Lucy Letby has been convicted of murdering seven babies and attempting to kill a further six in a hospital neonatal ward, following a nine-month trial at Manchester Crown Court.
The jury was told how doctors raised concerns with executiveswhen they became aware of the number of unexpected baby deaths at the Countess of Chester Hospital.
Here, The Telegraph outlines what concerns were raised to the director of nursing, the medical director and the head of nursing in urgent care, and what they did about them.
The director of nursing and quality at the hospital where Letby worked is accused of failing to act after concerns were raised with her about the killer nurse.
Alison Kelly, the nursing boss, metDr Stephen Brearey, the lead paediatrician on the unit, in the summer of 2015 to discuss the increase in deaths on the neonatal unit.
Dr Ravi Jayaram told Manchester Crown Court: “We had significant concerns from the autumn of 2015. They were on the radar of someone as senior as the executive director of nursing as far back as October 2015.
“As clinicians, we put our faith in the system, in senior management to escalate concerns and investigate them. The initial response was, ‘it’s unlikely that anything is going on. We’ll see what happens’.”
Ms Kelly – who is currently director of nursing at the Northern Care Alliance’s Rochdale Care Organisation – is being challenged over her response to medics’ concerns and whether more could have been done to stop the killer nurse.
The father of two children who Letby has been found guilty of attempting to murder in April 2016 said the hospital “had the chances” to stop Letby the previous year when Dr Jayaram raised concerns.
“If they’d acted on the initial suspicions, then definitely they could have stopped any more babies being attacked,” he said.
In a statement to The Telegraph Ms Kelly said: “It is impossible to imagine the heartache suffered by the families involved and my thoughts are very much with them.
“These are truly terrible crimes and I am deeply sorry that this happened to them.
“We owe it to the babies and their families to learn lessons and I will fully cooperate with the independent inquiry announced.”
The trust’s accounts show that Ms Kelly was paid up to £130,000 in 2019/20, when she was serving as deputy chief executive of the Countess of Chester alongside other duties.
During the court case, evidence emerged about doctors raising concerns about unexplained collapses of babies on the neonatal ward.
Dr Stephen Brearey, one of the lead paediatricians, had carried out a review into the circumstances around an infant’s death and met with Ms Kelly to discuss his findings in June or July 2015.
“Three deaths in a short period of concern were a matter of concern,” he told the jury in Manchester Crown Court.
Staff had already noticed that Letby was on duty when infants died, but at that point they struggled to believe it was anything more than an “association”.
“I think my comment at the time during the meeting was ‘it can’t be Lucy, not nice Lucy’,” Dr Brearey told the court.
Doctors testified that by October 2015 concerns around Letby were “on the radar” of senior management at the hospital.
In an interview with the BBC Dr Brearey claimed that he never heard back after his concerns about Letby were relayed to Ms Kelly that month.
In February 2016 a neonatologist from Liverpool Women’s Hospital carried out a review into the situation at the Countess of Chester.
Dr Brearey told the court that he sent the findings from this review to Ms Kelly and the medical director and he requested a meeting. According to testimony from his colleague Dr Jayaram, the executives took three months to respond to this request.
The father whose children Letby attempted to murder in April 2016 said that “higher management” needed to be “held accountable” for failing to act on doctors’ concerns. If hospital bosses had listened to staff earlier he said it “would have prevented multiple deaths”.
Ms Kelly arrived at the Countess of Chester in 2013 with decades of experience under her belt, and was picked out by the Nursing Times the following year as one of a number of “leaders” in the profession who would be likely to “leave a legacy”.
In its glowing write-up, the magazine said: “Alison is regarded as a visionary by her staff for her commitment to improving the working environment, which also benefits patient care.”
When babies started collapsing unexpectedly, it was natural that senior doctors turned to her with their concerns.
In 2016, when a local newspaper reported that there had been an increase in the number of serious mistakes being made by the Countess of Chester’s medical staff, Ms Kelly spoke of staff desire to “put things right”.
She has since moved on to prestigious positions elsewhere. Ms Kelly is currently director of nursing at the Northern Care Alliance’s Rochdale Care Organisation, and recently did a secondment to Salford Care Organisation as its interim director of nursing.
Ms Kelly did not give evidence in the trial.
The medical director of the Countess of Chesterwas promoted despite being slow to respond to a doctor who was concerned about the number of babies dying.
Ian Harvey did not respond to a request for a meeting about unexpected baby deaths for three months, the court was told.
Dr Stephen Brearey, a lead paediatrician at the hospital, told BBC News he requested an urgent meeting with Mr Harvey and the director of nursing, Alison Kelly.
But his request was ignored for three months, he said, during which time another two babies almost died. Finally, in May 2016 he sat down with the senior managers. “There could be no doubt about my concerns at that meeting,” he told BBC News.
But the senior managers did not appear to take his warnings seriously. Dr Brearey said Mr Harvey and Ms Kelly listened as he explained his concerns about Letby, but she was allowed to continue working.
Around the same time as Dr Brearey sat down with the managers, Mr Harvey was promoted.
In May 2016 he added the title of deputy chief executive to his role as medical director, on a salary of up to £175,000 a year.
Consultants were also pressured by Mr Harvey to stop communicating their concerns about Letby, according to Dr Brearey.
On June 29 2016, one of the consultants sent an email under the subject line: “Should we refer ourselves to external investigation?”
“I believe we need help from outside agencies,” he wrote, in the email shared with BBC News. “And the only agency who can investigate all of us, I believe, is the police.”
But in a terse response Mr Harvey wrote: “Action is being taken…All emails cease forthwith.”
Despite the medics’ wish for the matter to be referred to the police, Mr Harvey instead invited the Royal College of Paediatrics and Child Heath to review the care provided on the neonatal unit. He also contacted Dr Jane Hawdon, a premature baby specialist, and asked her to review the case notes of the babies who had died on the unit.
At a hospital board meeting in January 2017, Mr Harvey presented the findings of the two reviews, according to the BBC.
Both had recommended that some of the deaths should be investigated further, but Mr Harvey told the board that they had concluded the problems with the unit were due to issues with leadership and the timing of intervention.
When Dr Susan Gilby took over from Mr Harvey a month after Letby’s arrest she said her predecessor had warned her she would need to pursue action with the regulator the General Medical Council, against the neonatal unit’s consultants who had raised the alarm.
But after reviewing the files left in his office she discovered that the executive team had agreed in 2015 to have the first three baby deaths investigated by an external organisation, she told BBC News. That investigation never took place.
It is now likely that Mr Harvey will be facing questions about whether he responded sufficiently and whether Letby should have been removed from the wards earlier.
Mr Harvey briefly became the face of the Countess of Chester as the scandal broke.
He told the public: “Asking the police to look into this was not something we did lightly, but we need to do everything we can to understand what has happened here and get the answers we and the families so desperately want.”
He also assured expectant mothers that the neonatal unit was “safe to continue in its current form”.
It was to be Mr Harvey’s swan song. When he stepped down in August 2018 – weeks after Letby’s arrest – reports made clear that he was simply following through with plans put in place many months before.
Last year, he sold the four-bedroom house he owned with his wife in the countryside outside Chester, and is believed to have moved overseas.
Mr Harvey joined the Countess of Chester in the mid-nineties as an orthopaedic surgeon, specialising in upper limb and hand surgery. Over the years that followed, Mr Harvey rose through the ranks and assumed management roles, becoming medical director in 2012.
In a statement to BBC News he said: “At this time, my thoughts are with the babies whose treatment has been the focus of the trial and with their parents and relatives who have been through something unimaginable and I am sorry for all their suffering.
”As medical director, I was determined to keep the baby unit safe and support our staff. I wanted the reviews and investigations carried out, so that we could tell the parents what had happened to their children. I believe there should be an inquiry that looks at all events leading up to this trial and I will help it in whatever way I can.”
A nursing executive refused a request to stop Letby from coming to work after babies died in her care.
Karen Rees, then head of nursing in urgent care at the Countess of Chester hospital, was accused in court of ignoring three warnings from a doctor who was concerned about the deaths of two infant brothers who had been treated by Letby.
After the two babies from a set of triplets died on successive days in June 2016, consultant Dr Stephen Brearey testified that he telephoned Mrs Rees, who was the duty executive on call, to express his concern.
Dr Brearey, who was head of the neonatal unit, told Mrs Rees he did not want Letby to return to work until the fatalities had been investigated.
The senior medic told the court that he had been concerned because he could not find any “natural cause” for the death of the first sibling, known as Baby O. He said he had been planning to raise the alarm when the second triplet, Baby P, began to deteriorate.
According to his evidence, Mrs Rees refused to stand Letby down from her duties and said there was no evidence to support doing so.
Recounting the phone call, the consultant said he told Mrs Rees that he did not want Letby working “the following day or until this was investigated properly”.
Dr Brearey told the court: “The crux of the conversation was that I then put to her ‘Was she happy to take responsibility for this decision in view of the fact that myself and consultant colleagues would not be happy with Nurse Letby going to work the following day?’
“She responded ‘Yes, she would be happy’. I said ‘Would you be happy if something happened to any of the babies the following day?’ She said ‘Yes’.”
Letby remained in place until the following week, when executives at the trust took action and removed her from the neonatal ward.
Mrs Rees has been contacted for comment.
In autumn 2015, Mrs Rees was commended for “leading from the front”.
She had just been promoted from theatre manager to head of nursing in urgent care at the Countess of Chester hospital, and had her achievements recognised at an awards ceremony for staff.
A typed certificate claimed that she had developed “the service and communication” in operating theatres in a way that led to “a safer experience for patients”.
In November 2017, Mrs Rees was promoted to associate director of nursing. The married mother of one was also handed the Countess of Chester’s prestigious Haygarth Medal for Nurse of the Year, at a glamorous ceremony where she was praised as a “nursing stalwart”.
After the scandal broke, Mrs Rees left the hospital.
Letby and Mrs Rees are believed to have remained in touch following Letby’s arrest, and Mrs Rees is understood to have been disappointed not to have been called as a witness in her trial.