Thirlwall Inquiry: how were Lucy Letby killings able to happen?

An inquiry examining what exactly happened at the Countess of Chester Hospital during the time convicted murderer Lucy Letby worked there will begin this week.

Former neonatal nurse Letby was convicted in 2023 of murdering seven babies and attempting to kill seven others at the hospital between 2015 and 2016. She has been sentenced to multiple whole life sentences for her crimes.

What is the scope of the Thirlwall Inquiry?

The Thirlwall Inquiry is an independent public inquiry that aims to "examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital". 

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The inquiry will look into how Letby was able to carry out these crimes within the NHS hospital, as well as investigate how the NHS handled the case and its response to doctors who raised concerns. 

The inquiry, which will begin tomorrow at Liverpool Town Hall, will be chaired by Court of Appeal judge Lady Justice Thirlwall. Proceedings are expected to last four and a half months. Once the inquiry concludes, Lady Thirlwall will provide a final report with recommendations to the health secretary. 

Why was the Thirlwall Inquiry ordered?

Following Letby's conviction in August 2023, there was a public outcry and deep concern over how she was able to operate undetected. Steve Barclay, the then health secretary, ordered the inquiry, which he said would "seek to ensure the parents and families impacted get the answers they need". 

"Following on from the work already under way by NHS England, it will help us identify where and how patient safety standards failed to be met and ensure mothers and their partners rightly have faith in our healthcare system." 

What will the inquiry focus on?

While the inquiry has no power to determine criminal or civil liability, it will try to highlight where failings have occurred. The inquiry has said that its "key objectives" are to "seek answers for the victims' families and ensure lessons are learned". 

It will also "examine the wider circumstances, including the response and conduct of the NHS, its staff and its regulators", according to the inquiry's website.

The inquiry will be split into three areas, with Part A focused on exploring the "experiences of the Countess of Chester Hospital and other relevant NHS services, of all the parents of the babies named in the indictment". 

Part B will then look at the conduct of those working at the hospital, run by Countess of Chester Hospital NHS Foundation Trust, and how concerns raised by staff members about Letby were handled.

Part C will look at broader issues in the NHS, including management and governance structures, to assess if enough is being done to protect vulnerable patients like newborns while in hospital. 

Who will be involved in the inquiry?

The core participants giving evidence will include the families of Letby's victims, the Countess of Chester Hospital NHS Foundation Trust, several NHS bodies like NHS England, and key hospital staff who were in leadership roles while Letby worked at the Cheshire hospital. 

The inquiry, which was not initially given full statutory powers, was upgraded last year to have greater powers to compel witnesses to give evidence.

Why is the inquiry controversial?

Despite Letby's conviction, concerns have been raised by some medical experts and media outlets over the evidence presented at her trial. In August, two dozen scientists, medics and statisticians wrote to the health secretary, Wes Streeting, calling for the inquiry to be postponed, to "allow for further investigation and to hear wider professional concerns", said The Telegraph.

They were concerned the inquiry's terms of reference "may unintentionally deflect from multiple potential causes of neonatal deaths at the Countess of Chester Hospital and thus miss the opportunities to draw the correct wider lessons for the NHS". 

They said there were concerns over how the legal system could be "particularly vulnerable to errors when dealing with intricate scientific evidence, especially in cases involving statistical anomalies in healthcare settings, and the complex physiology of neonates".

In May 2024, The New Yorker magazine in the US published a controversial 13,000-word investigation that questioned the legitimacy of the Letby case. 

A solicitor representing the families of six Letby victims said online speculation about the safety of the nurse's conviction was "upsetting" for all of her clients. Speaking to BBC "Breakfast" this morning, Tamlin Bolton said: "I can't stress enough how upsetting that has been for all of the families that I represent."