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At first glance, the case against Lucy Letby in 2023 seemed overwhelming. She faced 22 charges of murder and attempted murder, arising from the deaths of an abnormally high number of newborn babies in her Countess of Chester Hospital.
Thousands of pieces of evidence were gathered for the first 10-month trial into Letby’s case, which led to her conviction for the murder of seven babies and attempted murder of six more – after around 110 hours of jury deliberations.
This year, she was found guilty of attempting to murder another child on the unit.
A public inquiry has now started to examine the events around Letby’s crimes. Led by Lady Justice Thirwall, it is also looking at the governance of hospitals across the UK, in a bid to ensure that Letby’s actions are never repeated.
For live updates on the public inquiry - click here
however, it comes as the convicted nurse’s new legal team prepares to launch a fresh appeal into her conviction. Recent months have seen speculation over the evidence used by the prosecution grow rife. It is enough, her lawyer argues, to show the conviction was unsafe.
Letby’s new barrister Mark McDonald told the BBC: “I knew almost from the start, following this trial, that there is a strong case that she is innocent.
“The fact is juries get it wrong. And yes, so do the Court of Appeal, history teaches us that.”
As the inquiry into her crimes gets underway, here are the key questions that have been raised surround Lucy Letby’s crimes:
The confession
A search of Letby’s Chester home found a number of Post-it notes, on which she had written: “I killed them on purpose because I’m not good enough”, “I am a horrible person”, and “I am evil I did this”.
The Guardian has reported that Lucy Letby scribbled the notes on the advice of her GP and hospital bosses to cope with her feelings of extreme stress about being under investigation for the unexpected deaths.
In excerpts from police interviews, Letby said: “I just wrote it because everything had got on top of me. It was when I’d not long found out I’d been removed from the unit and they were telling me my practice might be wrong, that I needed to read all my competencies – my practice might not have been good enough.
“I was blaming myself but not because I’d done something (but) because of the way people were making me feel.”
Letby herself spent 14 days in the witness box, facing close to 60 hours of questioning. The prosecution highlighted instances in her testimony in which Letby appeared to contradict her own evidence to police, or disputed evidence she had previously agreed with.
Speaking to Sky News after her guilty verdicts, prosecution expert witness Dr Dewi Evans suggested the “smoking gun” had been when two of the babies were found to have very high levels of unprescribed insulin in their blood, which Letby herself conceded would mean they had been “deliberately” attacked, but again insisted: “Not by me.”
Statistical evidence
In September 2023, the Royal Statistical Society wrote to the chair of the newly announced public inquiry into the Letby case to warn generally that “it is far from straightforward to draw conclusions from suspicious clusters of deaths in a hospital setting”.
Expressing hope “that lessons from such cases in the past will be learnt”, the society’s leaders wrote: “It is a statistical challenge to distinguish event clusters that arise from criminal acts from those that arise coincidentally from other factors, even if the data in question was collected with rigour.”
One key piece of statistical evidence was the rota data which suggested Letby was always on shift when babies in the neonatal unit where she worked took an unexpected turn for the worse.
While one such chart listed 25 collapses and fatalities in which Letby was present, the jury was not told about a further nine deaths over that period with which she was not charged, which were not included in the table, according to The Daily Mail.
A source said: “Four of the deaths were babies born with a congenital problem or birth defect, another baby was sadly asphyxiated or deprived of oxygen at birth, the remaining four died of infection and their deaths were precipitated with a period of time consistent with infection – they did not suddenly and unexpectedly collapse and die.”
The first review into the deaths was commissioned in July 2016, after fatalities at the unit rose from four each year in 2013-14 to an unusual spike of 13 deaths in the year to June 2016. That review found the unit was understaffed, with junior staff left feeling unable to call in consultants.
Cheshire Constabulary has not commented on the decision not to include the additional nine deaths in the table used in evidence.
Child K
One source of doubt originates in amended evidence offered when Letby was retried for, and found guilty of, one count of attempted murder.
Consultant paediatrician Dr Ravi Jayaram told the court that he had become increasingly concerned about Letby, following a spike in the number of baby deaths in the unit. When he realised that Letby was on her own with Baby K, he went into the nursery to reassure himself that everything was OK.
Dr Jayaram said he caught her “virtually red-handed” as he entered Nursery 1 at about 3.45am and he then went on to intervene and resuscitate Child K.
Dr Jayaram told jurors he saw “no evidence” that she had done anything to help the deteriorating baby as he walked in and saw her standing next to the infant’s incubator.
He said he heard no call for help from Letby or alarms sounding as Child K’s blood oxygen levels dropped.
From the witness box, Letby told the jury she had no recollection of the event described by Dr Jayaram and did not accept it took place.
Child K was transferred, as planned, to a specialist hospital later on 17 February because of her extreme prematurity and died there three days later.
The judge said that despite Child K’s fragility, her condition at the Countess of Chester was “good” and she was stable on a ventilator before Letby targeted her in the knowledge that a transfer was due to take place.
He told Letby: “I repeat what I have said before: only you know the reason or reasons for your murderous campaign.
“It was another shocking act of calculated, callous cruelty.”
Dr Jayaram has shied away from praise for blowing the whistle on Letby, tearfully telling ITV News last year: “I’m not a hero. I was just doing my job.”
Although Dr Jayaram was already suspicious of the nurse following a series of deaths and collapses, the court heard he failed to note down or report the incident.
Jayaram said it was a matter of “infinite regret” that he did not call 999, adding that he and his consultant colleagues were in “uncharted territory” feeling an “element of denial” about working alongside a serial killer.
“I only wish I had the courage to escalate [the concerns] in a different way,” he told the jury. “I only wish I had the courage to do that. That’s why it’s going to be in my nightmares forever.”
Senior crown prosecutor Nicola Wyn Williams, of CPS Mersey-Cheshire’s Complex Casework Unit, said: “Staff at the unit had to think the unthinkable – that one of their own was deliberately harming and killing babies in their care.
“Letby dislodged the tube a further two times over the following few hours in an attempt to cover her tracks and suggest that the first dislodgment was accidental. These were the actions of a cold-blooded, calculated killer.”
Campaigners have called for CCTV evidence of the interaction, with the conviction hinging on one doctor’s testimony – and an error in the data suggesting another nurse was present.
In the initial trial, the prosecution said Dr Jayaram, a consultant, had discovered Letby standing over Baby K at 3.50am on 17 February 2016. The baby was deteriorating and its breathing tube had been dislodged.
The prosecution said door-swipe data showed that the baby’s designated nurse had left the intensive care unit three minutes earlier.
But the data was amended in the retrial for an attempted murder charge to show a nurse had returned at that time, meaning Letby was not alone.
Air embolism
Analysis by the prosecution’s lead expert witness Dr Dewi Evans found that seven babies had been harmed by having air injected into them, which he said in some cases had caused fatal air embolisms, and in others alongside other harms such as liver trauma or overfeeding.
While other expert witnesses agreed that babies could have had air injected into their stomachs feeding tubes inserted into their nose, or into their bloodstream, seven neonatalogy clinicians told The Guardian that they believed it implausible that injecting air into the stomach in this way could cause a fatal collapse.
What happens next?
Letby is planning to launch a fresh appeal with a new legal team, her barrister has said.
In May, Letby lost her Court of Appeal bid to challenge her convictions from last year.
The BBC reported that her new barrister, Mark McDonald, told Radio 4’s File On 4 that he plans to make an application to the Criminal Cases Review Commission (CCRC) for Letby’s case to be sent back to the Court of Appeal.
“I knew almost from the start, following this trial, that there is a strong case that she is innocent,” he told the programme.
“The fact is juries get it wrong. And, yes, so do the Court of Appeal, history teaches us that.”
A public inquiry examining events at the Countess of Chester Hospital following Letby’s multiple convictions started on 10 September in Liverpool.
