Lucy Letby: How a child serial killer exploited disbelieving hospital executives

When experienced doctors on the Countess of Chester hospital neonatal ward consistently raised concerns about one particular nurse – Lucy Letby – senior management were indignant.

Lucy Letby being arrested at home in Chester on July 3, 2018. (Photo: Cheshire Constabulary/AFP.)

When experienced doctors on the Countess of Chester hospital neonatal ward consistently raised concerns about a nurse – Lucy Letby – senior management were indignant.

They did not want the bad publicity of an external investigation – were the police brought alerted the neonatal ward would become a crime scene. But they also insisted the complaints were baseless and made one particularly concerned doctor issue a personal apology to Letby.

Now Letby, 33, has been unveiled as Britain’s worst child killer – convicted of the murder of seven vulnerable, defenceless babies, and the attempted murder of another six, some of whom suffered life-changing brain injuries. The jury found her not guilty of two counts of attempted murder and failed to reach a verdict on another six counts of attempted murder.

The revelations during the harrowing nine-month trial in Manchester have angered the community, and a newly announced independent review means the spotlight is firmly on the highly-paid hospital executives who turned a blind eye to the increasing concerns of senior doctors that there was a killer on the ward.

It now appears the obfuscation, delays and fear of losing face at the top allowed Letby to kill at least two other infants – Baby O and Baby P – and attempted the murder of at least one other who were entrusted to her care before she was belatedly removed from the unit.

Police are also investigating the sudden, unexpected deaths of babies back to 2011 when Letby began training as a nurse.

Letby is now reviled not just as a serial killer, but a predator of the most innocent of children, On Monday she will likely receive a whole-of-life jail sentence with no possibility of parole.

In killing those children, Letby would to add insulin to the nutrient feeding bags, or inject air into their stomach or a vein, or dislodge or block their feeding tubes.

Concerns were first raised by doctors, dubbed the “Gang of Four” by the defence counsel, when three babies who were progressing well died suddenly in June 2015.

A pediatrician, Dr Stephen Brearey, carried out a review into the death of one of the three, a girl known as Baby D, who was born at full term by caesarean section. Baby D had suddenly and dramatically deteriorated. As well as being “distressed and crying” she developed an unusual rash, now known to be caused by an injection of air. Hours after the killing, Letby sent a message to a colleague saying: “Our job is just far too sad sometimes”.

The court was told that Letby, infatuated with a married doctor on the unit, had wanted to create crises the required the resuscitation of babies so as to seek his attention. The court was shown messages between the two.

On one occasion when a child known as Baby O had been resuscitated, this doctor, who cannot be named, wrote to her, saying: “I was glad you were there, everything felt safe. Thank you for looking out for me.”

Letby replied: “Don’t need to thank me. I’m pleased you were there. I think we work well together. Sorry for my loss of composure moment.”

Meanwhile even at the earliest stage of concern, the nursing manager of the neonatal unit had identified that Letby had been on shift during the deaths of all three babies, but this was not raised as an issue.

Nonetheless, doctors were alarmed that something was not right. Brearey, the lead consultant, met with the head of nursing and quality, Alison Kelly, about the issue in June or July 2015.

“Three deaths in a short period … were a matter of concern,” he told the court, adding that it had been noted that Letby was by association connected to the deaths. “I think my comment at the time during the meeting was ‘it can’t be Lucy, not nice Lucy’,” he said.

Hospital file notes show the executive team decided after the 2015 meeting to have the first three deaths examined by an external organisation, but there is no evidence it did.

Another senior doctor. Ravi Jayaram, told Manchester Crown Court: “We had significant concerns from the (northern) autumn of 2015. They were on the radar of someone as senior as the executive director of nursing as far back as October 2015. As clinicians, we put our faith in the system, in senior management to escalate concerns and investigate them. The initial response was, ‘It’s unlikely that anything is going on. We’ll see what happens’.” He told the court: “At the time we were being told that really we shouldn’t be saying such things and not to make a fuss”.

Another concerned medic, Dr John Gibbs, said that the senior doctors had discussed every death and every collapse that occurred after June 2015. “There was a common factor, and that became clear to all of us,” he said.

Eight months later, in February 2016, a neonatologist from Liverpool Women’s Hospital carried out a review into the Countess of Chester’s high death rates.

Brearey sent the review result to Kelly and medical director Ian Harvey, but it took three months – during which two more babies almost died – for them to respond to his request for an urgent meeting.

The meeting finally took place in May 2016 and Brearey said “there could be no doubt about my concerns at that meeting” – but Letby was allowed to continue working.

A hospital review about the ongoing deaths had been finished in March of 2016 which found “some themes occurred in more than one baby” but this was dismissed as coincidence.

By early June 2016, another child, Baby N, unexpectedly died. Then Baby P and Baby O – two of triplets – died at the end of that month. Jayaram said the doctors were so outraged there was discussion about introducing CCTV and they demanded immediate change. Brearey told the on-call duty executive, Karen Rees, to remove Letby from the unit.

“I phoned Karen Rees, the duty executive in urgent care, who was familiar with the concerns already”, he told the court.

“I explained what had happened and said I didn’t want nurse Letby to come back to work the following day or until this was investigated properly. Karen said no to that, and there was no evidence.

“The crux of the conversation was that I then put to her ‘Was she happy to take responsibility for this decision in view of the fact that myself and consultant colleagues would not be happy with nurse Letby going to work the following day’?

“She responded ‘Yes, she would be happy’. I said ‘Would you be happy if something happened to any of the babies the following day’? She said ‘Yes’.”

The doctors threatened to bypass the executives and go straight to the police.

One doctor emailed medical director Harvey writing: “I believe we need help from outside agencies. and the only agency who can investigate all of us, I believe, is the police.”

The BBC reported that Harvey responded, writing “action is being taken’’ and demanded “All emails cease forthwith.”

The next day another child – Baby Q – almost died on Letby’s watch. She continued for another three shifts before she was removed to administrative duties at the hospital’s risk and patient safety office.

Harvey did not call the police, instead asking the Royal College of Paediatrics and Child Heath (RCPCH) to review the neonatal unit.

Letby learned doctors were refusing to allow her to return to nursing duties and raised a grievance procedure with human resources. It was resolved in Letby’s favour in December 2016 and the doctors had to apologise to her in a letter dated February 2017. One doctor also apologised in person.

But the doctors continued to press for police intervention. About this time it appears a journalist was tipped off about the spate of baby deaths at the hospital and started asking questions of the hospital executives. Letby did not return to the neonatal unit on the date she had been expected in March 2017.

Brearey told the BBC that hospital management was seeking to avoid going to the police and wished instead to “engineer some sort of narrative”. He said: ”If you want to call that a cover-up then, that’s a cover-up.” Finally, in May 2017 the police were called in.

Letby was arrested on July 3, 2018, and on November 10, 2020, was charged with multiple counts of murder and attempted murder.

Her first known victim, if he had lived, would be starting school next month.