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A new guide has been published, intended to ensure doctors feel “supported to speak out”.

The document, from the General Medical Council (GMC), comes one day after the sentencing of nurse Lucy Letby.

The 33-year-old was handed 14 whole-life orders for murdering seven babies and attempting to murder six others while working in a hospital’s neonatal unit.

The GMC has set out the standards of patient care and professional behaviour expected of all medical professionals.

While the guide’s predecessor, published in 2013, placed a duty on all doctors to raise concerns about patient safety, the updated version emphasises that doctors in leadership and management positions should create a culture in which staff feel safe to speak out about concerns.

Dr Naru Narayanan, president of the Hospital Consultants and Specialists Association (HCSA), said whistle-blowers are “treated by bad employers like the problem” and can “find themselves on the receiving end of threats and bullying to remain silent”.

In the Lucy Letby case, it has emerged that doctors raised worries which were rejected by hospital bosses.

A retired doctor who also worked at the Countess of Chester Hospital, Dr John Gibbs, questioned why managers took 11 months to involve police when suspicions were raised.

Dr Ravi Jayaram – a consultant paediatrician at the hospital who gave evidence in Letby’s court case – said there are “things that need to come out about why it took several months from concerns being raised to the top brass before any action was taken to protect babies“.

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Letby: Why were warnings ignored?

The new guide has been welcomed by Professor Chris Whitty, England’s chief medical officer, who said it “emphasises how supportive workplaces are essential for patient care as well as clinical staff”.

Among the changes is guidance on sexual harassment, which has been included by the regulator for the first time as part of a “zero tolerance” approach.

It says that doctors “must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress”.

In addition to physical contact, it includes verbal or written comments and displaying or sharing images.

Professor Dame Carrie MacEwen, chairwoman of the GMC, said staff who experience harassment or bullying “must feel supported to speak out”.

She added: “Sexual harassment, bullying and discrimination are entirely unacceptable.

“Where workplace cultures of this kind of behaviour go unchecked, they are detrimental to wellbeing, performance and patient safety.”

Read more:
The victims of Lucy Letby – and full statements from their parents

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Letby: Hospital doctor speaks out

Tim Mitchell, president of the Royal College of Surgeons of England, said: “We need to be creating a work environment where every person feels welcome, safe and protected.

“The GMC’s new standards send a strong message to the profession that these behaviours will not be tolerated.”

However, the Medical Defence Union (MDU) said doctors are “concerned about digesting and implementing new standards”.

The fresh guidance will be implemented from January 2024 after a five-month familiarisation period for staff.

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Prince Andrew insisted on ‘gag order’ to stop allegations spoiling Queen’s Platinum Jubilee, memoir claims

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Prince Andrew insisted on 'gag order' to stop allegations spoiling Queen's Platinum Jubilee, memoir claims

Prince Andrew insisted his accuser, Virginia Giuffre, sign a one-year gag order – to prevent details of her allegations tarnishing the late Queen’s platinum jubilee, her memoirs have claimed.

Andrew relinquished his Duke of York title and remaining honours on Friday evening.

It came after discussions with King Charles, in consultation with the Prince of Wales, both of whom wanted to bring an end to the long-lasting scandal.

But, according to The Telegraph, Ms Giuffre’s book, which is due out on Tuesday, is focusing further attention on the sexual assault allegations and the prince’s friendship with paedophile Jeffrey Epstein, which led to the royal’s downfall.

She tells how Andrew’s “disastrous” Newsnight interview with Emily Maitlis was like an “injection of jet fuel” for her legal team, and it raised the possibility of “subpoenaing” his ex-wife Sarah Ferguson, and daughters Princess Beatrice and Princess Eugenie and drawing them into the legal case.

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Prince Andrew’s ’embarrassed’ Royals ‘for years’

The Telegraph also reports Ms Giuffre’s claims that she got “more out of” Andrew than a reported £12m payout and $2m (around £1.4m) donation to her charity because she had “an acknowledgement that I and many other women had been victimised and a tacit pledge to never deny it again”.

The former duke paid to settle a civil sexual assault case with Ms Giuffre in 2022, despite insisting he had never met her.

More on Prince Andrew

Ms Giuffre alleged she was forced to have sex with the prince when she was 17, after being trafficked by Epstein. Andrew continues to vehemently deny her allegations.

Read more:
Andrew giving up title is ‘Victory for Virginia’
Everything we know about Andrew losing titles
Prince Andrew: A timeline of events

Queen Elizabeth II was celebrating her platinum jubilee in 2022 – the first British monarch to reach the milestone – as the civil case against her son was gathering pace.

It was settled nine days after she reached the 70th anniversary of her accession.

According to the Telegraph, Ms Giuffre, who died in April, reveals in her book: “I agreed to a one-year gag order, which seemed important to the prince because it ensured that his mother’s platinum jubilee would not be tarnished any more than it already had been.”

Parades, processions, concerts and street parties were held across the UK in celebration of the Platinum Jubilee. Pic: PA
Image:
Parades, processions, concerts and street parties were held across the UK in celebration of the Platinum Jubilee. Pic: PA

In January 2022, a US judge ruled the civil case against Andrew could go ahead, and the Queen went on to strip him of his honorary military roles, with the prince also giving up his HRH style.

‘Devastating’ interview

His 2019 Newsnight interview, which he hoped would clear his name, backfired when he said he “did not regret” his friendship with convicted paedophile Epstein, who trafficked Ms Giuffre.

Prince Andrew and Virginia Giuffre (then Roberts) in 2001 - a picture the prince claimed had been doctored. Pic: Shutterstock
Image:
Prince Andrew and Virginia Giuffre (then Roberts) in 2001 – a picture the prince claimed had been doctored. Pic: Shutterstock


Andrew also said he had “no recollection” of ever meeting Ms Giuffre and added he could not have had sex with her in March 2001 because he was at Pizza Express with his daughter Beatrice on the day in question.

Ms Giuffre, whose book is called Nobody’s Girl: A Memoir of Surviving Abuse and Fighting for Justice, wrote, according to The Telegraph: “As devastating as this interview was for Prince Andrew, for my legal team it was like an injection of jet fuel.

“Its contents would not only help us build an ironclad case against the prince but also open the door to potentially subpoenaing his ex-wife, Sarah Ferguson, and their daughters, Princesses Beatrice and Eugenie.”

‘Amazed he was stupid enough’

She also told how Andrew had “stonewalled” her legal team for months before settlement discussions began moving very quickly when his deposition was scheduled for March 2022.

Ms Giuffre also wrote she was “amazed” that a member of the royal family would be “stupid enough” to appear in public with the convicted paedophile, after a photo of the pair walking in New York emerged.

Andrew, who remains a prince and continues to live in the Crown Estate property Royal Lodge, said on Friday the “continued accusations about me distract from the work of His Majesty and the royal family”.

He insisted he was putting his “family and country first” and would stop using “my title or the honours which have been conferred upon me”.

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Why William and Camilla likely had influential roles in decision over Prince Andrew’s titles

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Why William and Camilla likely had influential roles in decision over Prince Andrew's titles

It’s not the first seismic statement I’ve had to deal with from the Royal Family late into the evening.

But what I have learnt from past experience is that when they do come in this way, it’s because the decision has been made to act now and act fast.

Which inevitably has us all wondering, why now?

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Prince Andrew: ‘Too much of a distraction’

The latest stories about Prince Andrew and his email to Jeffrey Epstein were again a sign of just how close he’d been to the convicted paedophile, and an extract released from the late Virginia Giuffre’s book was heartbreaking and excruciatingly seedy.

And yes, the full book is released on Tuesday.

But in some ways, we have heard a lot of these lurid details before, albeit allegations that Prince Andrew denies.

Which is why it feels like this time, the family had just had enough.

It’s framed as a personal statement from Andrew, but the involvement of his relatives could not be any clearer: “In discussion with the King, and my immediate and wider family,” he writes, followed up by, “with His Majesty’s agreement, we feel I must now go a step further”.

It has always been hard to get a full picture of how much the King has engaged in the problems with his brother.

Prince Andrew speaks with King Charles as they leave Westminster Cathedral Pic: Reuters
Image:
Prince Andrew speaks with King Charles as they leave Westminster Cathedral Pic: Reuters

Speak to those who know the family well and they’ll tell you our current monarch “doesn’t like confrontation”, just like Queen Elizabeth II.

And while there has always remained “a warm familial feeling between the two brothers” which we’ve seen through Andrew’s appearance at family events, it is “tempered by the King’s responsibilities as head of state to be entirely separate from the perceived, real or alleged activities of the Duke of York”.

In the end, as head of the institution, and not as his brother, the King would have had to lead the discussions about the Andrew problem, but I suspect with heavy involvement from his eldest son and wife.

William, only in recent weeks, has told us there will be change when he becomes monarch, his advisors stressing he isn’t afraid to question why the Royal Family continues to do things in a certain way.

His very visible unease at standing next to Prince Andrew at the Duchess of Kent’s funeral showed us how uncomfortable he felt about his uncle being there at such a public moment.

His involvement in those discussions behind the scenes and making sure the institution was seen to be taking action against Andrew is likely to have been considerable.

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A timeline of allegations against Andrew

I know that Queen Camilla is also a quiet but hugely powerful influence behind palace walls.

She is her husband’s listening ear, sounding board, but also not afraid to tell him when she believes there needs to be change.

Her own work to break taboos around sexual violence and encourage survivors to speak out must have made it even more difficult for her to read the stories about Andrew’s links to Epstein, and the sexual allegations against her brother-in-law, even though he has always vehemently denied them.

And then there are those closest to the Prince.

You have to have sympathy with his daughters, Princess Beatrice and Princess Eugenie. Did they tell their father that he needed to do something for their sake to try and shut down the noise?

His ex-wife, Sarah Ferguson, has also been burned in recent weeks by her association with Epstein – a spectre who, despite his death, has continued to haunt the royal family.

So what of Prince Andrew? How will this impact him?

Any sense he might have a chance at returning to some kind of public life has truly evaporated. We wait to see if, with time, he is again allowed to appear at least for family occasions.

I’ve always been told “he is robust and self-contained and always has been”.

Interpret that how you will – arrogance that he could ride it out, or a very strongly-held conviction that he has never done anything wrong?

Either way, he clearly believes he has been unfairly punished by the court of public opinion.

One thing a source did tell me is that there is a sense he’s never really needed the affirmation of his family.

Read more from Sky News:
Andrew named in Epstein files
Harry denies fight with Andrew
Author: Andrew has no public future

He may not need their emotional support, but in the end, we have again seen how no member of the family is bigger than the institution.

Protecting the reputation of “the firm” has to come first.

Prince Andrew may feel that he has done the right thing, even done his family a favour, by personally relinquishing the use of his titles and honours, but this, in the end, was not just his choice.

No longer to be known as HRH or the Duke of York, he is now Prince Andrew only – ultimately forced to fall on his sword by his own family.

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Everything we know about Prince Andrew’s titles decision

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Everything we know about Prince Andrew's titles decision

Prince Andrew has announced he is giving up his royal titles, including the Duke of York.

The decision is understood to have been made in close consultation with King Charles and other members of the Royal Family.

Prince Andrew said continued accusations against him were distracting from the King’s work.

He had been accused by Virginia Giuffre, who died in April, of sexual assault. He denies this.

Which titles is he giving up?

Prince Andrew is giving up his Duke of York title. Sky News understands this will be immediate.

He will also give up his knighthood as a Knight Grand Cross of the Royal Victorian Order (GCVO) and his Garter role as a Royal Knight Companion of the Most Noble Order of the Garter.

He will retain the dukedom, which can only be removed by an Act of Parliament, but will not use it.

Prince Andrew will also remain a prince, as the son of Queen Elizabeth II.

Virginia Giuffre had accused Prince Andrew of sexually assaulting her before her death. Pic: AP
Image:
Virginia Giuffre had accused Prince Andrew of sexually assaulting her before her death. Pic: AP

Why is this happening now?

Ms Giuffre, who was one of billionaire paedophile Jeffrey Epstein’s victims, alleged Prince Andrew sexually assaulted her on three occasions when she was 17, and sued him in 2021.

In her posthumous memoir Nobody’s Girl, due to be published on Tuesday, she alleged he was “entitled” and “believed having sex with me was his birthright”.

Prince Andrew has always denied the allegations.

He has also always claimed that a well-known image of them together was doctored. Before her death, which her family said was by suicide, the case was settled outside of court for a sum believed to have been around £12m.

Ms Giuffre’s posthumous memoir goes on sale a week after an email emerged showing Andrew told Epstein “we are in this together”.

The email was reportedly sent three months after he said he had stopped contact with the convicted sex offender.

Flight logs released by a US committee from Epstein's estate name Prince Andrew. Pic: House Committee on Oversight and Government
Image:
Flight logs released by a US committee from Epstein’s estate name Prince Andrew. Pic: House Committee on Oversight and Government

On Friday evening, the US House Oversight Committee also released documents from Epstein’s estate showing “Prince Andrew” listed as a passenger on the financier’s private jet – the so-called Lolita Express – from Luton to Edinburgh in 2006, alongside Ghislaine Maxwell.

He was also listed on another flight to West Palm Beach, Florida, in 2000.

The flight logs have been reported on for years but the release may have added to pressure.

“The situation has become untenable and intolerable, and this week in particular, the tipping point had been reached,” said royal correspondent Laura Bundock.

It is understood that the changes will take effect immediately.

The Giuffre family has called for the King to go further and “remove the title of Prince”.

Prince Andrew’s decision to relinquish his titles also comes following increased pressure over his relationship with an alleged Chinese spy.

The move will not impact the Princesses, including Princess Beatrice, here.
Image:
The move will not impact the Princesses, including Princess Beatrice, here.

Will this affect his ex-wife and daughters?

Sky News understands that Andrew will continue to live at the Windsor Estate at the Royal Lodge. His ex-wife, Sarah Ferguson, will also remain living at the Royal Lodge.

But for the second year running, he will not attend the Royal Family’s annual Christmas celebrations at Sandringham, it is understood.

Andrew’s ex-wife will also no longer use her Duchess of York title.

She was dropped by numerous charities last month after it emerged that she wrote to convicted sex offender Epstein, calling him a “supreme friend”, despite publicly disowning him in the media.

The decision over Andrew’s titles will not impact on the position of his daughters, Princess Beatrice and Princess Eugenie, it is understood.

Sky News royal correspondent Rhiannon Mills says the move may not stop the influx of negative stories about him.

She said: “This ends the questions on what more the monarch could do to show how the family felt about the accusations, the upset and the embarrassment caused.

“Will it stop the stories, the allegations and the interest in Prince Andrew? That is far less certain. But in what is the prince’s first public statement since that ill-fated Newsnight interview in 2019, it is striking that he signs it off by saying, ‘I vigorously deny the accusations against me’.”

Prince Andrew made the decision to give up his titles in close consultation with King Charles, it is understood. Pic: Reuters
Image:
Prince Andrew made the decision to give up his titles in close consultation with King Charles, it is understood. Pic: Reuters

What did Prince Andrew say in his statement?

In his statement, Prince Andrew said: “In discussion with The King, and my immediate and wider family, we have concluded the continued accusations about me distract from the work of His Majesty and the Royal Family.

“I have decided, as I always have, to put my duty to my family and country first. I stand by my decision five years ago to stand back from public life.

“With His Majesty’s agreement, we feel I must now go a step further. I will therefore no longer use my title or the honours which have been conferred upon me.

“As I have said previously, I vigorously deny the accusations against me.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.

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