Inquiry finds complete failure to protect babies at English hospital

A statutory public inquiry has blamed the Countess of Chester Hospital in England for a “complete failure at all levels” to protect newborns after former neonatal nurse Lucy Letby was convicted of murdering seven babies in its care. Lady Justice Kathryn Thirlwall said several deaths and six attempted murders between June 2015 and June 2016 could have been prevented.

What the inquiry found

Thirlwall said errors were made by nurses, doctors and managers. She also found that safeguarding procedures were never invoked, despite the concerns surrounding Letby.

Hospital management conducted quiet internal reviews while keeping parents unaware. It also gave infants’ confidential medical files to external experts without parental knowledge or consent, which Thirlwall described as “reprehensible”.

Key points

• Thirlwall made 17 recommendations for neonatal care and hospital security.
• Hospital executives did not tell parents about mounting suspicions while internal reviews were conducted.
• Letby was given 15 life sentences and has been denied permission to appeal twice.
• Her legal team has applied to the Criminal Cases Review Commission.

Recommendations for neonatal wards

The inquiry’s 17 recommendations include equipping every incubator with a webcam or video monitor so families can watch their infants remotely.

Thirlwall also called for round-the-clock CCTV over hospital refrigerators containing insulin until facilities introduce tighter, keycard-restricted access to the drug used in Letby’s crimes.

What the inquiry did not decide

The inquiry focused on institutional failures and hospital management. Thirlwall said reassessing the trial evidence or the safety of the criminal verdicts was outside its legal remit. Read the context: Serbia gives convicted war criminal Ratko Mladic a military funeral.

Growing scrutiny from an international panel of medical experts and statisticians has challenged forensic evidence used to convict Letby. Letby continues to deny her guilt.

What happens next

Letby’s legal team has submitted an application to the Criminal Cases Review Commission in response to the challenges to the forensic evidence used at trial.