Criminal Law in Healthcare (Part 1): Corporate Manslaughter – Goodmayes Hospital, Lucy Letby and Beyond

“Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide this right thing to be always done?”
~ Florence Nightingale

Healthcare is grounded in the principle that clinicians must do no harm. Sometimes, that principle is so dramatically perverted that the criminal law must respond. In this two-part article series, Maya Sikand KC and Jordan Briggs consider the criminal and regulatory framework in healthcare in the context of patient safety. This first article describes the offence of corporate manslaughter, with a focus on the Lucy Letby case and the Goodmayes Hospital prosecution that concluded on 9 June 2025. The second article will consider the roles and impact of the Care Quality Commission and the Health and Safety Executive. 

On 2 January 2012, Lucy Letby began working in the neonatal unit of the Countess of Chester Hospital. Usually, no more than two to three babies died on the unit each year. Between June 2015 and July 2016, there were 61 cases of sudden infant death or collapse. Those cases coincided with Letby’s presence on the ward and ceased when she was moved into a back-office role. In August 2023, Letby was convicted of murdering seven babies and attempting to murder six others.

In this article, we discuss only summarily the less-prominent criminal laws in healthcare:  for example, gross negligence manslaughter (committed where a grossly negligent but otherwise lawful act causes death: see here) and offences under s.33(1) of the Health and Safety at Work etc. Act 1974 (HSWA 1974), including those committed when an employer fails to conduct their undertaking in such a way as to ensure, so far as is reasonably practicable, that their employees (s.2: see here) or those not in their employment who may be affected (s.3: see here) are not exposed to health and safety risks. We note human rights responses to gross failures in healthcare in the context of inquests and private law damages claims which are grounded in violations of the operational duty imposed by Article 2 of the European Convention of Human Rights, but those lie outside the scope of this article.

So, we begin with corporate manslaughter. On 3 October 2023, the Chesire police began a corporate manslaughter investigation into the Countess of Chester Hospital in relation to Lucy Letby’s conduct. This begs the question: with such an extraordinary rise in infant vulnerability and death, should the NHS have done more, sooner? This is one of the questions that is due to be answered by the Thirlwall Inquiry when the Chair reports in the Autumn. 

CORPORATE MANSLAUGHTER

Corporate Manslaughter is a complex offence created by section 1 of the Corporate Manslaughter and Corporate Homicide Act 2007 (CMCHA 2007), incorporating civil law concepts into the criminal law. It came into force on 6 April 2008, is triable only on indictment and carries an up-to unlimited fine. 

In short, the offence bites when the management or organisation of a corporation is so defective that it is treated as part of causal chain leading to death. To prove the offence, six elements must be satisfied.

1. The Defendant is a qualifying ‘organisation’: The Defendant must be one of the following (s.1 CMCHA 2007):

• A ‘corporation’ (which does not include a corporation sole but includes any body corporate wherever incorporated’, s.25 CMCHA 2007).
• A ‘body listed in Schedule 1’ (i.e. governmental departments).
• A ‘policy force’, or;
• A ‘partnership, or a trade union or employers’ association that is an employer’

2. The Defendant owed a ‘relevant duty of care’ to the deceased: The Defendant must owe a duty ‘under the law of negligence’ either (s.2 CMCHA 2007):

• ‘To its employees’ or similar;
• ‘As occupier of premises’;
• ‘In connection with… the supply by the organisation of goods or services’ or similar; 
• ‘to a person… for whose safety the organisation is responsible’, namely those who are detained or restricted in some way, including those ‘detained at a custodial institution’ or ‘at a removal centre’ or ‘a detained patient’ (s.2(2) CMCHA 2007).

s.3 - 7 of CMCHA 2007 limit when public bodies owe a ‘relevant duty of care’, including those making public policy decisions or exercising exclusively public functions or statutory inspections (section 3), military operations (section 4), police and law enforcement operations (section 5), emergency services responses (section 6) and those exercising child-protection and probation functions (section 7).

3. The breach of duty was ‘gross’: The Defendant must have breached the duty of care in a manner that is ‘gross’ (s.(1)(b) CMCHA 2007), meaning a manner that ‘falls far below what can reasonably be expected of the organisation in the circumstances’ (s.1(4)(b) CMCHA 2007). Section 8 sets out a non-exhaustive list of factors which the jury must consider in determining whether there has been a gross breach of duty. “Gross” is to be interpreted consistently with the gross negligence manslaughter test commonly used as the threshold as per R v Adomako (1994) 99 Cr App R 362 (“the defendant’s conduct was so bad in all the circumstances as to amount to a criminal act or omission”). 

4. There is a qualifying ‘senior management’: The Defendant must have a group of people classifiable as ‘senior management’, requiring that they ‘play significant roles in’ either (s.1(4)(c) CMCHA 2007):

• ‘The making of decisions about how the whole or a substantial part of its activities are to be managed or organised’ or; 
• ‘Actual managing or organising of the whole or a substantial part of those activities’.

5. The acts of ‘senior management’ were a ‘substantial element’ of the ‘gross breach’: For liability to attach, ‘the way in which [the Defendant’s] activities are manged or organised by its senior management [must be] a substantial element in the breach’ (s.1(3) CMCHA 2007).

6. The breach of duty ‘caused’ or ‘contributed’ to the death: The gross breach must be ‘an operational cause’ of death, making ‘more than a minimal contribution’ to it. It need not be the sole or even the main cause (s.1(1)(a) and CPS Guidance).

So, to prove the offence, one must adduce evidence about how the corporation was managed, organised and, most likely, structured. The more complex and multilayered the organisation, the more difficult it will be to identify the ‘senior management’ and trace a causal chain between their actions and the deaths. Those matters have a distinctly civil law flavour, and it may be difficult to prove them to the criminal standard. 

This might be why there are so few prosecutions of corporate manslaughter, and why many of the reported cases involve simply structured corporations. To date, there have been just 40 prosecutions of corporate manslaughter, of which 32 ended in convictions. The most common fact pattern involves manufacture and labouring, although roofing and waste-management cases are also common. A table of all cases to-date is annexed to the bottom of this article. The authors believe this to be the only full, up-to-date review of corporate manslaughter cases online.

HEALTHCARE CASES OF CORPORATE MANSLAUGHTER

There have been only four healthcare cases involving corporate manslaughter:

• R v Maidstone and Tunbridge Wells NHS Trust (2016): On 9 October 2012, the Defendant Trust performed a caesarean section on Mrs Cappuccini. Post-surgery, she bled significantly and was treated under general anaesthetic but sadly suffered a cardiac arrest and died. The prosecution appear to have argued that ‘senior management’ were those who onboarded and managed the surgical staff that day, as they framed the ‘gross breaches’ (for which they were responsible) as the recruitment of a doctor with inadequate overseas experience, the failure to discount his CPD credits and failure to supervise him on the day of death, and the recruitment of a second doctor without a formal interview. Coulson J held that the breaches were ‘nowhere near the sufficient gravity required to categorise their failure as criminal’ and held that there was no case to answer. 

• R v Sherwood Rise (2016): On 22 November 2012, the 86-year-old Mrs Atkin died whilst living in the Defendant’s care home. Conditions in the home were extremely poor, and Mrs Atkin died after becoming extremely malnourished, dehydrated and contracting pneumonia. The breaches appear to have been the total absence of ‘very basic essentials of human existence – food, water, heating, sanitation and cleanliness’ that caused Mrs Atkin to decline. The ‘senior management’ will have been framed as whoever was responsible: it may have been the Director, Mr Khan, although three other staff members appear in press reports. In any case, the Defendant plead guilty to corporate manslaughter and was fined £30,000 plus prosecution costs. Mr Khan was disqualified from being a company director for eight years and plead guilty to gross negligence manslaughter, for which he was sentenced to three years and two months in prison.

• R v Aster Healthcare Ltd (2021): On 8 February 2015, the 93-year-old Mrs Norris died after being placed in a boiling hot bath by staff of the Defendant care home. It is not clear who ‘senior management’ were, but were impliedly whoever was responsible for the home’s publicised failure to follow guidance for safe provision of hot water, and lack of bathing policy and staff training. The Defendant plead guilty and was fined £1.04m. The fine may have been so high because, after Mrs Norris’ death, the Defendant gave false water temperature records to the CQC and police, in an attempt to mislead both.

• R v North East London NHS Foundation Trust (2025): On 7 July 2015, Ms Figeiredo died whilst detained in the Goodmayes Hospital, run by North East London Foundation Trust (NELFT), for treatment of mental illness. The ‘breaches’ appear to have related to the hospital not addressing the risks of self-asphyxiation and self-harm that led to Ms Figeiredo’s death. The ‘senior management’ will have been the person or group that was responsible for managing or organising those decisions. The trial began on 29 October 2024 and, apparently following the joint-longest jury deliberation in English legal history (125 hours and 22 minutes), ended in an acquittal of the Trust for corporate manslaughter, but a conviction of the Trust of offences under s.3(1) and s.33(1) HSWA 1974, and of the ward manager under s.7(1)  and s.33(1). The BBC have reported on this case here and here. 

The short point is that, to-date, the NHS have never been convicted of corporate manslaughter. That may be because its organisation is too labyrinthine to identify ‘senior management’, or because there is such sentimentality about the NHS that prosecutions are not brought. In Ms Figeiredo’s case, it seems that this prosecution only got off the ground due to her parents’ relentless investigatory work, looking beyond and behind the Trust’s inadequate internal Serious Incident Report. Her stepfather considers that Alice’s case has ‘moved the dial’  on corporate manslaughter charges and Dr Victoria Roper of Northumbria University is reported as suggesting that ‘public bodies, the police and the CPS will… see what can be learned’ from the verdict. 

One lesson appears to be that, as ever, a corporate manslaughter conviction is unlikely to attach without clear evidence of how senior management’s acts contributed to death. Put conversely, a conviction may follow when that evidence is clear, especially if there are several deaths, each providing opportunities for causally implicating the senior management. If that is right, then the Letby case is the perfect opportunity to determine whether the dial has truly moved after the NELFT prosecution.

LUCY LETBY AND THE COUNTESS OF CHESTER HOSPITAL

The corporate manslaughter investigation into the Countess of Chester Hospital (run by the Countess of Chester Hospital NHS Foundation Trust) is apparently ongoing. While, on 14 March 2025, the police broadened their investigation to also consider whether individuals should be charged with gross negligence manslaughter, the two charges are not mutually exclusive and can be brought together (see for e.g. R v Timmins Waste Service, concerning the death of a construction worker inside an industrial shredder which a colleague switched on, and R v Deco-Pak, concerning the death of a labour caused by a robotic packing arm). Indeed, Detective Superintendent Paul Hughes has made clear that ‘the corporate manslaughter… elements of the investigation are continuing’ (see here). 

It is difficult to infer anything concrete about the merits of the corporate manslaughter investigation. Yet, the following demonstrates that there appear to be grounds for a corporate manslaughter charge to be brought because the six elements of the offence are satisfiable on current, publicly available evidence.

1. The NHS is a qualifying ‘organisation’: This is beyond doubt. CPS Guidance states that ‘[p]ublic bodies such as local authorities and NHS Trusts can… be held liable [under CMHCA 2007], on the grounds that they are bodies incorporated by statute’. 

2. The NHS owed a ‘relevant duty of care’ to Letby’s victims: This is also uncontroversial. Paragraph 22 of the explanatory notes to CMCHA 2007 states that the ‘relevant duty of care’ will ‘cover the supply of services by the public sector, for example, NHS bodies providing medical treatment’. 

3. The breach of duty was ‘gross’: This is where the analysis becomes complex. It would be for the prosecution to persuade the jury that there were failures in the NHS that fell ‘far below what can reasonably be expected of the [NHS] in the circumstances’. Thanks to the Thirlwall Inquiry, there is already much in the public domain about failures at the Countess of Chester Hospital. For example, NHS staff members are said to have dismissed doctors’ warnings (as early as October 2015) that Letby may have been killing infants, permitted an unreceptive approach to whistleblowers, failed to recognise that a specially-commissioned report did not exclude Letby as the cause of the deaths, and continued to roster Letby when she was the common factor to all deaths previously (see Letby’s unsuccessful appeal to conviction judgment, paragraph 27). The question is whether such conduct fell ‘far below what can reasonably be expected of the [NHS] in the circumstances’. Twelve jurors would decide on the answer if the Trust were charged. 

4. There is a qualifying ‘senior management’: While difficult to predict in advance, this limb would probably be satisfied. The question is whether an identifiable group of NHS staff ‘played significant roles’ in ‘the making of decisions’ about how ‘the whole or substantial part of [the NHS Trust’s] activities are to be managed or organised’, or ‘actual[ly] manag[ed] or organis[ed]’ those matters. Intuitively, ‘senior management’ candidates would be those NHS staff members who dismissed and/or overlooked concerns and permitted Letby’s continued rostering. That group will include the Board and likely the Executive Directors Group, or anyone else who had the relevant responsibilities that allow them to be brought within the causal chain. Presumably, if ‘gross breaches’ can be identified, the prosecution will be able to identify a ‘senior management’ who were responsible. We proceed on that basis.

5. The acts of ‘senior management’ were a ‘substantial element’ of the ‘gross breach’: It is difficult to predict the outcome of this limb because it builds upon those above. The question is whether a ‘substantial element’ of the ‘gross breach’ was the way in which ‘senior management’ within the NHS Trust either: (i) ‘made decisions’ about how ‘the whole or substantial part of [the NHS Trust’s] activities were managed or organised’, or; (ii) ‘actual[ly] manag[ed] or organis[ed]’ those matters. In plain English, this depends on how the prosecution frame the ‘gross breach’. If the prosecution say that the ‘gross breach’ was ‘continuing to give Letby opportunities to kill’, the question will be whether the actions of ‘senior management’ (e.g. dismissing doctors’ warnings and whistleblowers’ concerns and continuing to give Letby shifts) were a ‘substantial element’ in the hospital ‘continuing to give Letby opportunities to kill’. Again, twelve jurors would answer that question on the evidence. 

6. The breach of duty ‘caused’ or ‘contributed’ to the death: If all the above limbs are satisfied, there is no doubt that this would be too. If the jury accept that the hospital gave Letby opportunities to kill, they will surely conclude that those opportunities were an ‘operational cause’ of the ensuing deaths. 

Whether a charge is brought does not depend on whether Letby remains convicted herself. There has been a flurry of interest in overturning Letby’s conviction (see here), reflected in submissions to pause the Thirlwall Inquiry in light of ‘alternative explanations’ for the deaths, including ‘poor clinical management and care’ (here and here). While that evidence may make a corporate manslaughter prosecution more likely and may affect the safety of Letby’s own conviction, the two are not mutually exclusive. None of the six elements above turn on whether a natural person has been, or remains, convicted in relation to the same deaths.   

CONCLUSION

The offence of corporate manslaughter is seventeen years old. It is a teenager. It is still growing, especially in light of any new challenges it encounters. The most recent challenge was the Goodmayes Hospital / NELFT case, which ended in an acquittal for corporate manslaughter but convictions under HSWA 1974.

The Letby case is an intriguing opportunity for the offence. On paper, the Countess of Chester Hospital NHS Foundation Trust is apt for prosecution, as there is prima facie evidence to support each of the six elements of corporate manslaughter. If the evidential threshold is passed, the fact that the most vulnerable of already vulnerable babies were allowed to die, and others put at risk of death, will undoubtedly satisfy the public interest limb of the Full Code test, notwithstanding the publicity to date. It may be that the police are awaiting the Thirlwall Inquiry report before making a final decision. 

Yet, no NHS Trust has ever been successfully convicted. This is partly due to the complexity of the offence itself and no doubt partly because the NHS is a cherished national institution, funded by the State, and no-one wants to see it in the dock. That said, the NHS cannot hide behind its beloved status forever. Both the Thirlwall Inquiry and Lampard Inquiry into Essex Mental Health deaths are statutory inquiries tasked, inter alia, to scrutinise the culture and governance of the relevant NHS Trusts, and it is hoped that both will shine a light on patient safety and indefensible cultural practices within the NHS in general. Given the failure of internal investigations in these Trusts to date, and indeed the inability of the CQC to appreciate or investigate concerns in the Letby case, the criminal law may be a necessary backstop. 

ANNEX