of healthcare workers who put their lives on the line caring for COVID patients in their hour of need contracted the virus themselves, and many have since developed Long Covid and are living with the devastating and life-altering effects. Some have been left severely disabled and, for some, the consequences of the infection proved to be fatal.

“This has had serious financial implications for those healthcare workers who have had prolonged periods of absence from work or have not been able to return to work, and for families who have lost loved ones who used to support them financially.

“We are encouraging all healthcare workers who believe they may have been affected to come forward and join the action as soon as possible, so there is sufficient time for their claim to be fully considered and investigated. A claim will be pursued against all those at fault and whoever is considered liable for the injuries and losses.”

The LCD4A is campaigning for long/post-acute Covid to be recognised as an occupational disease, to help healthcare workers diagnosed with this condition access and claim Industrial Injuries Disablement benefit. They say it would also improve access to other physical and mental health services. The British Medical Association, Royal College of Nursing and the TUC have all backed the call. 

Bond Turner is leading the action in England and Wales. In Scotland, it is legal firm  Jackson Boyd.

Voices of Long Covid Doctors for Action members

“Before COVID, I was working a 48-hour week, playing rugby twice a week, swimming and running in my spare time. I was fit, capable and always on the go. COVID stripped me of my independence. It nearly took my life. I am clinging on to my career, which is unrecognisable. I only still have a home and relationship because of the unbelievable support offered by my partner. Every day is hard; I will likely never play sport again. I wouldn't wish this on my worst enemy.” – GP Registrar

“My life has completely changed since I contracted COVID and I fear I will never be the same person again. I have been in the news multiple times covering the story of my horrendous symptoms and I am glad I could raise awareness but all I want is to feel like me again. I was never an overly confident person but the confidence I did have has completely depleted. All I want is to be fit and well again but currently I am not. I feel lost, abandoned and distraught. 

“My disability has turned my life upside down and continues to do so. I have lost my partner, my normal way of life, job prospects, money, my enjoyment of the small things and my freedom… my life has changed forever. This has been a difficult period for me and I feel completely betrayed. I was fit and healthy before being diagnosed with COVID back in April 2020. This virus has had a severe impact on my life and sadly it is still doing so.” – Pharmacist

“I lost my partnership plus the job and team I thought I’d be with for the rest of my career. I lost my health. I now spend every workday hoping I can do the minimum self-care necessary to allow me to work for four hours so that I don’t lose our family home. I am much better than I was at my worst and I am nowhere near who I used to be before I got ill. My mum is moving to live near me so that she can, in her 70s, help look after me. I will probably never recover financially from nine months with no income. And I have to convince people I’m really ill.” – GP

“I wake up tired every day; every day is a struggle to get through. I never feel I'm doing my best at work or at home with my son. I never feel I'm good enough and don't think I will ever get back there. Now seriously thinking about non-acute careers as I am exhausted. It's been 3.5 years!” – Consultant

“I worked on the front line as an NHS consultant during the first wave of the pandemic until I became unwell with COVID and then Long Covid. I've had to take ill-health retirement from my clinical role, from a specialty I love and spent years training in. Long Covid has ruined my career and the NHS has lost a consultant.” – Consultant

Do you have a story that needs highlighting? Get in touch by emailing josiah@bylinetimes.com

The Thirlwall Inquiry into events at the Countess of Chester Hospital has begun gathering evidence. Later this year, there will be hearings. And careful work to discover how a neonatal nurse killed under her teammates’ noses, while doctors who urged managers to alert the police were ordered to draw a line, attend mediation, and apologise to the colleague they suspected of murdering.

The inquiry will explore the experiences of parents and has statutory powers to compel witnesses to give evidence under oath. It will examine not only the conduct of the board, managers and the medical workforce at the hospital and the role these played, but also the effectiveness of management, governance, and professional regulators throughout the NHS in keeping babies in hospital safe. It will ask whether the accountability of senior managers should be strengthened and consider how NHS culture may need to change. Once it concludes, will the public be safer?

Unlikely. At least, if history is any guide. Letby is the latest inquiry in a twenty-year string running from the Bristol Royal Infirmary children’s heart surgery scandal to the present. The awfulness uncovered in Mid-Staffordshire in 2013 produced an outcry. It led to an NHS-wide review of culture by Sir Robert Francis KC and the appointment of guardians to encourage speaking up.

Supported by an independent national officer, yet fatally on the payroll of local NHS trusts themselves, the guardians were trumpeted as holding boards to account. But they have ended up disappointing, including it seems, Sir Robert who spoke last year of an NHS where staff must “go on strike to get listened to.” Where the culture is “whatever the board wants.”

When higher-ups are the block, what remains? A democratic reset seems a surer way to give patients and workforces a voice than top-down programmes reliant on the character of local leaderships. A paper in the Journal of Medical Ethics by Dr Edwin Jesudason – a consultant in rehabilitation medicine in Scotland – offers some thoughts on how that might work.

Taking an axe to the management fiefdoms that control NHS trusts, the author, a former paediatric surgeon and whistleblower, argues that just as patients must give informed consent to medical procedures, where managers’ decisions can harm, the public should be informed of the risks and have the right to say no. Had managers had to publish the unexplained escalation in deaths at the Countess of Chester Hospital, some babies might have been saved. To put power in people’s hands and broaden decision-making, Jesudason recommends upping the representation of frontline staff and patients on NHS boards and placing term limits on executive appointments. Requiring managers to rotate back to the frontline, he argues, would lessen “us and them divides.”

The paper is a response to an NHS disaster. But its ideas have relevance wherever there are power ingroups and outgroups. In the Post Office, higher-ups exploited private prosecutions and legal muscle to pin IT-generated deficits on blameless sub-postmasters. In healthcare, poor leaders fear bad publicity, hide risks and hijack disciplinary processes, meant as public safeguards, to silence whistleblowers.

Once subjected to motivated allegations, whistleblowers face being put through the wringer of an opaque internal process. Simply for surfacing risks as medical ethics demand. In the best case, investigators may decide the allegations were baseless. But even then, the damage “can be lifelong”, as a 2015 report on regulatory referrals and suspensions noted. Alternatively, a doctor or nurse may emerge with their reputation for competence unblemished, yet still face the sack because the employer says relations have collapsed. Should they seek legal recourse, they must convince a judge that their whistleblowing was why they were dismissed and not the reason argued by the publicly funded big-name lawyers fighting the employer’s corner.

Requests for disclosure will meet with stonewalling, extreme redaction or point-blank refusals dressed up as legal privilege. People may discover that email accounts were deleted or meetings unminuted, only for notes to later surface.

They may even, as in Dr Chris Day’s disclosure-fraught legal marathon, be told an executive has destroyed up to 90,000 emails, but the judge considers “a fair trial is possible and there is no substantial risk of injustice”. Win or lose, the individual will emerge psychologically battered, with a sense, of  having “a target on my back”, says the whistleblower Peter Duffy, who was subjected to a two-year investigation by the General Medical Council (GMC), which eventually found there was no case to answer.

Despite promises to “learn lessons” inquiries often lament that again the same mistakes were made. They need not. Rather than chronicling how patients were failed and staff ignored, inquiries should track back to the underlying structures and power relationships that encourage non-consensual leadership and recommend reforms.

Jesudason’s paper offers the Letby inquiry some ideas to work with. These include: “meaningful representation of staff and patients” on boards in place of “placatory consultations.”  Also, beefed-up “local democratic oversight” that is not susceptible to board capture – a criticism that campaigners make of today’s councils of governors. Lastly, legal reform to prevent lawyers acting for public institutions from abusing legal privilege to bury risks that the public would want out in the open.

And there are other reform-minded campaigners with ideas that merit attention. One proposal, with widespread medical backing, including by Doctors Association UK and the British International Doctors Association, and a forward by a former NHS England chair, calls for the statutory establishment of independent elected scrutiny panels to ensure disciplinary proceedings are fair. Composed of senior doctors and nurses elected by the workforce, with non-executives representing the board, the panels would guard against miscarriages of justice, says Dr Arun Baksi, an emeritus consultant physician and co-author.

A democratised NHS would help rebuild trust between managers and the healthcare workforce. It would allow public money thrown at lawyers to be spent on patients. In the same way that the sub-postmasters punctured the Post Office’s narrative once they learned of each other’s stories, the pooling of knowledge that democracy enables would make cover-ups harder.

Democracy cannot guarantee good leadership. But when well administered – with safeguards such as modest term limits – it does require leaders to leave their siloes and hear the issues people are raising. Trinity College Dublin, unusually, has a tradition of electing its university provost, deans, and heads of schools. “It gives people some degree of ownership and a voice in what’s going on within their institution,” reflects Louis Brennan, a professor at the university. “That’s the big plus.”  

Democracy may not cure the NHS’s accountability crisis. But, as a step towards cultural recovery, it seems a better focus for inquiries than simply rehearsing the ways in which the public has been failed.