Lucy Letby - what's happening

[Viviennemary]

In the last few days I've heard conflicting news stories. One an ex coroner saying she is innocent. And another piece of news saying the Cheshire police want to charge her with more crimes believed to have been carried out at two other hospitals she worked at.

The RCPCH recommended follow up work looking at things case by case, and this was undertaken by Jane Hawdon.

There were certainly recommendations but which external reviews specifically linked medical care as contributing to deaths?

That was Jane Hawdon's report, which you sometimes see the hospital treating as part of the RCPCH report because the RCPCH recommended (but didn't carry out) case by case review of a number of deaths and incidents.

Jane Hawdon who has since said that if she had been told about the suspicions and given all the relevant information she would have categorised three more of the babies’ deaths as unexplained? (On top of the four that she categorised as unexplained anyway).

Can you point us to where she concluded that any of the deaths were due to poor medical care?

You can look at Hawdon's report on the Thirlwall website, but it's up there in fragments so difficult to read,.and most hasn't been published. You'll see where she categorises care failings as unlikely to have been relevant, possibly relevant, almost certainly relevant, and some of the matrices including the last two categories. Certainly, she suggested that a pathologist should take several cases from there, and this happened with McPartland, who in the end saw only one death as unexplained. Unexplained deaths do happen, but the international experts have since offered an explanation there.

I am dubious about that interpretation of Hawdon's statements at Thirlwall, but it's nuanced stuff, so I'd just encourage anyone interested to read the transcript rather than the press reports. But for the purposes of this exchange, I'm referring to what Rees and colleagues knew in 2017, which is that Hawdon, following review, found relevant care failings in many cases, and could not support the unit returning to the same level as previously.

These documents are what guided management responses to the doctors' accusations against Letby, but all this happened after she was taken off the ward anyway. So management weren't sitting around letting her harm children - that's a media myth.

Karen Rees and her exec colleagues failed to properly brief either the RCPCH or Jane Hawdon about the consultants’ suspicions that deliberate harm was being caused to the babies. So they knew full well that these documents were not an accurate reflection of the situation. Yet they still chose to base their management responses on them anyway. No wonder three execs (I wonder who 🤔) have been arrested.

And of course, the RCPCH have since apologised for not taking clinicians’ concerns more seriously when they were raised during the review process.

The RCPCH was told about the doctors' suspicions of Letby and went ahead with the inspection anyway. From a HR / legal perspective, I agree that was the wrong choice. But as some of the inspection team commented at the Thirlwall Inquiry, they considered it important to examine the unit urgently to ensure that it was functioning safely. Their findings around understaffing, irregular ward rounds, significant skills gaps, failings in emergency transport etc were valid whether or not Letby or anyone else was deliberately harming babies.

Jane Hawdon wasn't told there had been allegations against anyone before conducting her review, but she was told about them afterwards. At that point, she didn't in any way suggest that her review didn't stand. Again, the failings in care were evidenced in the notes she had examined. She responded by giving advice on how to handle any bruised egos among the consultants, advising that the downgrade of the unit shouldn't be called a downgrade.

Since the trial, the consultants have pushed a narrative suggesting management exposed children to further harm by ignoring them. If you look at the facts as supported by contemporary evidence, Letby was removed from the ward within a week of the consultants suggesting they feared deliberate harm (but acknowledging they had no evidence). The hospital undertook a thorough investigation, and Letby never returned to the ward. The coroner was informed of the accusations and the investigations. When the consultants refused to accept the outcome of the investigations, the hospital contacted the police as they requested.

I do think that informing the police from the outset would have been the best course of action, but that would not have affected any of the children Letby was charged with harming. It will be very interesting to see how the police justify any claims about criminal negligence manslaughter if that's the road they try to go down.

And after this exchange, they removed Letby from the ward as requested, started the external investigations, and, in the end, when the consultants didn't accept the findings of those investigations in full, contacted the police as the consultants wished. Letby never returned to the ward.

Your third paragraph is incorrect. The consultants escalated concerns about deliberate harm by Letby in October 2015 and she wasn’t removed from the unit until mid 2016. Five babies (L, M, N, O and P) were attacked or murdered during that period.

But, would they have removed Letby without these emails being sent?

Also, as police were contacted because consultants weren't happy (they wanted themselves to be investigated) and Letby.

Police came, arrested Letby so case closed? Police saw she's guilty, 10 month trial saw she was guilt hence her conviction.

There was a spike of neonatal deaths at the Countess of Chester hospital whilst Letby worked there. There were bigger spikes in neonatal deaths at other UK hospitals during a similar time period, but nobody is looking for a serial killer in those hospitals

They are, they just need time. They’ve announced they’re looking into her entire career history and where she’s worked. This includes her placement, when she did her degree. They’re investigating what’s happened, hence how 3 of her senior management have been arrested and she’s being charged with more babies murders. Investigation takes time.

No. My third paragraph is about when the consultants raised their fears about deliberate harm - this was June 2016, a week before Letby was removed from the unit.

Before that, the hospital had kept a running log and report on deaths, noting, among other things, which nurses were on duty, which doctors were in charge / present, main facts of each case.

When they first explicitly raised Letby's presence at a run of deaths is disputed, with different people having different memories of verbal exchanges. But we first see senior managers told explicitly about this association in March 2016. At that stage, the senior consultant and nursing manager had worked together to complete a nursing care review which found no problems with Letby's care - some incidents noted on shifts when she wasn't present. So this was certainly discussion and concern around Letby's wellbeing and competence from February 2016, with senior management first kept in the loop, then involved in plans in May 2016 to put her back on night shifts with which everyone concerned - lead consultant included - expressed themselves happy.

Nobody raised the issue of deliberate harm before June 2016, and the review of competence in care for all nurses involved showed no problems with Letby's care

I think the consultants confused or conflated their clashes with management after Letby was off the ward with their discussions before - but there is no evidence whatsoever of the consultants suggesting deliberate harm before late June 2016.

Who knows? But Steven Brearey was lead consultant for the paediatric ward, a manager himself, so it was his job to alert them to concerns - that's how you would expect them to get information about any events that needed urgent action. So they accepted his recommendation, though without agreeing with him, and they removed Letby from the ward.

Er no, I'm talking about hospitals where Letby did not work but had similar spikes in neonatal deaths during a similar time period as to when Letby worked at Countess of Chester..

You've misunderstood - the point is that they're not looking for serial killers apart from Letby. That's because spikes in deaths can be expected and happen at various hospitals every year.

There was no spike in deaths at Liverpool Women's Hospital, where Letby did two trainee placements. No concerns were raised at the time. During the first placement, she was a student who, the hospital has confirmed at Thirlwall, was extremely unlikely to have any unobserved contact with babies. During the second, the hospital has confirmed that they no longer have records showing which shifts Letby worked. So any attempts to associate her with any random happenings there will have to be even more far-fetched than we saw at the first trial.

Oh fml, maybe there's another baby killer out there!

They need to look for serial killers everywhere and investigate everything. This shouldn't be limited to Letby, at all.

Bradford, Kettering and Sherwood Forest hospitals had spikes in neonatal deaths in a similar time period as to when Letby was at Countess of Chester. They had more deaths in fact.

I have not been following this in detail.

I have a question though,

If the evidence of the panel of 14 experts trumps the evidence of the expert(s) that was presented at the court case, has anyone got a simple summary of where that leaves the case against Letby ?

Hard luck on the nurses, then.

The point is that if we expect any deaths among vulnerable infants - as we do - they won't happen neatly at the same rate in the one place. And they won't happen neatly so that one nurse or doctor isn't there for a disproportionate amount. So, if you are willing to lock hospital staff up based on these spikes, without forensic evidence of murder or eyewitness accounts, you should find another six or so a year.

I'd be surprised if anyone has any appetite for this kind of witch hunt, while we all watch the Letby case crumble.

It leaves a legal problem. To be allowed to appeal, Letby needs permission from the CCRC, which usually takes a few years. If they refer her case to the Court of Appeal, that will take another few years. Then, the Court of Appeal will need to agree that there is evidence that would have produced a different outcome, and that accepting this evidence now doesn't undermine the cause of justice. They may quash the conviction. They may order a retrial. The Crown Prosecution Service could then choose to bring the case again or not to contest and to drop the charges.

In other words, if Letby is innocent, there's a long way to go, unfortunately.

I didn’t listen to the trial but if what you are saying is true surely your reasoning for those notes would have also been presented to the jury? If they weren’t she must have had a pretty crappy defence lawyer. What were the defending arguments in court?

Dr Phil Hammond in the Private Eye is campaigning for an external team that could be brought in to do in-depth investigations whenever numbers suggest there may be a problem with a unit.

This seems a good idea - after all, if babies or anyone else are dying unnecessarily, you want to know and fix it whether or not it's murder. It's usually not murder, but there have been hundreds of avoidable deaths in NHS maternity units since Letby's time.

Why would it be a witch hunt? I advocated for cameras to be installed everywhere and it should be monitored along with recordings saved, not being deleted.

Let's say if a Nurse has suspicions about a doctor, she need to list the time, date and what happened. Then, CCTV will show what happened. Clear cut case.