The Thirlwall inquiry has revealed new insights about Lucy Letby and the neonatal unit where she worked. During the two criminal trials involving Letby, jurors were presented with an overwhelming amount of intricate evidence, including tens of thousands of pages of medical notes, swipecard data, witness testimonies, and Facebook messages. Letby, now 34, was convicted of the murders of seven infants and the attempted murder of another seven at the Countess of Chester Hospital in northwest England.
These convictions have sparked intense discussions, with some experts questioning the medical science and evidence that underpinned the trials. Nonetheless, four of Britain’s most senior judges have currently deemed there to be no grounds for an appeal. Letby’s new legal team is preparing a fresh challenge as concerns regarding the convictions intensify.
Amidst this controversy, a public inquiry is delving into the surge of premature infant deaths at the hospital. However, it is important to note that this investigation is not addressing the question of Letby’s guilt directly.
Over the course of five weeks at Liverpool Town Hall, the Thirlwall inquiry has unearthed new information about Letby, the neonatal unit’s operations, and the traumatic experiences of the families impacted by these events. For some, the new evidence—most of which was not disclosed during the criminal trials—provides a context for how a nurse, described by a detective as being able to “operate in plain sight,” could be involved in such a tragedy. For others, this revelation might reinforce the belief that these unfortunate incidents could have a more innocent explanation.
So far, here’s what we have learned from the Thirlwall inquiry:
Regarding Letby’s character, jurors in her original 10-month trial received only limited insight into her personality. No family members, friends, or colleagues came forward to testify on her behalf, leaving Letby to create her narrative during her 14 days of testimony, which left many within the courtroom with lingering questions.
The inquiry has painted a more nuanced and complex portrait of Letby. Some former colleagues described her as “a little strange,” “uncompassionate,” and “cold,” while others found her to be likable and skilled. Several nurses recounted that Letby relayed news about infant deaths—those for which she would later be convicted— in an “excited” and “gossipy” manner. For example, after the sudden death of a second triplet within 24 hours, she allegedly told a nurse, “You will never guess what’s just happened,” as she started her shift.
Even though some of her colleagues found Letby’s behavior unusual, she was considered a valued and competent member of the unit. Eirian Powell, the ward manager, previously described her as “one of my best nurses,” noting her meticulousness and professionalism. However, concerns regarding Letby’s capabilities did arise. A significant incident occurred in 2013 when she administered a newborn boy a morphine dose ten times higher than necessary, a potentially life-threatening blunder that was caught by a coworker in time.
The inquiry has also revealed that Letby initially failed her final student placement in 2011 due to worries about her competence—an unusual outcome for a trainee nurse on the cusp of qualifying. Nicola Lightfoot, the deputy manager of the children’s unit at the time, expressed concern over Letby’s interactions and communication skills.
Despite her setbacks, Letby ultimately qualified, just weeks after her placement failure, and became a well-liked member of the tight-knit nursing team. Her colleagues even organized a tea party to welcome her back following two external reviews that cleared her of harming infants in early 2017, although this return was never realized due to escalating police involvement.
The inquiry also noted missed opportunities to engage law enforcement. While staff were trained to identify safeguarding issues related to the infants’ families, there was no equivalent guidance for recognizing potential harm from a colleague—despite past tragic cases in the healthcare sector.
The Thirlwall inquiry has further illuminated issues regarding the unit’s staffing deficiencies, which became critical around 2015. Executive-level warnings highlighted the almost-breaking point for pediatric services due to a shortage of qualified personnel, resulting in significant gaps in oversight and care. Some staff observed that the chaotic environment allowed Letby to potentially conceal her actions amid the residual chaos.
A critical lapse occurred when doctors failed to grasp the implications of a blood test that indicated a newborn had been poisoned with insulin in August 2015. A delayed response meant that when professionals reviewed the result later, the child had already stabilized, thus missing a crucial opportunity to act.
Moving forward, the inquiry led by Lady Justice Kate Thirlwall is set to resume on November 4, with testimonies from senior clinicians and executives expected in the coming weeks. The hearings are anticipated to continue until early 2025, culminating in a report that will be published by late autumn of that year.
