I said I wasn’t going to come on this thread again, but just to confirm that as you suggested growstuff this accountability issue is for England only.
In Wales there is a clear accountability framework for all managerial posts. Of the two people most closely managerially accountable in the Letby case, if they were here, the Medical Director would be professionally accountable to the GMC, and have managerial accountability jointly to the Chief Executive and the Health Board Medical Director for the relevant aspects of his role. The Nurse Director would be professionally accountable to the NMC, and have managerial responsibility to the Chief Executive and the Chief Nurse for the Health Board. The Chief Executives are jointly accountable to the Chairman of the Board of their Health Board, and to the NHS Wales Chief Executive in Welsh Government. This doesn’t stop there being serious issues, but it means that ultimately the buck stops with Welsh Government, and if people don’t perform it is managed. I believe very similar arrangements apply in Scotland - I can’t speak for England as I don’t know how it works there.