Lucy Letby

Lucy Letby
Letby following her arrest in 2018
Born	(1990-01-04) 4 January 1990 (age 34) Hereford, Herefordshire, England
Occupation	Neonatal nurse
Conviction(s)	Murder (7 counts), attempted murder (7 counts)
Criminal charge	Attempted murder (1 count; to go to trial in 2024)
Penalty	14 life sentences (whole life order)
Details
Span of crimes	2015–2016
Country	United Kingdom
Killed	7
Injured	6
Date apprehended	3 July 2018
Imprisoned at	HM Prison Bronzefield as of January 2024[update]

Lucy Letby (born 4 January 1990) is a British former neonatal nurse who murdered seven infants and attempted to murder six others between June 2015 and June 2016. Letby was the focus of suspicion following a high number of infant deaths at the neonatal unit of the Countess of Chester Hospital, shortly after she was qualified to work with children in the hospital's intensive care unit, and owing to her being on duty whenever suspicious incidents took place.

Letby was charged in November 2020 with eight counts of murder and ten counts of attempted murder. During her trial, which lasted from October 2022 to August 2023, it was revealed that Letby's methods included injecting the infants with air or insulin, overfeeding them, and physically abusing them with medical tools. She also removed over 250 confidential nursing handover sheets from her workplace which should never have left the hospital, and she falsified patient records to avert suspicion. Several parents and colleagues of Letby had also entered the room during, or soon after, an attack. On 21 August 2023, Letby was sentenced to life imprisonment with a whole life order. Letby pleaded not guilty at her trial and told a subsequent Nursing and Midwifery Council disciplinary panel that she is innocent. An application to appeal her conviction was renewed in February 2024. Unrelated to any appeal, she faces a retrial in June 2024 on the one charge that the jury were unable to reach a verdict on in the original trial.

Letby is the most prolific serial killer of children in modern British history; the Cheshire Constabulary now suspects that she may have claimed more victims, including at Liverpool Women's Hospital, where two infants died during her training. Management at the Countess of Chester Hospital were criticised for ignoring warnings about Letby that could have prevented some of the killings. The British government has commissioned an independent statutory inquiry into the circumstances surrounding the murders.

Early life and education

Lucy Letby was born on 4 January 1990 in Hereford, Herefordshire, the only child of a finance manager and an accounts clerk.^[1] She was educated at Aylestone School and Hereford Sixth Form College.^[1][2] She had had a very difficult birth herself and was, according to a friend who knew her since secondary school, "very grateful for being alive to the nurses who would have helped save her life".^[3]: 18:40 This, the friend states, had led her to want to be a nurse all her life and that "everything that she did was geared towards that ultimate goal of becoming a nurse".^{[3]: 18:55 [4]} Letby pursued her education in nursing at the University of Chester, where she also worked as a student nurse during her three years of training, carrying out placements at Liverpool Women's Hospital and the Countess of Chester Hospital.^[1][5] Letby was the first member of her family to study at university and graduated in September 2011.^[1]

Career

Letby began working as a registered nurse at the neonatal unit of the Countess of Chester Hospital in 2012.^[6] In a 2013 staff profile, she said that she was responsible for "caring for a wide range of babies requiring various levels of support" and that she enjoyed "seeing them progress and supporting their families."^[7] Letby also took part in a campaign to raise funds for a new neonatal unit at the hospital.^[8]

Letby had two training placements at Liverpool Women's Hospital, in late 2012 and early 2015, which came under investigation after her conviction.^[5] In June 2016, consultants asked management to remove her from clinical duties pending an investigation into her conduct. She had previously been moved from night to day shifts in April 2016 by the unit's ward manager.^[6] Letby was transferred to the patient experience team in July 2016 and later to the risk and patient safety office, working there until her arrest in 2018.^[9]

Letby qualified to work with the infants who needed intensive care in 2015, the same year the suspicious incidents began.^[10] Letby had told others that she found non-intensive care work "boring".^[11] When she was moved to day shifts the suspicious incidents notably moved from occurring overnight to happening in the daytime when Letby was working.^[12]

Murders

Initial investigation

An informal review conducted in June 2015 by a consultant and lead neonatologist at the Countess of Chester Hospital NHS Foundation Trust revealed troubling details regarding four unexplained collapses that occurred in the same unit. Three of these cases resulted in deaths in the same month. It was observed that Letby had been on shift on each occasion. The unit's consultants promptly reported these deaths to the trust's committee responsible for addressing serious incidents. The committee classified the deaths as "medication errors". Had they been classified as "serious incident[s] involving unexpected deaths", an immediate investigation could have taken place if they were grouped together.^[6] The numbers of unexplained collapses were particularly abnormal: there had previously been only two or three deaths a year in the neonatal unit. What was also particularly unusual was that the babies did not respond to resuscitation attempts as they would be expected to.^[3]: 23:40 Usually babies that had got a heartbeat back would see an improvement in their breathing, but that did not happen in these cases.^[3]: 23:45 Detective Superintendent Paul Hughes, who later led the investigation,^[13] was told by two medical consultants that baby collapses which occurred during the spike had been unexpected and could not be explained, both of which were not usual with infant collapses in general.^[14]

In October 2015, a ward manager conducted her own review, noting that Letby was the only staff member consistently present throughout these incidents of unexplained collapses and deaths. These findings were relayed to the lead neonatologist. Further concerns were voiced to management by the unit's consultants that same month; concerns were either resisted by the Trust Executives or ignored.^[9][15] In February 2016, the lead neonatologist, along with other consultants, concluded a thematic review investigating five unexplained deaths and collapses within the unit. Their investigation determined that the only common factor in these cases was the presence of Letby. The lead neonatologist contacted the unit manager, the hospital's medical director and the director of nursing, requesting an urgent meeting.^[15] A meeting took place in May 2016.^[16] The executive team deemed the spike in deaths to be coincidental and no substantial action was taken.^[6][16]

Reports by the nationwide MBRRACE-UK project found a neonatal death rate at least 10% higher than expected between June 2015 and June 2016. Additionally, the neonatal death total in 2015 doubled that of the previous year.^[17][18][19] The mortality rate had risen above what might be considered 'normal' rates.^[20] During a hospital visit in February 2016, The Care Quality Commission (CQC) was informed of difficulties in raising concerns with managers, but heard no mention of an elevated mortality rate. The CQC's report identified issues of "short-staffing" and "skill-mix" issues within the unit, yet it praised the overall positive culture of the trust, where "[s]taff felt well supported, able to raise concerns and develop professionally."^[9]

On 24 June 2016, following the deaths of two triplet babies on that day and the previous day, the lead neonatologist phoned the duty executive demanding that Letby be removed from the unit. The duty executive insisted that Letby was safe to work and that she was "happy to take responsibility" if anything happened to any more babies under Letby's care.^[16][15] In late June 2016, the trust's executive directors convened to address the question whether to involve law enforcement. By this time, seven unexpected deaths had taken place within the unit. The belief among these executives was that the indications of Letby's involvement were largely circumstantial and they suspected certain doctors of embarking on a misguided "witch hunt". Moreover, they were concerned about potential harm to the Trust's reputation resulting from a police inquiry. Ultimately, they opted against engaging the police.^[6] The medical director and chief executive instead organised a review through the Royal College of Paediatrics and Child Health (RCPCH), which was initiated in September 2016. The unit's services were scaled back by hospital managers on 7 July 2016, cutting cot space numbers and no longer accommodating premature births before the 32-week mark.^[21]

The trust set a narrow scope for the review that excluded investigating Letby's actions or the deaths, but instead focused on the unit's general service. The RCPCH reported their findings to the medical director and chief executive in October 2016.^[6] They could not find a definitive explanation for the increase in mortality rate at the unit but found some insufficient staffing and senior cover. The report recommended a detailed case review of each death. The medical director asked neonatologist Jane Hawdon from Great Ormond Street Hospital to carry out the case reviews. Hawdon responded she could not conduct a detailed review because of lack of time but could provide a summary and did so after briefly reviewing the notes. She identified four cases that "potentially benefit from local forensic review as to circumstances, personnel etc".^[6][9][22] The board's chair at the time, has said that he was misled about the scope of that review and its findings.^[23] Despite the thorough external independent review recommended by the RCPCH or the forensic review recommended by Hawdon, records of the hospital board meeting show the medical director telling board members that the RCPCH and Hawdon reviews concluded that the deaths in the neonatal unit were due to issues with leadership and timely intervention.^[15]

In September 2016, Letby raised a formal grievance about her late June 2016 transfer from clinical duties to the hospital's risk and patient safety office.^[15] This grievance was upheld by the board in January 2017, which determined her removal had been "orchestrated by the consultants with no hard evidence". They supported her return to the neonatal unit and offered her a placement at Alder Hey Children's Hospital in Liverpool plus support to develop advanced practice or a master's degree. The medical director also commented in the report that the trust's intention was to "protect Lucy Letby from these allegations".^[6][9][24] The chief executive had met with Letby and her parents on 22 December 2016 to apologise on behalf of the trust and assure them that the doctors who made the allegations would be "dealt with".^[6] He later ordered the consultants to send a letter of apology to Letby, which they did in February 2017.^[24][13]

In March 2017, consultants asked management to involve the police after receiving advice from the regional neonatal lead, who suggested further investigation was needed.^[9] They then met with Cheshire Constabulary on 27 April 2017, to raise their concerns, with Letby due to return to work on 3 May 2017.^[13] The trust publicly announced the involvement of the police in May 2017, stating this move was to "seek assurances that enable us to rule out unnatural causes of death."^[9][25] The police's investigation was called Operation Hummingbird.^[26] Senior Investigating Officer Paul Hughes later said: "the initial focus was around the hypotheses of what could have occurred: so generic hypotheses of 'it could be natural-occurring deaths', 'it could be natural-occurring collapses', 'it could be an organic reason', 'it could be a virus', and then one of the hypotheses was that, obviously, it could be inflicted harm."^[20]

Timeline of cases

The first suspicious case occurred on 8 June 2015.^[20] At 8 pm a healthy baby boy – a twin – was being cared for in nursery 1 on the ward and the designated nurse was Letby.^[20][27] The boy had been handed over to Letby after she started her night shift, with the paediatric registrar having clocked off when Letby was 30 minutes into her shift.^[20][27][28] Twenty-six minutes later, she called a doctor with the baby's state rapidly deteriorating. The baby died half an hour later, less than 90 minutes into Letby's shift.^[20] The paediatric registrar later testified that when she heard about the death of the child the next day after returning to work that it was a "big surprise" and "completely out of the blue and very upsetting. [He] showed no signs of any problems throughout the day. He was handling well. I had no concerns at all for him or his twin sister".^[28] A fellow nurse said that when the baby started deteriorating she saw Letby standing over the infant's incubator and originally did not intervene. However, the nurse then did when she realised he was not recovering under Letby's care.^[28] Doctors attending the scene said that Child A developed an unusual blue and white mottling on his skin after collapsing, which they said they had never seen before.^[29] This symptom later occurred in other babies that were believed to have been intentionally injected with air.^[29] The day after Child A's death, Letby searched for his parents on Facebook.^[29]

About 28 hours after Child A's death, his twin sister, Child B, also collapsed and had to be resuscitated.^[27] After Child A's death, the parents had spent the day with Child B in the nursery with her, but were persuaded to go and rest before the baby's sudden crash.^[29] Tests later showed loops of gas-filled bowel in the child.^[27] As a result, it was later concluded that the baby had been injected with air.^[27] Letby had fed the baby 25 minutes before their collapse and the child had the same unusual rash on her skin as first seen on Child A hours earlier, indicating that they had also been injected with air.^[29]

A few days later, Child C, a boy in good condition, died.^[27] He suddenly collapsed as soon as another nurse left the nursery.^[29] Despite not being the designated nurse for the child, Letby was witnessed standing over his monitor as his alarm sounded when the other nurse came back in.^[27][29] Letby's shift leader had already told her to focus on her designated patient and the shift leader later testified that she had to keep pulling her away from the family room as Child C died.^[29] His parents later recalled a nurse they believe was Letby brought a ventilator basket in and said, even though their child was not dead, "You've said your goodbyes, do you want me to put him in here?".^[30]

On 22 June 2015, baby girl Child D collapsed three times in the early hours and died.^[27] Those who attempted to save the child noticed the girl's skin had been discoloured.^[27] A post-mortem X-ray showed a 'striking' line of gas in front of the spine, consistent with air being injected into the bloodstream.^[31] A doctor later testified that such a finding could not be explained by natural causes.^[32] The mother had noted Letby "hovering around" the family hours before the baby collapsed.^[29]

On 2 July, a doctor raised his concerns over the sudden collapses and deaths.^[27] No action was taken against Letby.^[27] At about 9 pm on 3 August, the mother of Child E, who had come to the neonatal unit to give him and twin Child F her expressed breast milk, rushed into the room of Child E, having been alarmed by a scream. She found the child having fresh blood around the mouth and being in extreme distress. Letby, standing near^[33] to his incubator, was described by the mother as "not doing anything" in the face of the apparent emergency.^[3]: 3:30 The mother would recount seeing Letby then as someone who "wants to look busy but they're not actually doing anything".^[3]: 3:30 Letby said that the bleeding had merely been from a rubbing feeding tube and asked the mother to calm down.^[33] The boy died in the early hours of 4 August after having lost about a quarter of his blood, a "striking" amount according to a blood specialist testifying at court, who agreed with defence that her observations did not help establish a cause of death; injection of air was another suspected reason for the death.^[27][34] Flecks of blood were found in his vomit.^[35] No post-mortem was carried out.^[36] The next evening, Child E's twin brother Child F was being cared for in nursery 2, the same room in which Letby was looking after another infant.^[20][27] At 1:54 am Child F suffered an unexpected drop in his blood sugar and saw a surge in his heart rate.^[20] The child survived and a blood test later revealed that he had been given an "extremely high" amount of exogenous pharmaceutical insulin, which he had never needed.^[20][27] Later, at trial, Letby did not contest that the baby had been intentionally injected with insulin, suggesting someone else must have done it.^[29] Letby searched for the parents of Child E and F on social media in the following weeks and months, and for other parents who were not part of the case.^[37][38]

On 7 September 2015, Child G, on her 100th day of being alive, collapsed for the first of three times in the following three weeks.^[27] After the first collapse, the baby girl was taken to Arrowe Park Hospital, but five days later she collapsed again, 15 minutes after Letby had been feeding her.^[27] The child survived, but is now severely disabled as a result of what happened to her.^[27] The baby was witnessed projectile vomiting so massively that it reached the chair next to the cot and canopy.^[39] Her heart rate and oxygen levels also dropped to unusually low levels.^[39] Later, at trial, an expert witness doctor concluded that the only viable explanation for the baby vomiting so extraordinarily was if she had received far more milk than that allocated down her feeding tube and that this could not happen accidentally.^[39] It was later discovered that Letby had deliberately altered the baby's temperature on her observation chart to make it seem like she was already unwell before she collapsed, and also falsified the time of the baby's collapse to make it seem like it coincided with when a colleague gave the baby a milk feed.^[29] A nurse noticed when she arrived after Letby's cry for help after one of the baby girl's collapses that the machine connected to the baby to measure its oxygen saturations and heart rate levels had been turned off.^[29] The nurse stated in court that two doctors had apologized to her for not having the machine switched back on after fitting a cannula to the baby girl. One of the doctors concerned told the court that he did not remember the apology but considered it possible that it had taken place. He agreed that leaving the monitor switched off was "not normal protocol" and possibly a result of his having to rush to another emergency.^[40] A colleague had also noticed that Child G's initial collapse occurred on the day she was originally due to be born.^[41]

About six weeks after Child G's multiple collapses, on 23 October 2015, Child I died.^[27] This was the fourth time the baby girl had collapsed.^[27] On the fourth collapse, Letby was found next to her incubator by another nurse.^[42] Letby later sent a sympathy card to the baby girl's parents on the day of her funeral, a card which Letby kept photos of on her phone.^[27][20][43] Letby also wanted to go to the funeral.^[44] Twice the baby was found to have excess air in her stomach which had affected her breathing.^[42] Before the second collapse, Letby had said to a colleague that Child I 'looked pale', even though it would have been hard to see from where they were standing in a doorway looking into the darkened nursery.^[29] Then, when the designated nurse for the child turned the light on, she saw the girl was not breathing.^[42] The child's mother later said Letby 'smiled' as she bathed her dead daughter and offered to take photos of the dead child.^[29][45] A doctor had seen unusual skin mottling on Child I's skin and X-rays showed the child had a massively enlarged stomach that was consistent with her having been deliberately injected with air.^[46][47] Letby later searched for Child I's mother on Facebook.^[45]

Later on 23 October, the hospital management was alerted to the concerns of the doctors on the unit.^[27] They were told to "not make a fuss".^[27] Staff reviews were carried out which highlighted that Letby was always on duty for the suspicious incidents and in February 2016 a doctor requested an "urgent" meeting with executives, but no meeting occurred until May 2016.^[27]

By April 2016, Letby had been moved to day shifts because of the concerns about her and the suspicious collapses began occurring in the daytime.^[29] On 9 April 2016, two twin brothers suffered sudden collapses within hours of each other.^[27] Tests found that Child L had insulin levels in his blood "at the very top of the scale that the equipment was capable of measuring".^[27] Hours later, twin brother Child M's heart rate and breathing suddenly dropped and he nearly died.^[27] Experts said that Child M's heart problems were likely to have been caused by air being injected into his bloodstream.^{[48][48]: 3:00} Although he lived, the child suffers from brain damage.^[27] It was noted that the collapses of Child L and M occurred in almost identical circumstances to Child E and F.^[29] Both were twins where one was believed to have been injected with insulin and the other with air.^[29] Child F had survived his injection of insulin and it was noted that Child L had been injected with twice the dose of insulin, the suggestion being that Letby had done so to ensure death on this occasion.^[29]

A meeting about the suspicious cases took place on 11 May 2016, but no action was taken.^[27]

A month later, Child N nearly died after suffering trauma to the throat.^[27] Doctors saw blood and "unusual" swelling at the back of his throat upon examination.^[49] The baby had been heard randomly "screaming", the jury was told.^[50] Child N's father said he then saw blood spattered around his son's mouth.^[51]

The final two cases occurred within hours of each other on 23 and 24 June 2016.^[27] The two children involved were triplets, siblings of each other, and the cases occurred on Letby's first shift back after a holiday in Ibiza.^[29][27][52] Child O, a "perfect" healthy baby, was due to be discharged home, but suddenly collapsed on 23 June.^[27] When the child initially became unwell, another nurse suggested he be moved to nursery 1 where the sickest children were treated, but Letby disagreed and the baby subsequently collapsed less than two hours later.^[20] He recovered, but suffered two further collapses and died almost exactly three hours later.^[20] The lead consultant noted that the child "should have responded better" to resuscitation.^[20] X-rays on a post-mortem showed he had an abnormal amount of gas in his body and liver damage that an independent pathologist later ruled had resulted from an "impact injury" similar to what would be seen in a car crash.^[29][27] 13 minutes after Child O's death, Letby was feeding his triplet brother Child P, who also was expected to be able to soon go home, but he collapsed after his diaphragm was somehow shattered.^{[27][48]: 4:40} Doctors believed he would make a full recovery. As they prepared him to go to another hospital, Letby said: "He's not leaving here alive, is he?".^[27] The boy soon died.^[27] X-rays likewise showed an inexplicable amount of gas inside the baby.^[53] These deaths have been described as "exceptional" and the "tipping point" when the consultants realised that "drastic" action needed to be taken.^{[48]: 4:40 [48]: 12:35} A consultant allowed the surviving triplet to be taken to a different hospital by medics who had turned up to take Child P.^[29] The consultant said she allowed this after her parents begged for it, as she now felt Letby was a "mortal danger" to the surviving triplet.^[29] Before the second triplet died, Letby had texted a doctor saying she would "be watching them both [Child P and the surviving triplet] like a hawk" and said "I'm OK. Just don't want to be here really. Hoping I may get the new admissions".^[53]

Towards the end of June 2016, Letby was removed from the neo-natal ward^[3]: 29:00 and instead moved to a clerical role within the hospital,^[54] and the suspicious collapses stopped.^[3]: 29:00

Prosecutions, trials and convictions

Arrest and charges

On 3 July 2018, Letby was arrested by police on suspicion of eight counts of murder and six counts of attempted murder, following a year-long investigation.^[55] Letby's home at Chester was searched by police following her arrest.^[56] After Letby's arrest the investigation was widened to include Liverpool Women's Hospital, another location at which Letby had worked. Police have begun looking into Letby's entire career, including at Liverpool Women's Hospital, since her conviction.^[22][14][57]

Letby was bailed on 6 July 2018 as the police continued their inquiries.^[58] She was rearrested on 10 June 2019 on suspicion of eight cases of murder and nine cases of attempted murder in relation to the cases described above, and released on bail on 13 June.^[59] She was arrested again on 10 November 2020.^[60][61] There were thousands of exhibits in the investigation, 16,571 of which were not even used as evidence and some of the items were themselves thousands of pages long. ^{[62][62]: 37:30} The 2019 arrest and bailing had been made as by this time three further cases of attempted murder had been identified which investigators needed to question Letby further on and as Letby had been found to have written extensively about the case on her 2018 arrest, detectives wished to see whether she had written anything further in the year while she was under investigation.^{[62]: 21:30}

On 13 March 2020, Letby was placed on an interim suspension by the Nursing and Midwifery Council.^[63]

On 11 November 2020, Letby was charged with eight counts of murder and 10 counts of attempted murder.^[61] She was denied bail and remanded in police custody.^[64] The Crown Prosecution Service were convinced to approve all of the charges Cheshire Constabulary requested against Letby after it reviewed the evidence the force collected against her.^{[62]: 30:30} Letby denied all charges against her, and pointed to issues of hospital hygiene and staffing levels.^[65]

On 18 August 2023, Andrea Sutcliffe, Chief Executive and Registrar of the Nursing and Midwifery Council, stated that Letby "remains suspended from our register, and we will now move forward with our regulatory action, seeking to strike her off the register".^[66]

2023 trial

Letby's trial began at Manchester Crown Court on 10 October 2022 before Mr Justice Goss.^[67][68] She pleaded not guilty to seven counts of murder and 15 counts of attempted murder.^[69] Letby's parents and the families of the victims attended the trial.^[70][71]

The child victims were referred to as Child A to Child Q.^[72] The press secrecy around the identities of the 17 babies and nine colleagues who gave evidence was "rarely seen outside proceedings involving matters of national security."^[73] Two years before the criminal trial, Mrs Justice Steyn banned the identification of the living victims until their 18th birthdays. Parents wanted their identifying information to be protected, though Steyn ruled that one parent's profession as a physician was relevant because of his medical expertise and that it would not make that parent identifiable to the public. Several witnesses requested anonymity, including a doctor with whom Letby was said to be infatuated. The judge approved these requests, ruling that getting testimony from the colleagues was more important than them being publicly identifiable.^[73]

The prosecutor said that Letby was a "constant malevolent presence" in the hospital's neonatal unit.^[69] There were witnesses that had apparently walked in during, or just after, Letby's attacks. A mother of one of the victims said she had walked in on Letby trying to kill her baby, with Letby saying "Trust me, I'm a nurse" when interrupted.^[74] Another mother had walked in hearing her baby screaming, to find her child had blood around his mouth with Letby in the room.^[3]: 3:30 Letby told the mother to go back to the ward.^[3]: 4:35 The baby's condition soon worsened and it later died in its parents' arms.^[3]: 5:15 The senior medical consultant who had not recommended a post-mortem examination at the time said later in court that she regretted her decision, which she said she had taken with a view to avoiding any further distress to the parents, who had expressed they were "not keen" to have a post-mortem carried out.^[36] Afterwards, Letby bathed the deceased baby in front of her parents.^[3]: 6:50 Another mother of a baby, who had died in October 2015, recounted an uncomfortable experience of Letby bathing her child, recounting: "Lucy Letby and another nurse asked me if I wanted to bathe my baby. While we were bathing her, Lucy came back in. She was smiling and kept going on about how she was present at the first bath and how our daughter had loved it. I wished that she would just stop talking".^[3]: 13:30 Letby's apparent obsession with this baby and her family later continued; she sent a sympathy card to the parents after the baby's death on the day of its funeral.^{[3]: 13:55 [75]: 16:25} Upon Letby's arrest it was found on her phone that she had photographed the card before she sent it and had still kept pictures of it.^[20][43]

In a text message sent to a friend on 9 April 2016 two hours after the collapse of Child M, Letby wrote: "Work has been shit but... I have just won £135 on Grand National!! [horse emoji]." and, in a group chat after the winning bet: "Unpacking party sounds good to me with my flavoured vodka ha ha."^[76] On the afternoon of 22 June 2016, following a holiday in Ibiza, she texted a friend: "Probably be back in with a bang lol". Child O died the next day.^[77][78] The texts were seen as important by the Crown Prosecution Service as it saw them in some instances as appearing to be similar to a live blogging of events.^[12] Letby had also told a colleague that taking Child A to the mortuary was "the hardest thing she ever had to do".^[79][80] Letby had also searched for the parents of several infant victims on Facebook, in one case on the anniversary of a baby's death.^{[3]: 45:40 [81]} In total Letby had searched for 11 of the families affected.^[20] When police had asked her why she had searched up the parents of Child O on the anniversary of its death, she had responded that she "could not explain why she would be doing it".^[82] The prosecutor asserted Letby had injected air into the bloodstream of two victims and had used insulin to murder others. It was also revealed during the trial that Letby had to be told more than once not to enter a room where the parents of one of the victims were grieving.^[83] Letby said, "It's always me when it happens."^[3]: 15:35

Letby's defence lawyer said that Letby was "a dedicated nurse in a system which has failed," that the prosecution's case was "driven by the assumption that someone was doing deliberate harm combined with the coincidence on certain occasions of Miss Letby's presence," and that there had been a "massive failure of care in a busy hospital neonatal unit – far too great to blame on one person."^[84] The defence argued that "extraordinary bleeding" in a baby boy murdered by Letby could have been caused by a rigid wire or tube.^[85][86] The therapeutic use of insulin was denied by Letby's colleagues.^[87]

A key piece of evidence was also given by a consultant who recounted that in February 2016 he had walked in and seen Letby standing over a baby and watching when they seemed to have stopped breathing.^[3]: 22:45 Letby was not doing anything despite the baby desaturating.^[3]: 22:55 When he asked her what was going on, she responded that he had only then just started declining.^[3]: 23:05 This baby went on to survive their collapse.^[3]: 23:20 By this stage all seven of the paediatrician consultants who worked on the neonatal ward agreed something was seriously wrong in the department.^[3]: 23:25 The deaths and near-deaths that were happening on the unit could not be medically explained.^[3]: 24:30 All the babies involved had been expected to live and so their deaths came out of the blue.^{[75]: 11:17} Previously, in the majority of times the premature babies had collapsed it had already been expected and in the very rare cases it was not already expected it could still be medically explained, unlike in all of these cases.^{[75]: 11:30} A paediatrician testified that he and other clinicians had previously raised concerns about Letby, but were told by hospital administration that they "should not really be saying such things" and "not to make a fuss." Another doctor testified that Letby commented an hour before one victim died, "He's not leaving here alive, is he?"^[88][89][90]

Between March and June 2016 another three babies almost died while under Letby's care.^[3]: 26:00 Towards the end of June, she was helping to care for triplets.^[3]: 26:05 One died at 6 pm one evening and another of the triplets died less than 24 hours later, both under Letby's watch.^[3]: 26:10 Both of them had been in very good health and the deaths on consecutive days were causing staff considerable distress and shock, with the notable exception of Letby, who merely told one consultant that she would be back on shift the next day when she was asked if she was upset after the events of the two days.^[3]: 26:25 This was not the first time that twins/triplets had collapsed within 24 hours of each other while under Letby's care, as two twins had experienced collapses on consecutive days in August 2015.^[3]: 37:00 Only hours after one of the twins had died that month, the other became seriously unwell and it was only during the police investigation and after analysis of a blood sample that it was found that someone had intentionally poisoned the baby with insulin.^[3]: 37:05 This evidence had been missed for two years.^[3]: 40:35 The insulin, which had not been prescribed to the child, was identifiable as exogenous pharmaceutical insulin as C-peptide would be present in the specimen if the insulin had been produced by the baby.^{[3]: 39:45 [27]} Laboratory analysis also showed that Child L had been poisoned with insulin.^{[75][75]: 9:40 [91]} This was also significant as only hours later his twin brother, Child M, inexplicably collapsed while under Letby's care but managed to survive after thirty minutes of resuscitation.^[75]: 9:40 It was believed that Letby had injected air into the latter's bloodstream.^[91] The prosecution also noted that, although by this point she was not supposed to work night shifts, Letby was caring for Child L as she specifically volunteered to do an extra shift to care for it, the prosecution arguing that she had seen an opportunity here to kill Child L where she had failed previously with Child F.^[42] Letby herself accepted at trial that the results showed that some victims had been deliberately injected with insulin and did not contest that someone must have administered it to them.^[92] The night after Letby tried to murder Child F she went salsa dancing.^[93]

Although the consultants made their desire to have Letby removed from duties known to hospital staff after the triplet incident, this was refused and the next day another baby almost died under Letby's care.^[3]: 26:20 As well as in the two cases in which insulin poisoning had been proved, evidence provided by medical experts indicated that all the babies had been harmed intentionally.^[3]: 42:05 This evidence was given by experts specialising in areas of paediatric radiology, paediatric pathology, haematology, paediatric neurology and paediatric endocrinology, with two main medical experts who were consultant paediatricians.^[94] Letby was the only staff member on duty for every one of the 25 suspicious incidents.^[3]: 43:00 After her removal from duty, and the downgrade of the unit,^[6][21] to concentrate on lower risk babies, no further incidents were deemed suspicious.^{[3]: 29:15 [better source needed]} Importantly, it was discovered that Letby had falsified patient records, covering her tracks by changing the times some babies collapsed to make sure she could not be placed at the scene.^{[75]: 16:00} Criminal psychologist Dr David Holmes states that the varied methods she used to attack her victims, such as insulin and air injections and overfeeding milk, would all have been specifically chosen as things that would dissipate and not be easily detected afterwards.^{[95]: 34:10}

On the fourth day of trial, the prosecution presented a handwritten note from Letby which said "I am evil, I did this," and that she "killed them on purpose" because she "couldn't take care of them."^[96] It further stated "I killed them" and "I'll never marry or have children, I'll never know what it's like to have a family".^{[3]: 46:00 [97][98]} The defence argued that the note was "the anguished outpouring of a young woman in fear and despair when she realises the enormity of what's being said about her, in the moment to herself" and said that Letby had written it when she was dealing with employment issues, including a grievance procedure with the NHS Trust. Several other notes from Letby were shown in court, two of which said, "Why/how has this happened – what process has led to this current situation? What allegations have been made and by who? Do they have written evidence to support their comments?" And, "I haven't done anything wrong and they have no evidence so why have I had to hide away?". The prosecution said that Letby was expressing through the notes her frustration about not being allowed back to work in the neonatal unit.^[99] The police had also discovered that Letby had secretly kept medical documents at home relating to the care of the children.^[3]: 44:00 Jurors were told that 257 nursing handover sheets were found at addresses linked to Letby, of which 21 related to babies she had allegedly harmed.^[100] Her trial judge stated at sentencing that she had kept documents as "morbid records of the dreadful events surrounding the collapses of [her] victims and what [she] had done to them".^[20] The sensitive documents, which should never have left the hospital, contained the names of the babies and the documents had been stuffed and hidden away in shopping bags under her bed.^{[20][62]: 24:15 [48]: 7:00} One note of medications given to a baby boy who had managed to survive after being on the brink of death, written on a paper towel, was found under Letby's bed.^[10] Letby claimed at trial that she had no means of destroying the confidential notes, yet the court heard a paper shredder which could have done so was found in her home.^[20] Her diary was also found to be marked with the initials of the babies she killed on the exact days they died.^[48]: 7:29 It was within this diary that the note that stated "I am evil I did this" was tucked inside.^[48]: 7:36 Furthermore, more notes were discovered that contained phrases such as "I'm sorry that you couldn't have a chance at life" , "I don't want to do this anymore", "how can life be this way?", "hate my life" and "help" in capital letters.^[20][101] The prosecution said the notes were evidently confessions of guilt, rather than just the words of a woman in "distress".^[20] These notes and documents had been found in searches of Letby's home in Chester and of her parents' house in Hereford.^[20]

Letby herself gave evidence to the court in May 2023, breaking down in tears and claiming she was made to feel as though she were incompetent but "meant no harm."^[102] When asked why she wrote the "I am evil, I did this," Letby said, "I felt at the time that if I'd done something wrong I must be such an evil, awful person. I'd somehow been incompetent and had done something wrong which had affected those babies."^[103] Letby said that the allegations had negatively impacted her mental health, saying, "I don't think you can be accused of anything worse than that. I just changed as a person, my mental health deteriorated, I felt isolated from my friends on the unit. From a self-confidence point of view, it made me question everything about myself." It was observed that Letby eventually began to lose her composure in the witness box, asking for a number of unplanned breaks.^[3]: 51:00 It was also observed that she only broke down when talking about herself and the impact it had on her, which the prosecution said was "telling".^{[75]: 15:00} She had not shown any emotion in relation to the fate of the babies.^{[75]: 15:05} It was also noted that she repeatedly contradicted herself, muddled up her story and became more and more frustrated with the prosecution's questions, which was unlike her usual calm demeanour.^[104]

Verdicts and sentencing

Final verdicts were returned by the jury on 18 August 2023.^[105] Letby was found guilty of seven counts of murder of seven babies. She killed them by injecting them with air, overfeeding them, poisoning them with insulin and assaulting them with medical tools. She is the most prolific serial killer of children in modern British history.^[106][107]

Letby was also found guilty of seven counts of attempted murder of six infants. Letby was found not guilty on two counts of attempted murder.^[106] The jury was unable to reach verdicts on six further attempted murder charges.^[106] Nicholas Johnson KC asked the court for 28 days to consider whether a retrial would be sought for these six counts.^[108]

On 21 August 2023, Letby was sentenced to life imprisonment with a whole life order, the most severe sentence possible under English law; she is the fourth woman in UK legal history to receive such a sentence.^[109] Goss said that Letby committed "a cruel, calculated and cynical campaign of child murder involving the smallest and most vulnerable of children." In closing, he stated, "there was a deep malevolence bordering on sadism [...] you [Letby] have no remorse [...] there are no mitigating factors [...] the offences are of sufficient severity to require a whole life order."^[110][111]

Letby opted^{[75]: 18:50} not to attend the sentencing hearing and as such heard neither the various victim impact statements which were read out, nor her sentence being passed.^[112][113] In response, Alex Chalk, Secretary of State for Justice, wrote that the government will "look at options to change the law at the earliest opportunity" to compel defendants to attend their sentencing.^[114] On 30 August 2023, Prime Minister Rishi Sunak announced that the UK government would introduce legislation to Parliament that would compel convicted criminals to attend their sentencing hearings, by force if necessary, or face the prospect of more time in prison.^[115]

After the trial, Lucy Letby was transferred to HMP Low Newton, a closed prison for women in County Durham.^[116] As of January 2024^[update], Letby is being held in HM Prison Bronzefield.^[117]

Appeal

In January 2024, a judge refused Letby permission to appeal her convictions, but as she renewed her application a court of three judges will decide whether to grant permission.^[118][119]

Scheduled retrial

At a hearing on 25 September 2023, the CPS confirmed that there would be a retrial on one of the six counts of attempted murder against Letby on which the jury at the original trial could not reach a verdict. A date of 10 June 2024 has been set but the trial will not be conducted until after judges had decided whether or not to grant Letby permission to appeal against her existing convictions.^[120]

Disciplinary action

Letby was removed from the nursing register on 12 December 2023, having informed the Nursing and Midwifery Council that she did not accept guilt but did not contest the removal.^[121]

Motives

During Letby's trial, the prosecution suggested several possible motives for the killings including boredom, that she "got a thrill" from the events surrounding the deaths and that she enjoyed "playing God". The prosecution told the jury that "[s]he was controlling things. She was enjoying what was going on. She was predicting things that she knew was going to happen." Another possible motivation suggested by the prosecution was that the killings were to gain the attention of a married doctor with whom Letby allegedly had a secret relationship. She had texted this doctor 'non-stop' during some night shifts, minutes before attacking babies.^[3]: 14:30 One sheet of paper found in Letby's office and shown to the court was an annual leave form, on which Letby had written phrases including, "I trusted you with everything and loved you", "you were my best friend" and "please help me".^[122] The doctor was one of those called when a baby rapidly deteriorated. Letby denied all these suggestions, including the allegation that she had a relationship with the married doctor.^[123] During her trial it was noted that Letby broke down for the first time only when this doctor who she allegedly had a crush on gave evidence and she tried to leave the dock without permission at this point.^{[75]: 14:30} When questioned why she did this Letby said she had "felt unwell" and when questioned, she claimed she "didn't know" what 'go commando' meant, even though the doctor she allegedly fancied had sent it to her in an apparently flirtatious text, to which she replied to with laughing emojis.^[124]

The Guardian, in its reporting after the verdict, said that "[t]he closest the prosecution had to a confession" were post-it notes found in Letby's handbag after her arrest. The notes bore hand-written jottings, one of which read, "I killed them on purpose because I'm not good enough to care for them." During the trial Letby denied this was a confession and that it was merely a reflection of her mental turmoil written while she was being investigated.^[123] The Telegraph also noted though that she had also suggested another motivation was her fear of never finding love or having children of her own, writing on the note: "I'll never marry or have children, I'll never know what it's like to have a family."^[98][97]

A former detective superintendent, the lead detective on the Beverley Allitt case of the 1990s, said that the amount of parallels between the cases made him think that "it's almost as if somebody's read the Allitt book" and that Letby's crimes may have been copycats.^{[75]: 17:30} Allitt had attacked over a dozen infants in her care while working as a nurse in Grantham, England, and the methods used in the cases were apparently identical, with Allitt having also injected some victims with air and insulin and physically assaulting them.^{[75]: 17:30} It was believed that Allitt may have been motivated by what was then called Münchausen syndrome by proxy, now known as factitious disorder imposed on another (FDIA), in which she harmed others to gain attention for herself. The theory that this could explain Letby's attacks was supported by criminal psychologist Dominic Wilmott.^{[75]: 18:00} Fellow criminal psychologist Dr David Holmes agreed that Letby was motivated by FDIA.^[95]31:15 Just like in Letby's case, the hospital in Allitt's case was criticised for its slow speed of response.^[125]

In an opinion piece published in the Guardian in August 2023, David Wilson, an emeritus professor of criminology, considered it possible that Letby was driven by a "hero complex".^[126] A senior nurse testified on 21 March 2023 that Letby had told her before June 2016 that she, Letby, found non-intensive care of babies "boring" and had always wanted to be allocated to the intensive care unit, notwithstanding concerns among nursing staff that working long periods in intensive care would place a high burden on the mental health of nurses.^[11] According to Wilson, healthcare killers like Letby "[have] already developed the desire to kill before they join the healthcare setting".^[125] Speaking on Newsnight, he said: "If you want to kill, of course you are going to identify people who are vulnerable. People whose deaths won't be noticed. And so guess what? The people that serial killers target, by and large, are older people, or they target very very young people, specifically in a neonatal unit in this case, where again small babies with chronic underlying healthcare where their deaths won't be commented upon or seen as being suspicious".^[125]

Post-conviction

Further investigations

Following the verdict, it was reported that police were investigating whether Letby harmed other babies. There was a continuing investigation of incidents which detectives had identified as "suspicious" at the Countess of Chester Hospital involving around 30 other infants. Neonatologists looked into about 4,000 admissions at the hospital and Liverpool Women's Hospital, where Letby had worked from 2012 to 2015, and were to pass on any cases of "unexpected and unexplained" deteriorations to police. At least one family was told by police that the birth of their child at the latter hospital was part of the enquiry.^[26][127] Cheshire Police have said that further charges could "possibly" be brought against Letby as a result of these further investigations.^[3]: 55:20

On 4 October 2023, Cheshire Constabulary announced an investigation into corporate manslaughter at the Countess of Chester Hospital.^[128]

Thirlwall inquiry

After Letby's conviction the UK government ordered an independent inquiry into the circumstances surrounding the murders.^[129] The Department of Health and Social Care said the inquiry would examine "the circumstances surrounding the deaths and incidents, including how concerns raised by clinicians were dealt with."^[130] It was affirmed that the inquiry would be non-statutory, so witnesses could not be compelled to give evidence and inquests would still be necessary. The trust's medical director, chief executive and the nursing director at the time of the murders all commented they would fully cooperate with the inquiry.^[131][6] The medical director retired in August 2018 and the chief executive resigned in September 2018 after signing a non-disclosure agreement.^[6]

Slater and Gordon, a law firm representing two of the victims' families, issued a statement calling for the inquiry to have the power to compel witnesses to participate, since a non-statutory hearing "must rely on the goodwill of those involved to share their testimony."^[132] The need for a statutory inquiry was a view echoed by, among others, Sir Robert Buckland, former Secretary of State for Justice,^[133] Samantha Dixon, MP for the City of Chester,^[132] Steve Brine, chair of the House of Commons Health and Social Care Select Committee,^[134] Sir Keir Starmer, Leader of the Opposition,^[135] and the Parliamentary and Health Service Ombudsman.^[136]

The education minister Gillian Keegan said that the type of inquiry would be reviewed after the chair was appointed.^[137][138] On 30 August 2023, Health Secretary Steve Barclay announced that the inquiry had been upgraded to a statutory inquiry, describing it as the best way forward and meaning that witnesses would be compelled to give evidence.^[139]

Lady Justice Thirlwall will chair the inquiry.^[140] The terms of reference of the inquiry were published on 19 October 2023 and updated on 22 November 2023,^[141] when Lady Justice Thirlwall formally opened the inquiry.^[142]

Calls for regulation and reform

The British Medical Association, which represents doctors, called for a process for NHS managers and healthcare administrators to be held accountable for mismanagement, in a similar way to how the General Medical Council may strike off doctors who harm patients.^[143] A neonatal consultant who alerted administrators about his suspicions about Letby also called for regulation of healthcare management.^[144]

The Parliamentary and Health Service Ombudsman Rob Behrens, called for radical change to NHS management in order to prevent future similar occurrences.^[136][145]

Doubt about conviction

A small number of Letby's friends and former colleagues continue to believe in her innocence.^[146] After the verdict, conspiracy theories soon began circulating on the internet doubting the outcome and suspecting a miscarriage of justice similar to the case of Lucia de Berk.^[147][146] The Letby case has joined a trend where amateur "internet sleuths" purport to have uncovered evidence suggesting that a miscarriage of justice has taken place.^[147][148]

Statistician Richard D. Gill and lawyer Neil Mackenzie KC, who co-authored a work with others on the use of statistics in court cases, have also questioned the outcome.^[147][149] Gill raised concerns that "a meaningful statistical analysis was not carried out to explore whether or not there was a higher rate of incidents during Letby’s shifts than outside them, while controlling for relevant factors."^[150]

Other reactions

Dewi Evans, a retired consultant paediatrician who served as a prosecution witness, has called for an investigation into the possibility of charges of corporate manslaughter in relation to the Letby case.^[151]

The Royal College of Paediatrics and Child Health stated, "We must learn from these crimes and how Lucy Letby was able to bring harm to these babies so that no situation like this can ever happen again" and welcomed the independent inquiry.^[152] NHS England's Chief Nursing Officer Dame Ruth May issued a statement saying, "The NHS is fully committed to doing everything we can to prevent anything like this ever happening again, and we welcome the independent inquiry announced by the Department of Health and Social Care to help ensure we learn every possible lesson from this awful case."^[153]

On 21 August 2023, it was announced that the nursing director at the Countess of Chester Hospital at the time Letby was based there had been suspended from her job as a senior nursing officer at Northern Care Alliance NHS Foundation Trust with immediate effect, because of information that came to light during the trial.^[154] The Nursing and Midwifery Council subsequently announced she would face an investigation into her fitness to practice.^[155] She and other executives at the hospital have been accused of ignoring warnings about Letby.^[154]

It was reported that the British government were examining how Letby's pension can be stopped.^[156] The NHS pension scheme regulations provide for a forfeit of pensions after a conviction of certain crimes.^[157]

The Government announced that it would introduce new powers to compel convicted criminals to attend sentencing hearings.^[158]

See also

• List of prisoners with whole life orders
• List of serial killers in the United Kingdom
• 2011 Stepping Hill Hospital poisoning incident – saline poisoning deaths in Greater Manchester, England
• Benjamin Geen – British nurse convicted in 2006 of murdering two patients
• Genene Jones – American nurse responsible for the deaths of up to 60 infants and children in her care during the 1970s and 1980s
• Colin Norris – British nurse convicted of murdering four patients with insulin in 2008
• Harold Shipman – British general practitioner convicted in 2000 of 15 murders but suspected of as many as 250
• Elizabeth Wettlaufer - Canadian nurse who murdered eight senior patients between 2007 and 2016

References