Lucy Letby inquiry: ‘Basic failures’ by hospital had ‘fatal consequences’ on babies
“Basic failures” by the hospital where Lucy Letby worked had “fatal consequences”, an inquiry heard.
The former neonatal nurse was sentenced to life imprisonment last year for murdering seven babies and attempting to murder six more at the Countess of Chester Hospital between the summers of 2015 and 2016.
On the third day of the inquiry looking into how Letby, 34, was able to commit her crimes, Peter Skelton KC, representing seven of the families, detailed five “basic failures” by the hospital.
Speaking at Liverpool Town Hall, he said: “The first failure was to conduct swift, careful and methodical investigations into why each of the deaths occurred and whether there were connections between the deaths.”
He added: “That was a major and catastrophic failure.”
Mr Skelton said it meant vital information was overlooked, with “fatal consequences” for other children.
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‘To lose a baby is heartbreaking experience, which nobody should go through’
‘Deaths should have been escalated’
Mr Skelton said the cluster of deaths and collapses should have been escalated to senior management within the hospital trust immediately, so they could have overseen investigations.
“It should have been in the minds of those conducting and overseeing the investigations that the cluster of unexpected and unexplained deaths might have been caused by the criminal acts of a member of hospital staff,” he said.
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‘Staff should have kept minds open’
The barrister said a report into Beverley Allitt, a nurse who killed children at Grantham Hospital, Lincolnshire, in 1991, sought to ensure that healthcare staff were prepared to keep their minds open to the possibility of criminal conduct.
Mr Skelton also noted how in May 2015, nurse Victorino Chua was sentenced for murdering patients at Stepping Hill Hospital.
“It is difficult to understand why events at Stepping Hill did not at the very least alert those at the Countess of Chester from the start that the cluster of unexpected deaths were the result of potential criminality and that active steps were required to rule out that possibility,” he said.
Read more:
Doubts over Letby conviction as families seek answers
Serial killer case formed part of Letby’s training – inquiry
‘Police and coroner should have been informed’
Mr Skelton said the police and coroner should have been informed at the outset, which could have had a “profound effect” on the course of events.
He told the inquiry the fifth failure was not to inform the families that the deaths were being investigated with a view to finding out why they occurred.
At a recent retrial, Letby was convicted of attempting to murder another baby.
It confirmed her as the most prolific child serial killer in modern British history.
The inquiry, chaired by Lady Justice Thirlwall, is expected to sit until early 2025, with findings published by late autumn of that year.
In 2019, nine men were jailed for raping and abusing two teenage girls living in a children’s home in Bradford.
One of the victims, Fiona Goddard, says more than 50 men raped her.
When the government began to talk about offering councils money for local inquiries, Fiona hoped Bradford would be one of the first to take up the offer. But there didn’t seem to be much enthusiasm.
The council was quick to point out that there had already been an independent case review into Fiona’s case, along with four other victims.
This, then, was Fiona’s first reasoning for wanting a national inquiry: The council felt it had done all that needed to be done. Fiona didn’t.
The Independent review, published in July 2021, found that while in the children’s home, Fiona “went missing almost on a daily basis”. The police attitude was that she could look after herself – she was “street-wise”.
There was “agreement by all agencies that Fiona was either at risk of Child Sexual Exploitation (CSE) or actively being sexually abused and exploited”. But “this was not addressed by any single agency”.
And “when Fiona became pregnant at the age of 15, there was little curiosity or enquiry who the father was”.
So, obvious failings were discovered.
The predictable response was that lessons had been learned and new processes put in place. But no one seemed to be held accountable.
Grooming gangs timeline: What happened, what inquiries there were and how Starmer was involved
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Grooming gangs: What happened?
Ms Goddard told Sky News: “In my serious case review she [Jane Booth, the independent chair] found seven incidences at least, in them records that she found, of them not reporting sexual abuse or rape or assault, from as young as eight years old, and one of the incidences I literally turned up covered in blood and they didn’t report it.
“That is not just misunderstanding a crime, that is making intentional decisions not to report the sexual abuse of a child.”
She adds: “Let’s not forget, these people still work within social services and the police force.”
Not only did this Independent review not satisfy Fiona, but it also didn’t begin to reflect the levels and scale of abuse Fiona had experienced outside of Bradford.
‘I literally turned up covered in blood and they didn’t report it,’ Fiona says
Asked where she was trafficked to, Fiona rattles off a list of cities.
“Blackburn, Rotherham, Rochdale, Birmingham, Edinburgh, Oldham – never Telford, I’d never even heard of Telford until it all came out if I’m honest – Nottingham, Oxford.”
Then she remembers she didn’t go to Oxford – men from Oxford came to her – but the point is made.
Local enquiries can’t possibly begin to explore the networks of men who traffic women, often down routes of drug trafficking being done by the same gangs.
Bradford Council told Sky News it contributed to the national Independent Inquiry into Child Sexual Abuse (IICSA) and published more than 70 reports where child sexual exploitation was discussed and has implemented findings from the independent local review which included Fiona’s case.
Fiona believes there are numerous connections leading back to Bradford – but victims from each city often believe their abusers are at the centre of it.
We’ve spoken to grooming victims across the country, and in 2022, a case was reopened in Humberside after a Sky News investigation, where we found diary entries, texts, photos, and school reports all indicating that teenage victims had been abused.
Read more on this story:
Telford child abuse victims speak out
What we know about grooming gangs, from the data
The women who blew whistle on Rotherham
One of them was “Anna”, who also wants a national inquiry. She believes there is a national pattern of police forces not believing victims or even criminalising them instead.
Obtaining her own police records using a Subject Access Request (SAR), Anna found officers’ attitudes towards her were similar to what we heard with Fiona in Bradford, blaming her abuse and injuries on “lifestyle choices of her own”.
Anna said: “Every time I look at my Subject Access Request, I still think it’s shocking.
“It was the same sort of terminology – lifestyle choices, liar, attention seeker, and the majority of it was negative.
“It was really rare that I’d come across something where they were actually listening or they were concerned.”
Humberside Police told us: “As the investigation is active, it is imperative we protect its integrity; as such are unable to comment on aspects of the investigation as this could impact or jeopardise any criminal or judicial proceedings.”
But it is years now since Anna first reported her abuse, and she believes the police have left it too late to gather evidence.
She told Sky News: “I think it’s either happening everywhere, or young people have been taken everywhere.
“I think the attitudes of the professionals, the police, social services, from what I’ve heard and seen, they seem very similar in every area.”
The government-commissioned rapid review by Baroness Casey is due to be published next week and is expected to call for a national inquiry into grooming gangs.
Like Anna and Fiona, many victims will welcome Sir Keir Starmer’s early response accepting the recommendation.
They will want the inquiry to probe into the operations of the perpetrators – who they are and how they are connected.
But they will also want clear accountability of the people and organisations who failed to act when they reported their abuse – and an understanding of why, so often, authorities fail to protect these vulnerable girls.
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