What Did Nurse Lucy Letby Actually Do?

On the 10th of October 2022, the UK saw the start of a trial that will forever remain at the forefront of everyone’s minds. After the 9-month long trial, the jury were sent out to deliberate on the 10th of July 2023 and verdicts were returned starting on August 8th. But, what did Lucy Letby actually do?

Who Is Lucy Letby?

Lucy Letby was born on the 4th of January 1990. She was the only child of a finance manager and an accounts clerk. She grew up not far from Wales in Hereford, England. From a young age, a childhood friend has revealed, that she wanted to become a nurse responsible for new-borns and knuckled down at her studies. Lucy started her education in nursing at the University of Chester, where she also worked as a student nurse during her three years of training, carrying out work placement and training at Liverpool’s Women’s hospital and the Countess of Chester Hospital. Lucy was actually the first member of her family to graduate from university in September 2011.

Lucy Letby's Nursing Career

By 2012, Lucy was working as a registered nurse somewhere she was already familiar with, the neonatal unit at the Countess of Chester Hospital. A staff profile in 2013 stated that she was responsible for “caring for a wide range of babies requiring various levels of support” and that she enjoyed “seeing them progress and supporting their families.” She also took part in a campaign to raise funds for a new neonatal unit at the hospital. In June 2016 consultants asked management to remove Lucy from clinical duties pending an investigation into her conduct. She had already been moved from the night shifts to the day shifts in April 2016 by the unit’s ward manager. In July 2016, she was transferred to the patient experience team and then moved on to the risk and patient safety office where she was still working up until her arrest in 2018.

How did she get caught?

In June 2015, an informal review conducted by a consultant and lead neonatologist at the hospital where Lucy worked revealed details regarding four unexplained collapses that occurred on the same unit. Three of these cases resulted in deaths in the same month. Lucy Letby was on shift on each occasion. Even though the unit’s consultants reported these deaths to the trust’s committee responsible for addressing serious incidents such as these, they were marked as “medication errors” rather than actually recognizing them as “serious incident[s] involving unexpected deaths." This prevented an immediate investigation from taking place.

In October 2015, a ward manager decided to conduct her own investigations to find that Lucy was the only staff member that linked these fatal incidents. Her findings were passed to the lead neonatologist and further concerns were relayed to management in the same month. These concerns were either ignored or met with silence. In February 2016, the lead neonatologist, along with some other consultants, concluded in a review that the only common factor in the deaths of 5 babies by this point was nurse Lucy Letby. The lead neonatologist passed the findings through an “urgent” email to the trust’s medical director, Ian Harvey, leading to an eventual meeting in May 2016. However, no further action was taken as the executive team deemed it to be coincidental.

Reports by MBRRACE-UK (Mothers and babies: Reducing Risk through Audits and Confidential Enquiries across the UK) found the neonatal death rate to be at least 10% higher than expected between June 2015 and June 2016. Also, that the neonatal death total doubled in 2015 from the previous year. During a hospital visit in February 2016, The Care Quality Commission (CQC) was informed of difficulties in raising concerns with managers, but heard nothing about an elevated mortality rate. The CQC’s report identified issues of “short staffing” and “skill mix” issues within the unit, yet it praised the overall positive culture of the trust, where “staff felt well supported, able to raise concerns and develop professionally.”

On June 24th 2016, the lead neonatologist had finally had enough and phoned the duty executive, Karen Rees, insisting that Lucy Letby be removed from the unit. Karen Rees insisted that Lucy was safe to work and that “she was happy to take responsibility” if anything happened to anymore babies under Lucy’s care. After this phone call, the trust’s executive directors held a meeting to make a critical decision- whether to involve law enforcement. By this time, there had been seven unexpected deaths of babies that had taken place within the unit all under the care of nurse Lucy Letby.

However, the executives believed that the indications of Lucy’s involvement were purely circumstantial. Their concerns were more held towards certain doctors that seemed to be on a “witch hunt.” They also harboured apprehensions about potential harm towards the Trust’s reputation resulting from a police inquiry. In the end, the executives made the decision to not inform law enforcement. The medical director and chief executive instead organized an autonomous evaluation through the Royal College of Paediatrics and Child Health (RCPCH), which was initiated in September 2016. At the same time, the unit’s services were scaled back in July 2016 which meant that they no longer accommodated premature births before the 32-week mark. Such cases were instead redirected to other hospitals in the North West of England, like Alder Hey Children’s Hospital for example.

The Trust's review focused on the unit’s general service. They could not find a definitive explanation for the rise in mortality rates at the unit but found some insufficient staffing and senior cover. The report recommended a detailed case review into each of the deaths. The medical director asked neonatologist Jane Hawdon from Great Ormond Street Hospital to carry out these reviews. She responded that she could not conduct a detailed review due to lack of time but could instead provide a summary which she did after briefly examining each of the case notes. She identified 4 cases that “potentially benefit from local forensic review as to circumstances, personnel etc.”

Sir Duncan Nichol, chairman of the board of trust at the time, has said that he was misled about the scope of that review and its findings. Despite the thorough external independent review recommended by the RCPCH or the forensic review conducted by Dr. Hawdon, records of the hospital board meeting show executive medical director, Ian Harvey, telling board members that the RCPCH and Hawdon reviews concluded that the deaths in the neonatal unit were actually due to issues with leadership and timely intervention.

In September 2016, Lucy Letby raised a formal grievance herself about her transfer from clinical duties to the hospital’s risk and patient safety office. This grievance was upheld by the board in January 2017, which determined her removal had been “orchestrated by the consultants with no hard evidence.” They supported her return to the neonatal unit and offered her a placement at the Alder Hey Children’s Hospital in Liverpool plus support to develop advanced practice or a master’s degree. The medical director also commented in the report that the trust’s intentions were to “protect Lucy Letby from these allegations.”

The hospital’s CEO Tony Chambers had met with Lucy and her parents on December 22nd 2016 to apologize on behalf of the trust and assure them that the doctors who made the allegations were to be “dealt with.” Tony Chambers ordered all the consultants who accused Lucy Letby to send a letter of apology which she received in February 2017.

In March 2017, consultants asked management to involve the police after receiving advice from the regional neonatal lead, who suggested further investigation was needed. They then met with the Cheshire Constabulary on April 27th 2017 to raise their concerns formally with the police. Lucy Letby was due to return to work on May 3rd 2017. The trust publicly announced the involvement of law enforcement in May 2017, stating that this move was “to seek assurances that enable us to rule out unnatural causes of death.” This was officially the start of the police investigation named Operation Hummingbird.

The Police Investigation

After just over a year of police investigation, Lucy Letby was arrested on suspicion of eight counts of murder and six counts of attempted murder.

When they searched her home in Cheshire, three handwritten notes were discovered which included declarations of love for a colleague doctor, next to his name was "I loved you" and "my best friend." On another note she wrote "Help me", "I can't do this anymore", and "How can life be this way?" A diary was also found in a chest of drawers which included accounts from 2016. A reference for "twins" was recorded for April 8th, the date of birth for two twin boys that the court later found her guilty of attempting to murder. On April 9th the note "Twins resus" was written. Further notes written on June 23rd, 24th and 25th included the initials related to other babies, including two triplet boys that Lucy had allegedly attacked on those dates following her return from a holiday to Ibiza. Both sets of triplet boys did not survive the attack. Inside the diary, a third post-it note was found which was used for the prosecution in the trial.

An A4 sized piece of paper full of jumbled handwritten notes were found inside the diary as well. One sentence read: "I killed them. I don't know if I killed them. Maybe I did. Maybe this is down to me." Along with the words "Kill me" written in bold. Other words appearing on the A4 paper were “foreign objects”, “slander”, “tired”, “crime number”, “diagnosis compromised”, “risk factors” and, repeatedly, “help me”.

Under an Ibiza bag, four handover shift sheets were found for the dates of June 23, June 24, June 25 and June 28 2016. Inside the bag was her "registered children's nurse" badge. A morrisons bag found in her bedroom contained 31 different handover shift sheets, a blood gas reading from a child she allegedly attacked and a paper towel which had handwritten resuscitation notes.

Searches also took place at Lucy Letby's parents home and her work office. An annual leave request form from Letby – covered with untidily written jumbled words – was found in a blue folder of papers during the office search, the court heard. Hearts were doodled on the form along with random words “Tigger”, “Smudge”, “Bergerac” and “Help Me”. Tigger and Smudge were later revealed to be the names of rescue cats that Letby owned. Sentences scrawled across the form included “I trusted you with everything and loved you”, “I really can’t do this any more, I just want life to be as it was,” “I want to be happy in the job that I loved… really don’t belong anywhere, I’m a problem to those who do know me and it would be much easier for everyone if I just went away”. A total of 257 handover sheets were recovered during searches in the investigation, of which 21 included the names of babies in the indictment.

Only a few seconds of footage from her initial interrogation has been released to the public which you can find here:

Following her arrest, the investigation was widened to include Liverpool Women’s Hospital, another location that Lucy officially worked, but no evidence that patients at that hospital came to any harm was found. However, police are still looking in to this as they take a closer look into her entire nursing career. Lucy Letby was bailed on 6th of July 2018 as the police continued with their inquiries. She was then rearrested nearly a year later on 10th of June 2019 in connection with the original eight counts of murder and now 10 counts of attempted murder. She was denied bail this time and remanded in police custody. Lucy Letby denied every single one of the 22 charges against her and blamed the deaths on hospital hygiene and staffing levels.

The Trial

This brings us to the beginning of the 9-month long trial where Lucy Letby pleaded not guilty to 7 counts of murder and now 15 counts of attempted murder. Each of the victims were referred to as Child A to Child Q due to their ages. The secrecy in the press involving the 17 victims and 9 colleagues who gave evidence was “rarely seen outside proceedings involving matters of national security.”

The prosecutor opened with stating that Lucy Letby was a “constant malevolent presence” in the hospital’s neonatal unit and that she had even searched for the parents of several infant victims on Facebook, including sending one family a sympathy card. The prosecutor revealed that Lucy had actually injected air into the bloodstream of two of the victims and had used insulin to murder others. A mother of one of the victims stated that she had actually walked in on Lucy Letby attempting to kill her baby, with Lucy saying “trust me, I am a nurse” when caught. It was also revealed that Lucy had to be told more than once not to enter the room where the parents of one victim were grieving.

Lucy Letby’s defence team started with an opening statement that claimed she was a “dedicated nurse in a system which has failed” and that the prosecution’s case was solely “driven by the assumption that someone was doing deliberate harm combined with the coincidence on certain occasions of Lucy Letby’s presence” and that there had been “a massive failure of care in a busy neonatal unit at the hospital- far too great to blame one person.” The defence argued that “extraordinary bleeding” in a baby boy under Lucy’s care could have been caused by a rigid wire or tube and that one of the babies who survived had an “extremely high” dose of insulin. The therapeutic use of insulin was denied by all of her colleagues during the trial.

The court was shown texts sent by Lucy to her friends, one of which discussed the deaths of the babies in her care where she described it as “sad and cruel.” She continued to text “It’s heart-breaking. It’s not about me or anyone else, it’s those poor parents that have to walk away without their baby, it’s so unbelievably sad.” Lucy had also discussed with a colleague that taking baby A to the mortuary was “the hardest thing she ever had to do.”

A paediatrician testified that he and other clinicians had previously raised concerns about her but were told by hospital administration that “they shouldn’t be saying such things” and “not to make a fuss” about it. Another doctor testified that around an hour before one of her victims had even died, Lucy made the comment of “He’s not leaving here alive, is he?”

Only four days into the trial, the prosecution presented a handwritten note from Lucy Letby which read: “I am evil, I did this” and that she had “killed them on purpose” because “she couldn’t take of them.” The defence argued that the note was an “anguished outpouring of a young woman in fear and despair when she realises the enormity of what’s being said about her, in the moment to herself” and said that she had written it when she was dealing with employment issues, including a grievance procedure with the NHS trust. Several other notes from Lucy were shown in court which included her frustrations at the time of writing. One of which read “Why/how has this happened-what process has led to this situation? What allegations have been made and by who? Do they have written evidence to support their comments?” Another read: “I haven’t done anything wrong and they have no evidence so why have I had to hide away?” Both of these notes were clearly Lucy Letby releasing her frustrations with the situation she found herself in.

A big factor during trial was determining her motives for such merciless killing on multiple defenceless infants. The prosecution suggested several possibilities, including boredom, that she “got a thrill” from the events that surrounded the deaths and that she enjoyed “playing god,” The prosecution continued on with: “She was controlling things, she was enjoying what was going on. She was predicting things that she knew was going to happen.” Another possible motivation was that the killings were to gain the attention of a married doctor that she had a secret relationship with. He was one of the doctors called when a baby would be rapidly deteriorating. She denied all these suggestions, including the allegation that she was in a secret relationship.

Lucy Letby gave evidence herself to the court in May 2023, breaking down in tears and claiming she was made to feel as though she were incompetent but “meant no harm.” When questioned on the note presented by the prosecution, Lucy stated: “I felt at the time that I’d done something wrong, I must be such an evil awful person. I’d somehow been incompetent and had done something wrong which had affected those babies.” She went on to explain how her mental health has deteriorated and that it made her “question everything about herself.”

But What Did She Actually Do?

After 9 long months, the Jury was finally sent to deliberate amongst themselves on the 10th of July 2023. Verdicts were returned over several days starting on the 8th of August but none of them were made public until the 18th. Lucy Letby was found guilty of all seven counts of murder. She killed them by injecting them with air, overfeeding them, poisoning them with insulin and assaulting them with medical tools. This makes her the most prolific serial killer of children in modern British history. She was also found guilty on seven counts of attempted murder, not guilty on two counts of attempted murder and a verdict was not met on the other six counts of attempted murder she stood trial for.

Sentencing

On the 21st of August 2023, Lucy Letby was sentenced to life imprisonment with a whole life order, the most severe sentence possible under current British law; she is the fourth woman in UK legal history to receive such a sentence. Lucy did not attend the sentencing hearing which meant she did not hear the victim impact statements and her sentence. Alex Chalk, Secretary of State for Justice, stated that the government will “look into options to change the law at the earliest opportunity” to compel defendants to attend their sentencing. Lucy Letby’s parents also did not turn up for the sentencing even though they were present throughout the entire trial.

Aftermath

After her conviction, the government ordered an independent inquiry into the circumstances surrounding the murders. The Department of Health and Social Care said the inquiry would examine “the circumstances surrounding the deaths and incidents, including how concerns raised by clinicians were dealt with.” The inquiry would be non-statutory, so witnesses could not be compelled to give evidence and inquests would still be necessary. The trust’s medical director, chief executive and the nursing director at the time of the murders all commented that they would cooperate fully. The medical director, Ian Harvey, retired in August 2018.

The chief executive, Tony Chambers, resigned in September 2018 after signing a non-disclosure agreement and a guaranteed £1m pension.

Dewi Evans, a consultant paediatrician who served as a prosecution witness, has called for an investigation into the possibility of charges of corporate manslaughter in relation the Lucy Letby case.

On August 21st 2023, Alison Kelly, a senior nursing manager at the Countess of Chester Hospital at the time Lucy Letby was based there, was suspended from her job as senior nursing officer at Northern Care Alliance NHS Foundation Trust, following information that came to light during the trial. The Nursing and Midwifery Council announced that she would face an investigation into her fitness to practise. She, along with other senior managers at the hospital, have been accused of ignoring numerous warnings about Lucy Letby.