Senior NHS managers should be disqualified if they are found unsuitable to carry out their roles, the inquiry over the crimes of child killer nurse Lucy Letby has heard.

Sir Robert Francis KC told the Thirlwall Inquiry that, unlike doctors, there was currently no regulator “with teeth” to impose sanctions on poorly performing non-clinical directors.

Giving evidence on Monday, September 30, the chairman of the Mid Staffordshire NHS Trust public inquiry said: “If a doctor is not thought to be fit and proper then the General Medical Council will investigate and if it sees fit it refers a case to the Medical Practitioners Tribunal Service, an independent adjudicator, who decides on the fitness of that person to continue in practice.

“There is no equivalent for non-clinical managers and I think there should be.

“The absence of that means there is no fair process for deciding these things and of course in all these cases there can be two sides to the story and you need a place where those issues can be resolved.

“The result I’m afraid is that people who haven’t done terribly well one way or the other may leave one job and you will then find they pop up in another because there is no overall certification as to whether someone is a fit and proper person at any given time to do these roles.

“So I am in favour of there being a system of regulation that at least has that element to do it.

“I think there ought to be a means of disqualifying someone from being a chief officer or a senior director of an NHS organisation.”

In a report to inquiry chairwoman Lady Justice Thirlwall, he wrote: “Effective external scrutiny depends on action and intervention either by NHS England or the Care Quality Commission.

“Neither is fully equipped to do this task, and as a result there is a risk that unsuitable directors remain in post or are permitted to apply for similar posts elsewhere.

“I consider that some form of more direct regulation is now required.”

Sir Robert’s inquiry into care failings at Mid Staffordshire NHS Foundation Trust – published in 2013 – uncovered the neglect of hundreds of patients at Stafford Hospital between 2005 and 2009 and made sweeping recommendations for change.

Some families have told Lady Justice Thirlwall they feel senior management at the Countess of Chester Hospital were “complicit” in Letby’s attack spree in 2015 and 2016 and also accused them of “facilitating a murder” by ignoring concerns raised by consultants.

However, senior managers have claimed they were not informed until late June 2016 about suspicions from medics that Letby was deliberately harming babies in the neonatal unit.

She was removed from the unit weeks later to a non-patient role, although police were not called in by the hospital until May 2017.

Letby, 34, from Hereford, is serving 15 whole-life orders after she was convicted at Manchester Crown Court of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims, between June 2015 and June 2016.

The inquiry is expected to sit at Liverpool Town Hall until early next year, with findings published by late autumn 2025.