Lucy Letby: What we have learnt from the evidence given to the public inquiry
After Lucy Letby was sentenced to 15 whole-life terms for murdering seven babies and attempting to murder seven others, an inquiry was launched to ensure lessons were learnt.
The Thirlwall Inquiry is examining three broad themes – the experiences of all victims’ parents, how the concerns of clinicians were handled, and to ensure lessons are learnt from the case of the most prolific child serial killer in modern British history.
About 133 witnesses, including parents who lost their children, hospital executives, and Letby’s former colleagues at the Countess of Chester Hospital, have provided live evidence to the inquiry since September, with a further 396 giving written statements.
The closing statements this week come days after a police investigation into corporate manslaughter was widened to include gross negligence manslaughter.
The inquiry also heard that two baby deaths remain the subject of ongoing police investigation, which Letby has been interviewed in prison over.
Inquiry chair Lady Justice Thirlwall is expected to publish her official report in the autumn, outlining the detailed findings and recommendations based on the evidence that has been heard.
This week, the Thirlwall Inquiry is hearing closing submissions from the various interested parties. Here’s what has been said during the key testimonies so far.
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From September 2024: Letby public inquiry set to begin
Why is it called the Thirwall inquiry and why are there calls for it to be suspended?
Opening the inquiry at Liverpool Town Hall on 10 September last year, Lady Justice Thirlwall said the probe bears her surname so that the parents do not repeatedly see the name of the person convicted of harming their babies.
She said the babies who died or were injured would be at the “heart of the inquiry” and condemned comments at the time that questioned the validity of Letby’s convictions – which the nurse tried and failed to challenge at the Court of Appeal – and some of the evidence used at trial.
The inquiry also remains separate to a 14-member expert panel, led by retired neonatologist Dr Shoo Lee and senior Conservative MP David Davis, which in February said it had analysed medical evidence considered during Letby’s trial and claimed there was no medical evidence that the nurse murdered or attempted to murder 14 premature babies.
Letby’s lawyers have since applied for a review of her case as a “potential miscarriage of justice” by the Criminal Cases Review Commission (CCRC) after two failed bids at the Court of Appeal.
On Monday, the judge said she had received a request last month from lawyers representing former executives at the Countess of Chester Hospital asking for the public inquiry to be suspended.
Lady Justice Thirlwall also said she had recently received a written request from solicitors representing Letby for her to pause the inquiry.
In the letter to the judge, which Sky News has seen, Letby’s lawyers warned Lady Justice Thirlwall that her final report would “not only be redundant but likely unreliable” if it was not put on hold until after the conclusion of the former nurse’s CCRC application.
Chair of the inquiry Lady Justice Thirlwall. Pic: PA
Letby couldn’t ‘wait to get first death out of the way’
One of the nurses who started as a newly qualified nurse at the Countess of Chester Hospital on the same day as Letby told the inquiry that the serial killer had told her she “can’t wait for her first death to get it out the way”.
The nurse said she thought the comment was “strange” at the time, but she put it down to Letby just making conversation.
She also recalled Letby being “animated” when telling her she had been involved with resuscitation attempts of a child on the ward in 2012.
“It was kind of like she was excited to tell me about it,” the nurse said.
‘Likely’ Letby murdered or attacked more children
Neonatal clinical lead at the Countess of Chester Hospital, Dr Stephen Brearey, told the inquiry that he thought it was “likely” Letby murdered or started to harm babies prior to June 2015.
He agreed that “on reflection” several unexpected collapses and deaths before that date now “appear suspicious”.
Dr Brearey added he did not have concerns about those incidents at the time, saying that hospital staff “thought we were going through a busy or particularly difficult patch”.
The Countess of Chester Hospital in 2023. Pic: PA
The inquiry was told that the dislodgement of breathing tubes, which was how Letby tried to kill Child K, generally occurs on less than 1% of shifts.
However, it happened on 40% of shifts that Letby worked when she was a trainee at Liverpool Women’s Hospital.
Newborn given potentially fatal morphine overdose
Two years before Letby carried out the murder of Child A, she and another nurse gave a potentially fatal dose of morphine to a newborn baby.
Neonatal unit ward deputy ward manager, Yvonne Griffiths, told the inquiry that the infant received 10 times the correct amount of the painkiller at the end of a night shift in July 2013.
Describing it as a “very serious error”, she said the infant could have died if colleagues had not spotted the error an hour later.
Letby was told she had to stop administering controlled drugs as a result of the error, a decision that she told management she was not happy about.
Letby offered ‘tips’ on how to get away with murder
In a WhatsApp exchange in 2017, Letby and union rep Hayley Griffiths discussed the US legal drama How To Get Away With Murder.
The discussion took place a year after the neonatal nurse was moved to clerical duties following concerns she may have been deliberately harming babies.
In a message to Letby, Ms Griffiths wrote: “I’m currently watching a programme called How To Get Away With Murder. I’m learning some good tips.”
To which Letby replied: “I could have given you some tips x.”
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From 2023: Former health secretary Steve Barclay on Letby inquiry
Ms Griffiths responded saying she needed “someone to practice on to see if [she] could get away with it”, and Letby replied: “I can think of two people you could practice on and will help you cover it up x.”
The union rep said: “I truly and deeply regret having started that conversation… this is completely unprofessional.”
No support or counselling given to parents
The parents of two triplet boys murdered by Letby told the inquiry they were given no support or counselling after the deaths of their children.
The children died on successive days in June 2016. Letby was their designated nurse and their deaths led to her being removed from the Countess of Chester Hospital’s neonatal unit to a non-patient facing role.
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How the police caught Lucy Letby
The triplets’ father said: “Following the deaths of our children, we didn’t receive any support or counselling from anyone. Had we received some support, we might have been in a better position to try and act on what our instincts were telling us, which was that something had gone badly wrong.”
Senior consultant: ‘I should have been braver’
Letby’s trial in 2023 heard that senior paediatrician Dr Ravi Jayaram caught the serial killer “virtually red-handed” after an incident in a nursery room at the hospital in February 2016.
Addressing that incident while giving evidence at the inquiry, Dr Jayaram said he had walked into the nursery after feeling “significant discomfort” that Letby was alone with Child K.
Read more from Sky News:
Letby defence calls for miscarriage of justice investigation
Letby interviewed in prison over more baby deaths
After walking in, he said he saw “a baby clearly deteriorating” and the child’s endotracheal tube (ET) dislodged. Despite his concern over the incident, the consultant did not tell anyone at the hospital, or the police.
Explaining why he said nothing, Dr Jayaram said: “It’s the fear of not being believed. It’s the fear of ridicule. It’s the fear of accusations of bullying.
“I should have been braver and should have had more courage because it was not just an isolated thing. There was already a lot of other information.”
Dr Ravi Jayaram. Pics: Rex/ITV/Shutterstock
Hospital boss: ‘I should’ve done better’
Tony Chambers, the former chief executive of the Countess of Chester Hospital, was a key witness to give evidence during the inquiry.
During his evidence, Mr Chambers offered an apology to the families who had fallen victim to Letby and said his language had been “clumsy” in telling the killer nurse the hospital had “her back”.
“I absolutely acknowledged that we hadn’t got that right. We could have done better, we should have done better. I should have done better,” he said.
When pressed on if he tried to “stall and obstruct the police being called or this being made public”, he added: “Had that been what I had done then it would be. But I think it’s an outrageous statement and I do not believe it represents my actions.”
Lady Justice Thirlwall at Liverpool Town Hall. Pic: PA
Jeremy Hunt: ‘Terrible tragedy happened on my watch’
Jeremy Hunt appeared at the inquiry in January where he apologised to the victims’ families, saying he was sorry “for anything that didn’t happen that could potentially have prevented such an appalling crime”.
Mr Hunt was health secretary at the time Letby committed her crimes in 2015 and 2016.
Hunt arrives at Thirlwall Inquiry. Pic: PA
The MP told the inquiry the former nurse’s crimes were “a terrible tragedy” which “happened on my watch” and “although he doesn’t bear direct personal responsibility for everything that happens in every ward in the NHS” he does have “ultimate responsibility for the NHS”.
He recommended that medical examiners should be trained to see the signs or patterns of malicious harm in the work of a healthcare professional.
A care worker who reported the alleged abuse of an elderly care home resident, which triggered a criminal investigation, is facing destitution and potential removal from Britain after speaking up.
“Meera”, whose name we have changed to protect her identity, said she witnessed an elderly male resident being punched several times in the back by a carer at the home where she worked.
Sky News is unable to name the care home for legal reasons because of the ongoing police investigation.
“I was [a] whistleblower there,” said Meera, who came to the UK from India last year to work at the home.
“Instead of addressing things, they fired me… I told them everything and they made me feel like I am criminal. I am not criminal, I am saving lives,” she added.
‘Meera’ spoke up about abuse she said she witnessed in the care home where she worked
Like thousands of foreign care workers, Meera’s employer sponsored her visa. Unless she can find another sponsor, she now faces the prospect of removal from the country.
“I am in trouble right now and no one is trying to help me,” she said.
Meera said she reported the alleged abuse to her bosses, but was called to a meeting with a manager and told to “change your statement, otherwise we will dismiss you”.
She refused. The following month, she was sacked.
The care home claimed she failed to perform to the required standard in the job.
She went to the police to report the alleged abuse and since then, a number of people from the care home have been arrested. They remain under investigation.
‘Migrants recruited because many are too afraid to speak out’
The home has capacity for over 60 residents. It is unclear if the care home residents or their relatives know about the police investigation or claim of physical abuse.
Since the arrests, the regulator, the Care Quality Commission (CQC), carried out an investigation at the home triggered by the concerns – but the home retained its ‘good’ rating.
Meera has had no reassurance from the authorities that she will be allowed to remain in Britain.
In order to stay, she’ll need to find another care home to sponsor her which she believes will be impossible without references from her previous employer.
She warned families: “I just want to know people in care homes like these… your person, your father, your parents, is not safe.”
She claimed some care homes have preferred to recruit migrants because many are too afraid to speak out.
“You hire local staff, they know the legal rights,” she said. “They can complain, they can work anywhere… they can raise [their] voice,” she said.
Sky’s Becky Johnson spoke to ‘Meera’
Sky News has reported widespread exploitation of care visas and migrant care workers.
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More than 100 migrants face being in UK illegally
Immigration crackdown will fuel ‘exodus’ of nurses
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Currently migrants make up around a third of the adult social care workforce, with the majority here on visas that are sponsored by their employers.
As part of measures announced in April in the government’s immigration white paper, the care visa route will be closed, meaning care homes will no longer be able to recruit abroad.
‘Whole system is based on power imbalance’
But the chief executive of the Work Rights Centre, a charity that helps migrants with employment issues, is warning that little will change for the tens of thousands of foreign care workers already here.
“The whole system is based on power imbalance and the government announcement doesn’t change that,” Dr Dora-Olivia Vicol told Sky News.
She linked the conditions for workers to poor care for residents.
Work Rights Centre CEO Dr Dora-Olivia Vicol
“I think the power that employers have over migrant workers’ visas really makes a terrible contribution to the quality of care,” she said.
Imran agrees. He came to the UK from Bangladesh, sponsored by a care company unrelated to the one Meera worked for. He says he frequently had to work 14-hour shifts with no break because there weren’t enough staff. He too believes vulnerable people are being put at risk by the working conditions of their carers.
Migrant workers ‘threatened’ over visas
“For four clients, there is [a] minimum requirement for two or three staff. I was doing [it] alone,” he said, in broken English.
“When I try to speak, they just directly threaten me about my visa,” he said.
“I knew two or three of my colleagues, they are facing the same issue like me. But they’re still afraid to speak up because of the visa.”
A government spokesperson called what happened to Imran and Meera “shocking”.
“No one should go to work in fear of their employer, and all employees have a right to speak up if they witness poor practice and care.”
James Bullion, from the CQC, told Sky News it acts on intelligence passed to it to ensure people stay safe in care settings.
Additional research by Leah Adin
Donald Trump may be denied the honour of addressing parliament on his state visit to the UK later this year, with no formal request yet submitted for him to be given that privilege.
It comes after President Macron’s successful state visit this week, in which he was invited to speak in front of both Houses of Parliament.
Sky News has been told the Speaker of the House of Commons, Sir Lindsay Hoyle, hasn’t so far received a request to invite the US president to speak in parliament when he is expected to visit in September.
It was confirmed to MPs who have raised concerns about the US president being allowed to address both houses.
Kate Osborne, Labour MP for Jarrow and Gateshead East, wrote to the speaker in April asking him to stop Mr Trump from addressing parliament, and tabled an early-day motion outlining her concerns.
“I was happy to see Macron here but feel very differently about Trump,” she said.
“Trump has made some very uncomfortable and worrying comments around the UK government, democracy, the Middle East, particularly around equalities and, of course, Ukraine.
“So, I think there are many reasons why, when we’re looking at a state visit, we should be looking at why they’re being afforded that privilege. Because, of course, it is a privilege for somebody to come and address both of the houses.”
But the timing of the visit may mean that any diplomatic sensitivities, or perceptions of a snub, could be avoided.
France’s President Emmanuel Macron addressed parliament during his state visit this month
Lord Ricketts, a former UK ambassador to France, pointed out that parliament isn’t sitting for much of September, and that could help resolve the issue.
In 2017, he wrote a public letter questioning the decision to give Donald Trump his first state visit, saying it put Queen Elizabeth II in a “very difficult position”.
Parliament rises from 16 September until 13 October due to party conferences.
The dates for the state visit haven’t yet been confirmed by Buckingham Palace or the government.
However, they have not denied that it will take place in September, after Mr Trump appeared to confirm they were planning to hold the state visit that month. The palace confirmed this week that the formal planning for his arrival had begun.
With the King likely to still be in Scotland in early September for events such as the Braemar Gathering, and the anniversary of his accession and the death of Queen Elizabeth on the 8th September, it may be expected that the visit would take place sometime from mid to the end of September, also taking into consideration the dates of the Labour Party conference starting on the 28th September and possibly the Lib Dem’s conference from the 20th-23rd.
Mr Trump has said he believes the trip to the UK will take place in September. Pic: Reuters
When asked about parliamentary recess potentially solving the issue, Ms Osborne said: “It may be a way of dealing with it in a very diplomatic way… I don’t know how much control we have over Trump’s diary.
“But if we can manoeuvre it in a way that means that the House isn’t sitting, then that seems like a good solution, maybe not perfect, because I’d actually like him to know that he’s not welcome.”
A message from the speaker’s office, seen by Sky News, says: “Formal addresses to both Houses of Parliament are not automatically included in the itinerary of such a state visit.
“Whether a foreign head of state addresses parliament, during a state visit or otherwise, is part of the planning decisions.”
Mr Trump made his first state visit to the UK in June 2019 during his first presidency. File pic: Reuters
It’s understood that if the government agrees to a joint address to parliament, the Lord Chamberlain’s office writes to the two speakers, on behalf of the King, to ask them to host this.
It will be Mr Trump’s second state visit.
During his first, in 2019, he didn’t address parliament, despite the fact that his predecessor, Barack Obama, was asked to do so.
It was unclear if this was due to the fact John Bercow, the speaker at the time, made it clear he wasn’t welcome to do so.
However, it didn’t appear to dampen Mr Trump’s excitement about his time with the Royal Family.
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Speaking earlier this year, he described his state visit as “a fest” adding “it’s an honour… I’m a friend of Charles, I have great respect for King Charles and the family, William; we have really just a great respect for the family. And I think they’re setting a date for September.”
It is expected that, like Mr Macron, the pageantry for his trip this time will revolve around Windsor, with refurbishment taking place at Buckingham Palace.
Liverpool have retired the number 20 shirt in honour of Diogo Jota – the first time it has made such a gesture.
The club said it was a “unique tribute to a uniquely wonderful person” and the decision was made in consultation with his wife and family.
The number 20 will be retired at all levels, including the men’s and women’s first teams and academy squads.
A statement said: “It was the number he wore with pride and distinction, leading us to countless victories in the process – and Diogo Jota will forever be Liverpool Football Club’s number 20.”
The club called it a “recognition of not only the immeasurable contribution our lad from Portugal made to the Reds’ on-pitch successes over the last five years, but also the profound personal impact he had on his teammates, colleagues and supporters and the everlasting connections he built with them”.
Jota’s wife joined Liverpool players to view tributes at Anfield on Friday. Pic: Liverpool FC
Pic: Liverpool FC
Newly-married Jota died alongside his brother when his Lamborghini crashed in northern Spain on 3 July.
Police said this week that all the evidence so far suggests Jota was the one driving the vehicle.
Liverpool teammates joined members of Jota’s family, including his wife Rute, at a huge memorial site outside Anfield on Friday.
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A fan looks at messages on a memorial wall near Anfield. Pic: Reuters
Virgil van Dijk and Andy Robertson were among players at the funeral. Pic: Reuters
The star’s funeral took place last weekend, with Liverpool colleagues and members of the Portuguese national team in attendance.
Reds captain Virgil van Dijk carried a shirt bearing the number 20 made from flowers.
Liverpool players returned to the club’s training ground for the start of pre-season on Tuesday.
Their first game since Jota’s death will be on Sunday when they play a friendly away against Preston North End.
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