In a case that has gripped the world’s media, Lucy Letby, a young British nurse, has been convicted of murdering seven babies and attempting to kill six others. There is more to this story than lurid tabloid tragedy. The big issue is why whistleblowers in the National Health Service, on this occasion and many others, were ignored by hospital managers.

Letby is not the only psychopath to have stalked the British medical profession in recent years. Nurse Beverley Allitt was jailed for life in 1991 after murdering four children, while doctor Harold Shipman was convicted in 2000 of taking the lives of 15 patients, although he is suspected of murdering as many as 200 more.

These were not the first medical practitioners to abuse their positions to play God, or rather the Devil, with their patients, and they will not be the last. Amazon Prime has streamed several series of a true-crime docudrama Nurses Who Kill about health carers who have abused positions of trust to kill the vulnerable. The question is not why such people exist — that’s one for psychologists, philosophers and theologians — but how to detect them at the outset of their homicidal careers before the suffering and harm multiplies.

British politicians and much of the media, however, have engaged in a massive displacement activity in the past week, focusing the debate on whether Letby should have been hauled into court before the judge to hear her sentence, as is customary.

Last month, a professional hitman who murdered a young girl refused to leave his cell to hear his punishment. His defiance is being copied by others, including Letby. Tabloid newspapers deprived of their grand trial climax frothed. Then, a headline-hunting Tory minister rose to the bait and proposed a new law to force convicted criminals into court, with other politicians joining the hue and cry. We are unlikely to hear the last of the matter.

I do not doubt criminal contempt of court is an insult both to the law and to the families of the victims, but this argument is likely to go down a rabbit hole leading to confusion. Judges already can take a prisoner’s refusal to appear into account when handing down sentencing. But what to do if, as in Letby’s case, the criminal receives life imprisonment? No further tariff can be added. If a law were enacted to force her and her kind to show up, however, no one is seriously addressing the practical details of how to drag an unwilling prisoner into the dock. Punch-ups in court or disruptive screaming matches do not answer the craving for more visible justice. Terrorists might even welcome the melodrama of an appearance in manacles to broadcast their contempt for the system and their attachment to their cause. Why bother with a cumbersome law when court proceedings can be piped by television monitor into prisoners’ cells with the volume turned up?

The Government has ordered an independent inquiry into why senior consultants at the Countess of Cheshire hospital where Letby worked were ignored by hospital managers and the chief of nursing. But without statutory powers being assigned to the probe, many witnesses who have moved jobs or retired can refuse to give evidence. Inquiries, statutory or not, have a habit of running for years. The best can complete their task briskly — a recent one into poor care standards at the Mid Staffordshire hospital took three months. The Government should quickly pick a chairman, set tight terms of reference and get on with it.

But stopping nurses who kill is only a small part of the problem. A pattern of negligence has already been established in maternity wards. Last year the official Care Quality Commission found that two out of five maternity units in England were offering “substandard care to mothers and babies”. That report followed a three-year investigation in East Kent Hospital Trust’s maternity unit, which revealed that as many as 45 babies might not have died between 2009 and 2020 had they been provided with “nationally recognised standards of care”.

I have written previously about the professional rivalry between hospital consultants and nurses which lies behind many of these tragedies. We can also guess at the imperatives that drive bad hospital managers, who succeed in failing upward. On the principle that all publicity is bad publicity, they fight to cover up scandals that might damage their careers and use human resources departments to smother whistleblowers. And when the police are called to investigate, they dole out taxpayers’ money to the victims’ families and solemnly pronounce that “lessons have been learnt”.

Lessons clearly have not been learnt. Two brave paediatricians tried to bring the correlation of the deaths of the first three babies and an above-national-average rise in baby collapses with the timing of Letby’s shifts on the ward to the attention of Countess of Chester managers. They were reportedly ignored by the hospital’s chief executive and the head of nursing, even when joined by five other colleagues. Senior consultants were even forced by the HR department to apologise to Letby for doubting her professional expertise.

The inquiry will doubtless get to the facts of the case. In the meantime, it has been sensibly suggested that just as doctors and nurses can be disbarred for clinical malpractice, so should hospital managers who are allowed to move on from their failures to the next cushy job or fade into retirement without a reckoning. But something more is required.

The NHS needs to learn from best practice at home and abroad, and to make itself more accountable. Advances in artificial intelligence will help in better pattern detection — but human interaction makes the connections that protect lives.

It beggars belief that even when fatalities and injuries rise without explanation far above the mean, safeguarding systems do not snap into action. And when a health service which is seen as a national trophy cannot guarantee safety, it needs to ask more demanding questions of those who appoint its senior managers. There is no such thing as a failure-free healthcare system. The Letby case reminds us that trust is an asset easily undermined when vigilance falters. Patients deserve better — and not just in the most extreme circumstances.

• Martin Ivens is the editor of the Times Literary Supplement. Previously, he was editor of The Sunday Times and its chief political commentator