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Meg Bakewell, who has cancer and cancer-related heart disease, sometimes emails her primary care physician, oncologist, and cardiologist asking them for medical advice when she experiences urgent symptoms such as pain or shortness of breath.

This story also ran on The Sacramento Bee. It can be republished for free.

But she was a little surprised when, for the first time, she got a bill a $13 copay for an emailed consultation she had with her primary care doctor at University of Michigan Health. The health system had begun charging in 2020 for e-visits through its MyChart portal. Even though her out-of-pocket cost on the $37 charge was small, now shes worried about how much shell have to pay for future e-visits, which help her decide whether she needs to see one of her doctors in person. Her standard copay for an office visit is $25.

If I send a message to all three doctors, that could be three copays, or $75, said Bakewell, a University of Michigan teaching consultant who lives in Ypsilanti, Michigan, and is on long-term disability leave. Its the vagueness of the whole thing. You dont know if youll get into a copay or not. It just makes me hesitate.

Spurred by the sharp rise in email messaging during the covid pandemic, a growing number of health systems around the country have started charging patients when physicians and other clinicians send replies to their messages. Health systems that have adopted billing for some e-visits include a number of the nations premier medical institutions: Cleveland Clinic, Mayo Clinic, San Francisco-based UCSF Health, Vanderbilt Health, St. Louis-based BJC HealthCare, Chicago-based Northwestern Medicine, and the U.S. Department of Veterans Affairs.

Billing for e-visits, however, raises knotty questions about the balance between fairly compensating providers for their time and enhancing patients access to care. Physicians and patient advocates fret particularly about the potential financial impact on lower-income people and those whose health conditions make it hard for them to see providers in person or talk to them on the phone or through video.

A large part of the motivation for the billing is to reduce the messaging. Soon after the pandemic hit, health systems saw a 50% increase in emails from patients, with primary care physicians facing the biggest burden, said A Jay Holmgren, an assistant professor of health informatics at UCSF, the University of California-San Francisco. System executives sought to compensate doctors and other providers for the extensive time they were spending answering emails, while prodding patients to think more carefully about whether an in-person visit might be more appropriate than a lengthy message. Email Sign-Up

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After UCSF started charging in November 2021, the rate of patient messaging dipped slightly, by about 2%, Holmgren and his colleagues found.

Like UCSF, many other health systems now charge fees when doctors or other clinicians respond to patient messages that take five minutes or more of the providers time over a seven-day period and require medical expertise. They use three billing codes for e-visits, implemented in 2020 by the federal Centers for Medicare & Medicaid Services.

E-visits that are eligible for billing include those relating to changes in medication, new symptoms, changes or checkups related to a long-term condition, and requests to complete medical forms. Theres no charge for messages about appointment scheduling, prescription refills, or other routine matters that dont require medical expertise.

So far, UCSF patients are being billed for only 2% to 3% of eligible e-visits, at least partly because it takes clinicians extra time and effort to figure out whether an email encounter qualifies for billing, Holmgren said.

At Cleveland Clinic, only 1.8% of eligible email visits are being billed to patients, said Eric Boose, the systems associate chief medical information officer. There are three billing rates based on the time the clinician takes to prepare the message five to 10 minutes, 11 to 20 minutes, and 21 minutes or more. He said patients havent complained about the new billing policy, which started last November, and that theyve become a little smarter and more succinct in their messages, rather than sending multiple messages a week.

The doctors at Cleveland Clinic, like those at most health systems that bill for e-visits, dont personally pocket the payments. Instead, they get productivity credits, which theoretically enables them to reduce their hours seeing patients in the office.

Most of our physicians said its about time were getting compensated for our time in messaging, Boose said. Were hoping this helps them feel less stressed and burned out, and that they can get home to their families earlier.

Its been a frustration for many physicians for many years that we werent reimbursed for our pajama-time work, said Sterling Ransone, the chair of the American Academy of Family Physicians Board of Directors. Ransones employer, Riverside Health System in Virginia, started billing for e-visits in 2020. We do it because its the right thing for patients. But rarely do you see other professions do all this online work for free, he said.

We see physicians working two to four hours every evening on their patient emails after their shift is over, and thats not sustainable, said CT Lin, the chief medical information officer at University of Colorado Health, which has not yet adopted billing for email visits. But we worry that patients with complex disease will stop messaging us entirely because of this copay risk.

Many health care professionals share the fear that billing for messages will adversely affect medically and socially vulnerable patients. Even a relatively small copay could discourage patients from emailing their clinicians for medical advice in appropriate situations, said Caitlin Donovan, a senior director at the National Patient Advocate Foundation, citing studies showing the dramatic negative impact of copays on medication adherence.

Holmgren said that while patients with minor acute conditions may not mind paying for an email visit rather than coming into the office, the new billing policies could dissuade patients with serious chronic conditions from messaging their doctors. We dont know who is negatively affected, he said. Are we discouraging high-value messages that produce a lot of health gains? That is a serious concern.

Due to this worry, Lin said, University of Colorado Health is experimenting with an alternative way of easing the time burden of e-visits on physicians. Working with Epic, the dominant electronic health record vendor, it will have an artificial intelligence chatbot draft email replies to patient messages. The chatbots draft message will then be edited by the provider. Several other health systems are already using the tool.

There also are questions about price transparency whether patients can know when and how much theyll have to pay for an email visit, especially since much depends on their health plans deductibles and copays.

While Medicare, Medicaid, and most private health plans cover email visits, not all do, experts say. Coverage may depend on the contract between a health system and an insurer. Ransone said Elevance Health, a Blue Cross Blue Shield carrier, recently told his health system it would no longer pay for email or telephonic visits in its commercial or Medicaid plans in Virginia. An Elevance spokesperson declined to comment.

Another price concern is that patients who are uninsured or have high-deductible plans may face the full cost of an email visit, which could run as high as $160.

At University of Michigan Health, where Bakewell receives her care, patients receive a portal alert prior to sending a message that there may be a charge; they must click a box indicating they understand, said spokesperson Mary Masson.

But Donovan said that leaves a lot of roo for uncertainty. How is the patient supposed to know whether something will take five minutes? Donovan said. And knowing what youll be charged is impossible because of health plan design. Just saying patients could be charged is not providing transparency.

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Under-the-radar players who could emerge for every top 25 team

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Under-the-radar players who could emerge for every top 25 team

With less than two months left before college football is back in full swing, we’re taking a look at players who could be considered sleepers — under-the-radar players who could make a big impact — on each team in our post-spring top 25.

From true freshmen who could make a name for themselves to players coming back from injury to transfers looking to make an immediate impact, there are plenty of players to watch for this fall.

Our reporters break down the potential sleepers they’re keeping tabs on.

Sleeper: C Nick Dawkins

Offensive linemen naturally get overlooked, and Dawkins is no exception, but he once again will occupy a vital role as Penn State chases its first Big Ten title since 2016 and its first national title since 1986. Dawkins is at the heart of an offensive line that has stabilized and excelled in recent years. He earned honorable mention All-Big Ten honors last fall, when he served as a captain, started all 16 games and allowed only two sacks. The 6-foot-4, 297-pound senior has drawn excellent reviews from the staff and will lead a line protecting quarterback Drew Allar and creating space for running backs Nicholas Singleton and Kaytron Allen. — Adam Rittenberg


Sleeper: WR Tyler Brown

One of the reasons Clemson is expected to compete for a national championship this season is the return of its stellar receiver group, which made vast improvements a year ago to help the Tigers offense rediscover its footing. Antonio Williams, Bryant Wesco Jr. and T.J. Moore have received the bulk of the headlines nationally, but don’t forget about Brown, a freshman All-American in 2023 who was forced to take a redshirt last season with an ankle injury. Coach Dabo Swinney spoke highly about Brown during spring practice and is expecting him to have a big role in the offense. Adding depth to a position that had been a weak spot until last season is crucial. — Andrea Adelson


Sleeper: TE Jack Endries

Endries had a breakout season at Cal last year, catching 56 passes for 623 yards and two touchdowns, making him less of an off-the-radar prospect. But the former Golden Bears tight end signed with Texas in April and slides into a talented Longhorns offense. With star recruits Ryan Wingo and DeAndre Moore returning at receiver, 1,000-yard rusher Quintrevion Wisner back at running back with Cedric Baxter and Christian Clark returning from injuries alongside him, Arch Manning will have weapons. But Manning singled out Endries, a former walk-on, as someone who could emerge as a household name by season’s end as he solidifies a position of need after Gunnar Helm, who caught 60 passes for 786 yards and seven TDs last year, developed into a fourth-round pick of the Tennessee Titans and Amari Niblack transferred to Texas A&M. — Dave Wilson


Sleeper: RB Bo Walker

Walker wasn’t the most heralded prospect in Georgia’s most recent recruiting class, but he turned some heads in spring practice with his physical style and speed. Walker ran for more than 2,000 yards as a high school junior before spending his senior year at a smaller private school. Nate Frazier and Illinois transfer Josh McCray will probably be the top two backs entering preseason camp, but Walker has a chance to earn playing time. Would you expect anything less from a tailback named both Bo and Walker in the SEC? — Mark Schlabach


Sleeper: WR Carnell Tate

Tate was overshadowed by first-round pick Emeka Egbuka and true freshman phenom Jeremiah Smith last season. But Tate still played a key role for the Buckeyes, starting every game for the national champions. In the playoff semifinals against Texas, he made the Longhorns pay for their coverages taking away Smith by hauling in a game-high seven passes for 87 yards. With Egbuka gone to the Tampa Bay Buccaneers, Tate is set to play an ever bigger role for the Buckeyes as a junior. He could easily surpass the 52 receptions and 733 receiving yards he had last season, and he should be a valuable wingman to Smith in yet another talented Ohio State receiving corps. — Jake Trotter


Sleeper: WR Barion Brown

If you’re familiar with Brown from his high school days, you may not consider him a sleeper. But the Kentucky transfer could finally reach his full potential in Baton Rouge. After a standout freshman season in Lexington, he never made the big statistical leaps many expected. But with Garrett Nussmeier at quarterback and other talent at receiver (Aaron Anderson, Oklahoma transfer Nic Anderson) and tight end (Trey’Dez Green, Oklahoma transfer Bauer Sharp), perhaps Brown can break out in 2025. — Harry Lyles Jr.


Sleeper: DL Bryce Young

With Rylie Mills and Howard Cross III leaving for the NFL, the Fighting Irish are looking for another player who can rush the quarterback. The answer might be sophomore Bryce Young, who certainly looks the part at 6 feet, 7 inches and 273 pounds. Last season, he played in all 16 games and had 23 tackles with a team-high three blocked kicks. Young has the right potential too. His father, Bryant Young, was an All-American at Notre Dame and a Pro Football Hall of Famer after a standout career with the 49ers. His mother, Kristin, ran track and field for the Fighting Irish. — Schlabach


Sleeper: WR Malik Benson

It’s difficult to call a four-star wide receiver a sleeper, but given the kind of season Florida State had last year, Benson was not exactly the talk of the sport after putting up 25 catches for 311 yards and one touchdown. Now in Eugene, Benson has the tools to be exactly the kind of wideout that flourishes in Will Stein’s offense. With a new quarterback in Dante Moore taking the reins and Evan Stewart dealing with a serious injury, I wouldn’t be surprised if Benson becomes Moore’s top target this coming season. — Paolo Uggetti


Sleeper: S Bray Hubbard

Now in his third season in the program, Hubbard is poised to be an All-SEC caliber player and will team with a healthy Keon Sabb to give Alabama one of the best safety duos in the SEC. Hubbard, who chose Alabama out of high school over Mississippi State, Navy and Tulane, started the final six games a year ago after Sabb suffered a season-ending injury against Tennessee and made a name for himself with three interceptions. Look for Hubbard in 2025 to be one of the top names on Alabama’s defense. — Chris Low


Sleeper: RB LJ Martin

After rushing for 518 and 718 yards in the past two seasons, Martin has steadily become a key player for BYU, but he hasn’t quite broken out nationally. He already figured to see his role grow as a junior in 2025, but with quarterback Jake Retzlaff set to transfer, Martin could be relied on more heavily — especially early in the season as the QB situation gets settled. Martin had a pair of 100-yard rushing games last season and finished with a strong performance in the bowl win against Colorado, with 88 yards rushing and a pair of touchdowns. — Kyle Bonagura


Sleeper: S Miles Scott

Miles Scott isn’t even the most decorated Scott in the Illinois secondary — Xavier (no relation) earned first-team All-Big Ten honors in 2024 — but contributes to a unit that could be among the Big Ten’s best this fall. Miles had two interceptions last season and finished fifth on the team with 55 tackles (33 solo). The team captain also forced and recovered a fumble last fall. Scott has played in all 38 games during his Illinois career, starting the past 25, beginning his career as a walk-on wide receiver before moving to safety. He joins his roommate Xavier Scott, leading tackler Matthew Bailey, cornerback Torrie Cox Jr. and others in one of the nation’s most experienced secondaries. — Rittenberg


Sleeper: CB Nyland Green

The Arizona State defense returns eight starters, including both cornerbacks (Keith Abney II and Javan Robinson) — the Sun Devils are blessed with continuity on that side of the ball that most top-25 teams don’t have. But that makes cornerback Nyland Green one heck of a luxury add: The Purdue transfer, who started his career as a blue-chipper at Georgia, was an all-or-nothing playmaker with an overwhelmed Boilermakers defense last year, but in more select roles, with better experience and talent around him, he could turn into a major difference-maker for the defending Big 12 champs. — Bill Connelly


Sleeper: Edge Bryan Thomas

Much of the attention within the Gamecocks’ pass-rush depth will be centered on sophomore phenom Dylan Stewart and Charlotte transfer Demon Clowney, cousin of former two-time All American Jadeveon Clowney. But as South Carolina works to replace the production of 2024 SEC sack leader Kyle Kennard, fourth-year edge Thomas will have an important role to play as well. The 6-foot-2, 247-pounder logged career highs in sacks (4.5) and total tackles (23) a year ago, and he’s poised to step into a starting role opposite Stewart this fall following Kennard’s jump to the NFL. If the Gamecocks are going to feature one of the nation’s fiercest pass rushes again in 2025, Thomas will have to be a big part of it. — Eli Lederman


Sleeper: DL Elijah O’Neal

O’Neal turned in a productive 2024 season, finishing with four sacks and 4.5 tackles for loss in what was expected to be his final season in Tempe. However, as a former junior college transfer, O’Neal benefited from the ruling that granted juco transfers an extra year of eligibility and will return for his final season with a chance to develop into a more well-rounded pass rusher. He started six games last year, and with the strong possibility of an expanded role, it wouldn’t be a surprise if O’Neal chases double-digit TFLs or sacks. — Bonagura


Sleeper: RB Derrick McFall

Aside from SMU’s game against FCS Houston Baptist, McFall got just eight carries as a true freshman in 2024, but he flashed a skill set that could make him an apt replacement for Brashard Smith in the Mustangs’ backfield. A four-star recruit, McFall is quick, elusive and versatile — a lot like his predecessor at SMU. At 5-11, 183 pounds, he’s still looking to fill out his frame a bit, but his explosiveness and ability to catch the ball out of the backfield figure to be serious weapons. More importantly, with Smith on to the NFL and LJ Johnson‘s transfer, McFall is the clear favorite to fill a major hole on SMU’s offense. — David Hale


Sleeper: DL Romello Height

A transfer from Georgia Tech, Height is not necessarily an unknown. But for as bad as the Texas Tech defense was last season (only Tulsa allowed more passing yards, and the Red Raiders allowed 35 points or more eight times), Height could play a massive role in Lubbock if he’s able to help fix what was a painful watch for Texas Tech fans at times in 2024. The more high-profile transfer on this defensive line unquestionably is David Bailey, who comes in from Stanford, but Height could very well become a name that Red Raiders fans will become familiar with given his potential. — Lyles Jr.


Sleeper: RB Roman Hemby

Stepping into a Hoosiers backfield without a settled returning starter, Maryland transfer Hemby has the opportunity to emerge as Indiana’s leader on the ground in 2025. Hemby hasn’t matched the 989-yard, 10-touchdown production he delivered in 2022 in either of his past two seasons, but the 6-foot, 208-pound rusher has averaged at least 4.5 yards per carry in each of his past three seasons and can be a threat in the passing game as well. Indiana spread its carries nearly evenly between top rushers Justice Ellison and Ty Son Lawton a year ago, and will likely do the same again with upperclassmen Kaelon Black and Lee Beebe Jr. also vying for carries. But Hemby has the potential to break through in a big way in 2025. — Lederman


Sleeper: Edge Tobi Osunsanmi

Kansas State returns four starters from last year’s defensive front six, but the Wildcats will need someone to replace the lost production of sacks leader Brendan Mott (13.5 tackles for loss, 8.5 sacks). Enter Tobi Osunsanmi. The converted linebacker played a backup role last season, averaging about 22 snaps per game, but he actually averaged more havoc plays (TFLs, forced fumbles, passes defended) per snap than Mott — a 3.0% rate to Mott’s 2.5%. Between Osunsanmi and sophomore Chiddi Obiazor (2.5% havoc rate at 23 snaps per game), K-State has a couple of exciting options on the edge up front. — Connelly


Sleeper: LB Myles Graham

We saw what Graham was capable of as a freshman for the Gators with 30 tackles. He also had three tackles for loss, one sack, an interception and a forced fumble. With a line that should only be stronger in front of him, along with playing next to Grayson Howard, Graham has the potential to take another step in 2025. The great Florida teams of the 21st century have all had good linebacker play, and it feels like Graham could play that part for this team as it looks to rise again. — Lyles Jr.


Sleeper: CB Zeke Berry

From Mike Sainristil to Will Johnson, Michigan’s dominant defenses in recent years have featured a big-time cornerback. Berry is primed to become the next one, on the heels of a breakout junior season. After starting the year at nickelback, Berry slid to the outside following an injury to Johnson and thrived. Berry finished the year with 37 tackles and a team-high 11 pass breakups. He also forced a fumble to go along with his two interceptions. If Berry can take another step forward as the leader of the Michigan secondary, he quietly figures to be one of the top corners in the Big Ten — if not the country. — Trotter


Sleeper: S Zechariah Poyser

You may have heard of Poyser, one of the top available players in the transfer portal this past season. But he should still be considered a sleeper because of the impact he is projected to have in his first year with the Hurricanes. The 6-foot-2, 190-pound safety played his first two seasons at Jacksonville State, earning Freshman All-America honors as a redshirt freshman this past season with 75 tackles and three interceptions. His addition gives the Hurricanes an instant upgrade at safety, where they struggled at times last season. Miami made other additions at defensive back in the portal, but safety was the most glaring area of need and it appears to be filled. — Adelson


Sleeper: S D’Angelo Hutchinson

The Cardinals struggled against the pass last season, and they’ll enter 2025 with a markedly different secondary that comes with its own share of questions. But one carryover from 2024 could help provide some answers. Hutchinson, a 6-foot-3 senior, saw action in all 13 games last season and came on strong down the stretch, including a standout performance in a win over Clemson in which he racked up nine tackles, two pass breakups and a blocked kick. Hutchinson brings length and speed to the back end, and head coach Jeff Brohm said he thinks the veteran could be in line for a breakout campaign. — Hale


Sleeper: CB Tyreek Chappell

Chappell returns after missing almost all of last season with an lower leg injury suffered in a non-contact setting in practice, making just three tackles. The Aggies’ secondary play was particularly frustrating to Mike Elko as last year wore on, and the return of Chappell, a former starter who was a three-star recruit and the team’s top defensive newcomer in 2021, is a key to the Aggies’ hopes of bolstering that unit. With the return of Will Lee III and the addition of Georgia transfer Julian Humphrey, Chappell, who had 88 tackles in his first two seasons, but just 24 in the past two, might be overlooked by fans. But inside the program, Chappell is expected to have a big year at the nickel spot. — Wilson


Sleeper: WR Cayden Lee

It’s odd to classify Lee as a sleeper following his breakout sophomore campaign in 2024, but hype around the third-year pass catcher has been buried this offseason amidst the Rebels’ additions of five transfer receivers, headlined by De’Zhaun Stribling and Harrison Wallace III. Lee finished second among Ole Miss receivers a year ago with 57 receptions, which he converted into 874 receiving yards and a pair of touchdowns. As the Rebels enter a new era at quarterback in 2025 with first-year starter Austin Simmons, Lee has the potential to become a critical, go-to target, particularly if he can find the end zone more. — Lederman


Sleeper: WR Zion Kearney

The Sooners were besieged with injuries at the receiver position last season, and some of their more talented pass catchers hit the transfer portal, including Nic Anderson. With new offensive coordinator Ben Arbuckle and his Air Raid offense coming to Norman, that means Oklahoma will utilize even more receivers. Kearney, a true sophomore, has a chance to make a big jump after playing as a backup in 11 games as a freshman. He has the size (6-1, 207 pounds) and speed (4.28 40-yard dash in high school) to be a staple in the Sooners’ passing game, especially with John Mateer stepping in at quarterback. — Low

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‘Catastrophic failure’ led to Heathrow power outage – with chances missed to prevent it

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'Catastrophic failure' led to Heathrow power outage - with chances missed to prevent it

A power outage that shut Heathrow Airport earlier this year, causing travel chaos for more than 270,000 passengers, was caused by a “catastrophic failure” of equipment in a nearby substation, according to a new report.

Experts say the fire at the North Hyde Substation, which supplies electricity to Heathrow, started following the failure of a high-voltage electrical insulator known as a bushing, before spreading.

The failure was “most likely” caused by moisture entering the equipment, according to the report.

Photo taken with permission from the social media site X, formerly Twitter, posted by @JoselynEMuirhe1 of the fire at Hayes electrical substation. More than 1,300 flights to and from Heathrow Airport will be disrupted on Friday due to the closure of the airport following the fire. Issue date: Friday March 21, 2025.
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The fire at Hayes electrical substation, which led to Heathrow Airport shutting down in March. Pic: @JoselynEMuirhe1/PA

National Grid, which owns the substation, missed two opportunities to prevent the failure, experts found, the first in 2018 when a higher-than-expected level of moisture was found in oil samples.

Such a reading meant “an imminent fault and that the bushing should be replaced”, according to guidance by the National Grid Electricity Transmission.

However, the report by National Energy System Operator (NESO) said the appropriate responses to such a serious issue were “not actioned”, including in 2022 when basic maintenance was postponed.

“The issue therefore went unaddressed,” the report added.

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Moment Heathrow substation ignites

The design and configuration of the airport’s internal power network meant the loss of just one of its three supply points would “result in the loss of power to operationally critical systems, leading to a suspension of operations for a significant period”, the report added.

Heathrow – which is Europe’s biggest airport – closed for around 16 hours on 21 March following the fire, before reopening at about 6pm.

Around 1,300 flights were cancelled and more than 270,000 air passenger journeys were disrupted.

The North Hyde electrical substation which caught fire. More than 1,300 flights to and from Heathrow Airport will be disrupted on Friday due to the closure of the airport following the fire. Picture date: Friday March 21, 2025.
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The North Hyde electrical substation which caught fire. File pic: PA

Tens of millions of pounds were lost, thousands of passengers were stranded, and questions were raised about the resilience of the UK’s infrastructure.

More than 71,000 domestic and commercial customers lost power as a result of the fire and the resulting power outage, the report said.

NESO chief executive, Fintan Slye, said there “wasn’t the control within their [National Grid’s] asset management systems that identified that this [elevated moisture levels] got missed.

“They identified a fault, [but] for some reason the transformer didn’t immediately get pulled out of service and get repaired.

Smoke rises from a fire at the North Hyde Electricity Substation.
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Smoke rises following the fire

“There was no control within the system that looked back and said ‘oh, hang on a second, you forgot to do this thing over here’.”

Sky’s science and technology editor, Tom Clarke, pointed to the age of the substation’s equipment, saying “some of these things are getting really very old now, coming to the end of their natural lives, and this is an illustration of what can happen if they are not really well maintained”.

The report also highlights a lack of joined-up thinking, he said, as “grid operators don’t know who’s critical national infrastructure on the network, and they don’t have priority”.

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Heathrow bosses were ‘warned about substation’

Responding to the report’s findings, a Heathrow spokesperson said: “A combination of outdated regulation, inadequate safety mechanisms, and National Grid’s failure to maintain its infrastructure led to this catastrophic power outage.

“We expect National Grid to be carefully considering what steps they can take to ensure this isn’t repeated.

“Our own Review, led by former Cabinet Minister Ruth Kelly, identified key areas for improvement and work is already underway to implement all 28 recommendations.”

In May, Ms Kelly’s investigation revealed that the airport’s chief executive couldn’t be contacted as the crisis unfolded because his phone was on silent.

Stranded passengers at Heathrow Terminal 5.
Pic: PA
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Stranded passengers at Heathrow Terminal 5 following the fire
Pic: PA

Energy Secretary Ed Miliband, who commissioned the NESO report, called it “deeply concerning”, because “known risks were not addressed by the National Grid Electricity Transmission”.

Mr Miliband said energy regulator Ofgem, which opened an investigation on Wednesday after the report was published, is investigating “possible licence breaches relating to the development and maintenance of its electricity system at North Hyde.

“There are wider lessons to be learned from this incident. My department, working across government, will urgently consider the findings and recommendations set out by NESO and publish a response to the report in due course.”

National Grid said in a statement it has “a comprehensive asset inspection and maintenance programme in place” and said it has “taken further action since the fire”.

This includes “an end-to-end review” of its oil sampling process and results, further enhancement of fire risk assessments at all operational sites, and “re-testing the resilience of substations that serve strategic infrastructure”.

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A spokesperson said: “We fully support the recommendations in the report and are committed to working with NESO and others to implement them. We will also cooperate closely with Ofgem’s investigation.

“There are important lessons to be learnt about cross sector resilience and the need for increased coordination, and we look forward to working with government, regulators and industry partners to take these recommendations forward.”

The Metropolitan Police previously confirmed on 25 March that officers had “found no evidence to suggest that the incident was suspicious in nature”.

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Prosecutors consider more charges against Lucy Letby

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Prosecutors consider more charges against Lucy Letby

Prosecutors are considering whether to bring further criminal charges against Lucy Letby over the deaths of babies at two hospitals where she worked

The Crown Prosecution Service said it had received “a full file of evidence from Cheshire Constabulary asking us to consider further allegations in relation to deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital”.

“We will now carefully consider the evidence to determine whether any further criminal charges should be brought,” it added.

“As always, we will make that decision independently, based on the evidence and in line with our legal test.”

Letby, 35, was found guilty of murdering seven children and attempting to murder seven more between June 2015 and June 2016 while working in the neonatal unit of the Countess of Chester Hospital and is currently serving 15 whole-life orders.

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Letby worked at the Countess of Chester Hospital and Liverpool Women’s Hospital

She is understood to have carried out two work placements at Liverpool Women’s Hospital, where she trained as a student, between October and December 2012, and January and February 2015.

Police said in December that Letby was interviewed in prison as part of an investigation into more baby deaths and non-fatal collapses.

A Cheshire Constabulary spokesperson said: “We can confirm that Cheshire Constabulary has submitted a full file of evidence to the CPS for charging advice regarding the ongoing investigation into deaths and non-fatal collapses of babies at the neo-natal units of both the Countess of Chester Hospital and the Liverpool Women’s Hospital as part of Operation Hummingbird.”

Detectives previously said the investigation was looking into the full period of time that Letby worked as a nurse, covering the period from 2012 to 2016 and including a review of 4,000 admissions of babies.

Letby’s lawyer Mark McDonald said: “The evidence of the innocence of Lucy Letby is overwhelming,” adding: “We will cross every bridge when we get to it but if Lucy is charged I know we have a whole army of internationally renowned medical experts who will totally undermine the prosecution’s unfounded allegations.”

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Three managers at the hospital where Lucy Letby worked have been arrested on suspicion of gross negligence manslaughter.

On Tuesday, it was confirmed that three managers at the Countess of Chester hospital had been arrested on suspicion of gross negligence manslaughter in a separate investigation.

Read more from Sky News:
‘Catastrophic failure’ that led to Heathrow power outage revealed
Man charged with murder of 93-year-old woman in Cornwall

Police said the suspects, who occupied senior positions at the hospital between 2015 and 2016, have all been bailed pending further inquiries.

There is also an investigation into corporate manslaughter at the hospital, which began in October 2023.

A public inquiry has also been examining the hospital’s response to concerns raised about Letby before her arrest.

In May, it was announced the inquiry’s final report into how the former nurse was able to commit her crimes will now be published early next year.

Earlier this year, Letby’s lawyers called for the suspension of the inquiry, claiming there was “overwhelming and compelling evidence” that her convictions were unsafe.

In February, an international panel of neonatologists and paediatric specialists told reporters that poor medical care and natural causes were the reasons for the collapses and deaths.

Their evidence has been passed to the Criminal Cases Review Commission (CCRC), which investigates potential miscarriages of justice, and Letby’s legal team hopes her case will be referred back to the Court of Appeal.

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