Lucy Letby

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Lucy Letby
Letby following her arrest in 2018
Born	(1990-01-04) 4 January 1990 (age 33) Hereford, Herefordshire, England
Occupation	Neonatal nurse
Conviction(s)	Murder (7 counts), attempted murder (7 counts)
Criminal penalty	14 life sentences (whole life order)
Details
Span of crimes	2015–2016
Country	United Kingdom
Killed	7
Injured	6
Date apprehended	3 July 2018
Imprisoned at	HM Prison Low Newton

Lucy Letby (born 4 January 1990) is a British serial killer and former neonatal nurse who murdered seven infants and attempted to murder six others at the Countess of Chester Hospital between 2015 and 2016. Letby was the focus of much suspicion as the outbreak of unexpected collapses and infant deaths commenced shortly after she was qualified to work with children in the hospital's intensive care unit and was consistently on duty when each incident took place. As soon as Letby was removed from duties in June 2016, the suspicious incidents stopped.

Letby was charged in November 2020 with eight counts of murder and ten counts of attempted murder. During her trial, which lasted from October 2022 to August 2023, it was revealed that Letby's methods included injecting the infants with air or insulin, overfeeding them or physically assaulting them. She also stole over 250 confidential documents relating to the children's care to keep as mementoes of her crimes and falsified patient records to avert suspicion. A number of parents and staff members had also walked in during, or just after, Letby's attacks on victims. On 21 August 2023, Letby was sentenced to life imprisonment with a whole life order.

Letby is the most prolific serial killer of children in modern British history; the Cheshire Constabulary now suspects that she may have claimed more victims, including at Liverpool Women's Hospital, where two babies died while she was training there. Management at the Countess of Chester Hospital were criticised for ignoring warnings about Letby that could have prevented some of the killings. The British government has since announced that an independent statutory inquiry would be held into the circumstances surrounding the murders.

Early life and education

Lucy Letby was born on 4 January 1990 in Hereford, Herefordshire, the only child of a finance manager and an accounts clerk.^[1] She was educated at Aylestone School and Hereford Sixth Form College.^[1][2] She had had a very difficult birth herself and was, according to a friend who knew her since secondary school, "very grateful for being alive to the nurses who would have helped save her life".^[3]: 18:40 This, the friend states, had led her to want to be a nurse all her life and that "everything that she did was geared towards that ultimate goal of becoming a nurse".^{[3]: 18:55 [4]} Letby pursued 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 placements at Liverpool Women's Hospital and the Countess of Chester Hospital.^[1][5] Letby was the first member of her family to study at university and graduated in September 2011.^[1] A friend described her as "quite awkward and geeky".^[6]

Career

Letby began working as a registered nurse at the neonatal unit of the Countess of Chester Hospital in 2012.^[7] In a 2013 staff profile, she said 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."^[8] Letby also took part in a campaign to raise funds for a new neonatal unit at the hospital.^[9] Parents noted that Letby happily chatted about her life, such as telling them about how she was single and happy being single.^[3]: 11:20

Letby had two training placements at Liverpool Women's Hospital, in late 2012 and early 2015, which came under investigation after her conviction.^[5] In June 2016, consultants asked management to remove her from clinical duties pending an investigation into her conduct. She had previously been moved from night to day shifts in April 2016 by the unit's ward manager.^[7] Letby was transferred to the patient experience team in July 2016 and later to the risk and patient safety office, working there until her arrest in 2018.^[10]

Letby had finally qualified to work with the infants who needed intensive care in 2015, the same year the suspicious incidents began.^[11] Letby had told others that she found non-intensive care work "boring" and sought the action of the intensive care unit.^[12] When she was moved to day shifts the suspicious incidents notably moved from occurring overnight to happening in the daytime when Letby was working.^[13]

Murders

Initial investigation

An informal review conducted in June 2015 by a consultant and lead neonatologist at the Countess of Chester Hospital NHS Foundation Trust revealed troubling details regarding four unexplained collapses that occurred in the same unit. Three of these cases resulted in deaths in the same month. It was observed that Letby had been on shift on each occasion. The unit's consultants promptly reported these deaths to the trust's committee responsible for addressing serious incidents. The committee classified the deaths as "medication errors". Had they been classified as "serious incident[s] involving unexpected deaths", an immediate investigation could have taken place if they were grouped together.^[7] The numbers of unexplained collapses were particularly abnormal: there had previously been only two or three deaths a year in the neonatal unit. What was also particularly unusual was that the babies did not respond to resuscitation attempts as they would be expected to.^[3]: 23:40 Usually babies that had got a heartbeat back would see an improvement in their breathing, but that did not happen in these cases, which was distinctly unusual.^[3]: 23:45 A misconception of the later Senior Investigating Officer on the case, Detective Superintendent Paul Hughes, was that sick babies on such a ward for vulnerable patients could collapse at any moment; in fact baby collapses are usually expected beforehand. On the rare occasions when a collapse is not predicted, a medical explanation can usually be found, unlike in this case.^{[14][14]: 6:15}

In October 2015, a ward manager conducted her own review, noting that Letby was the only staff member consistently present throughout these incidents of unexplained collapses and deaths. These findings were relayed to the lead neonatologist. Further concerns were voiced to management by the unit's consultants that same month; concerns were either resisted by the Trust Executives or ignored.^[10][15] In February 2016, the lead neonatologist, along with other consultants, concluded a thematic review investigating five unexplained deaths and collapses within the unit. Their investigation determined that the only common factor in these cases was the presence of Letby. The lead neonatologist communicated the findings via an "urgent" email to the trust's medical director leading to an eventual meeting in May 2016.^[16] However, no substantial action was taken, as the executive team deemed it to be coincidental.^[7][16]

Reports by the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK project (MBRRACE-UK) found a neonatal death rate at least 10% higher than expected between June 2015 and June 2016. Additionally, the neonatal death total in 2015 doubled that of the previous year.^[17][18][19] The mortality rate had risen above what might be considered 'normal' rates.^[20] During a hospital visit in February 2016, The Care Quality Commission (CQC) was informed of difficulties in raising concerns with managers, but heard no mention of 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 "[s]taff felt well supported, able to raise concerns and develop professionally."^[10]

On 24 June 2016, following the deaths of two triplet babies on that day and the previous day, the lead neonatologist phoned the duty executive demanding that Letby be removed from the unit. The duty executive insisted that Letby was safe to work and that she was "happy to take responsibility" if anything happened to any more babies under Letby's care.^[16][15] In late June 2016, the trust's executive directors convened to address a critical decision: whether to involve law enforcement. By this time, seven unexpected deaths had taken place within the unit. The belief among these executives was that the indications of Letby's involvement were largely circumstantial and they suspected certain doctors of embarking on a misguided "witch hunt". Moreover, they were concerned about potential harm to the Trust's reputation resulting from a police inquiry. Ultimately, they opted against engaging the police.^[7] The medical director and chief executive instead organised a review 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,^[7] no longer accommodating premature births before the 32-week mark. Such cases were redirected to other hospitals in the North West of England, such as Alder Hey Children's Hospital.^[21]

The trust set a narrow scope for the review that excluded investigating Letby's actions or the deaths, but instead focused on the unit's general service. The RCPCH reported their findings to the medical director and chief executive in October 2016.^[7] They could not find a definitive explanation for the increase in mortality rate at the unit but found some insufficient staffing and senior cover. The report recommended a detailed case review of each death. The medical director asked neonatologist Jane Hawdon from Great Ormond Street Hospital to carry out the case reviews. Hawdon responded she could not conduct a detailed review because of lack of time but could provide a summary and did so after briefly reviewing the notes. She identified four cases that "potentially benefit from local forensic review as to circumstances, personnel etc".^[7][10][22] The board's chair at the time, has said that he was misled about the scope of that review and its findings.^[23] Despite the thorough external independent review recommended by the RCPCH or the forensic review recommended by Hawdon, records of the hospital board meeting show medical director telling board members that the RCPCH and Hawdon reviews concluded that the deaths in the neonatal unit were due to issues with leadership and timely intervention.^[15]

In September 2016, Letby raised a formal grievance about her late June 2016 transfer from clinical duties to the hospital's risk and patient safety office.^[15] 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 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 intention was to "protect Lucy Letby from these allegations".^[7][10][24] The chief executive had met with Letby and her parents on 22 December 2016 to apologise on behalf of the trust and assure them that the doctors who made the allegations would be "dealt with".^[7] He later ordered the consultants to send a letter of apology to Letby, which they did in February 2017.^[24][25]

In March 2017, consultants asked management to involve the police after receiving advice from the regional neonatal lead, who suggested further investigation was needed.^[10] They then met with Cheshire Constabulary on 27 April 2017, to raise their concerns, with Letby due to return to work on 3 May 2017.^[25] The trust publicly announced the involvement of the police in May 2017, stating this move was to "seek assurances that enable us to rule out unnatural causes of death."^[10][26] The police's investigation was called Operation Hummingbird.^[27] Senior Investigating Officer Paul Hughes later said: "the initial focus was around the hypotheses of what could have occurred: so generic hypotheses of 'it could be natural-occurring deaths', 'it could be natural-occurring collapses', 'it could be an organic reason', 'it could be a virus', and then one of the hypotheses was that, obviously, it could be inflicted harm."^[20]

Timeline of cases

The first suspicious case occurred on 8 June 2015.^[20] At 8 pm a healthy baby boy – a twin – was being cared for in nursery 1 on the ward and the designated nurse was Letby.^[20][28] The boy had been handed over to Letby after she started her night shift, with the paediatric registrar having clocked off and by this point Letby was 30 minutes into her shift.^[20][28][29] 26 minutes later she called a doctor with the baby's state rapidly deteriorating. The baby died half an hour later, less than 90 minutes into Letby's shift.^[20] The paediatric registrar later testified that when she heard about the death of the child the next day after returning to work that it was a "big surprise" and "completely out of the blue and very upsetting. [He] showed no signs of any problems throughout the day. He was handling well. I had no concerns at all for him or his twin sister".^[29] A fellow nurse said that when the baby started deteriorating she saw Letby standing over the infant's incubator and she originally did not intervene. However, the nurse then did when she realised he was not recovering under Letby's care.^[29] Doctors attending the scene said that Child A developed an unusual blue and white mottling on his skin after collapsing, which they said they had never seen before.^[30] This symptom later occurred in other babies that were believed to have been intentionally injected with air.^[30] The day after Child A's death, Letby searched for his parents on Facebook.^[30]

About 28 hours after Child A's death, his twin sister, Child B, also inexplicably collapsed and had to be resuscitated.^[28] After Child A's death the parents had spent the day with Child B in the nursery with her, but were persuaded to go and rest before the baby's sudden crash.^[30] Tests later showed loops of gas-filled bowel in the child.^[28] As a result, it was later concluded that the baby had been injected with air.^[28] Letby had fed the baby 25 minutes before their collapse and the child had the same unusual rash on her skin as first seen on Child A only hours earlier, indicating that it had also been injected with air.^[30]

A few days later, Child C, a boy in good condition, died.^[28] He suddenly collapsed as soon as another nurse left the nursery.^[30] Despite not being the designated nurse for the child, Letby was witnessed standing over his monitor as his alarm sounded when the other nurse came back in.^[28][30] Letby's shift leader had already told her to focus on her designated patient and the shift leader later testified that she had to keep pulling her away from the family room as Child C died.^[30] His parents later recalled a nurse they believe was Letby brought a ventilator basket in and said, even though their child was not dead, "You've said your goodbyes, do you want me to put him in here?".^[31]

On 22 June 2015, baby girl Child D collapsed three times in the early hours and died.^[28] Those who attempted to save the child noticed the girl's skin had been discoloured.^[28] A post-mortem X-ray showed a 'striking' line of gas in front of the spine, consistent with air being injected into the bloodstream.^[32] A doctor later testified that such a finding could not be explained by natural causes.^[33] The mother had noted Letby "hovering around" the family hours before the baby collapsed.^[30]

On 2 July, a doctor raised his concerns over the sudden collapses and deaths.^[28] No action was taken against Letby.^[28] The suspicious cases stopped for a month.^[28] On 4 August 2015, a mother walked into the unit to give her baby boy, Child E, his milk, only to find Letby apparently in the process of attacking the child.^{[28][3]: 3:15} She found the baby distressed and bleeding from the mouth, with Letby standing nearby "faffing around, not doing anything" and wanting "to look busy but not actually doing anything".^{[30][3]: 3:30} The boy later died after suffering a fatal bleed, which was believed to have been the cause of death as well as the injection of air.^[28][34] Flecks of blood were found in his vomit.^[35] The next evening, Child E's twin brother Child F was being cared for in nursery 2, the same room in which Letby was looking after another infant.^[20][28] At 1:54 am Child F suffered an unexpected drop in his blood sugar and saw a surge in his heart rate.^[20] This child survived and a blood test later revealed that he had been given an "extremely high" amount of exogenous pharmaceutical insulin which he had never needed.^[20][28] No baby on the unit had been prescribed insulin at the time and so there was no reason why the baby should be given it.^[20] The insulin was kept in a locked fridge next to a nurses' station.^[20] Later, at trial, Letby did not contest that the baby had been intentionally injected with insulin, suggesting someone else must have done it.^[30] Letby searched for the parents of Child E and F on social media in the following weeks and months.^[36]

At this point the lead consultant made his feelings known that he wasn't happy with Letby working on the unit, but this was dismissed.^[20]

7 September 2015 was the 100th day of Child G being alive and the nurses had put up banners and made a cake for her parents to mark the day.^[30] On that same day the child collapsed and did so again on two other occasions in the following three weeks.^[28] After the first collapse, the baby girl was taken to Arrowe Park Hospital, but five days later she collapsed again, 15 minutes after Letby had been feeding her.^[28] The child survived, but is now severely disabled as a result of what happened to her.^[28] The baby was witnessed projectile vomiting, so massively that it reached the chair next to the cot and canopy which an attending doctor said he had never witnessed before.^[37] Her heart rate and oxygen levels also dropped to unusually low levels.^[37] The doctor said that he could not find a natural cause for the drastic vomiting.^[37] Later, at trial, an expert witness doctor concluded that the only viable explanation for the baby vomiting so extraordinarily was if it had received far more milk than that allocated down her feeding tube and that this could not happen accidentally.^[37] It was later discovered that Letby had deliberately altered the baby's temperature on her observation chart to make it seem like it was already unwell before it collapsed, and she also falsified the time of the baby's collapse to make it seem like it coincided with when a colleague gave the baby a milk feed.^[30] A nurse noticed when she arrived after Letby's cry for help after one of the girl's collapses that the machine connected to the baby to measure its oxygen saturations and heart rate levels had been turned off.^[30] A colleague had also noticed that Child G's initial collapse occurred on the exact day she was originally due to be born.^[38]

About six weeks after Child G's multiple collapses, Child I died on 23 October 2015.^[28] This was the fourth time the baby girl had collapsed.^[28] On the fourth collapse, Letby was found next to her incubator by another nurse.^[39] It was the parents of this child to which Letby later sent a sympathy card to on the day of its funeral, a card which Letby kept photos of on her phone.^[28][20][40] Letby also wanted to go to the funeral.^[41] Twice the baby was found to have excess air in her stomach which had affected her breathing.^[39] Before the second collapse, Letby had suspiciously said to a colleague that Child I 'looked pale', even though it would have been hard to see from where they were standing in a doorway looking into the darkened nursery.^[30] Then, when the designated nurse for the child turned the light on, she saw the girl was not breathing.^[39] The child's mother later said Letby 'smiled' as she bathed her dead daughter and offered to take a photo of the dead child.^[30][42] A doctor had seen unusual skin mottling on Child I's skin and X-rays showed the child had a massively enlarged stomach that was consistent with her having been deliberately injected with air.^[43][44] Letby later searched for Child I's mother on Facebook.^[42]

Later on 23 October, the hospital management was alerted to the concerns of the doctors on the unit.^[28] They are told to "not make a fuss".^[28] Staff reviews were carried out which highlight that Letby was always on duty for the suspicious incidents and in February 2016 a doctor requested an "urgent" meeting with executives, but no meeting occurred until May 2016.^[28]

At 11:26 pm on Christmas Day 2015, Letby searched on Facebook for the parents of the twins, Child E and Child F.^[45][36]

By April 2016 Letby had been moved to day shifts because of the concerns about her and the suspicious collapses duly began occurring in the daytime.^[30] On 9 April 2016, two twin brothers suffered sudden collapses within hours of each other.^[28] Tests found that Child L inexplicably had insulin levels in his blood "at the very top of the scale that the equipment was capable of measuring".^[28] Hours later twin brother Child M's heart rate and breathing suddenly dropped and he nearly died.^[28] Experts say that Child M's heart was likely caused by air being injected into his bloodstream.^{[46][46]: 3:00} Although he lived, the child now suffers from brain damage.^[28] It is noted that the collapses of Child L and M occurred in almost identical circumstances to Child E and F.^[30] Both were twins where one was believed to have been injected with insulin and the other with air.^[30] Child F had survived his injection of insulin and it was noted that Child L had been injected with twice the dose of insulin, the suggestion being that Letby had done so to ensure death on this occasion.^[30]

The meeting about the suspicious cases took place on 11 May 2016, but no action was taken.^[28]

A month later, Child N nearly died after suffering trauma to the throat.^[28] Doctors saw blood and "unusual" swelling at the back of his throat upon examination.^[47] The baby had been heard randomly 'screaming'.^[48] Child N's father said he then saw blood spattered around his son's mouth.^[49]

The final two cases occurred within hours of each other on 23 and 24 June 2016 respectively.^[28] The two children involved were triplets, siblings of each other and the cases occurred on Letby's first shift back after she had returned from a trip abroad to Ibiza and after Letby texted a colleague saying she would "be back with a bang".^[30][28][50] Child O, a "perfect" healthy baby, was due to be discharged home, but then suddenly collapsed on 23 June.^[28] When the child initially became unwell another nurse suggested he be moved to nursery 1 where the sickest children were treated, but Letby disagreed and the baby subsequently collapsed less than two hours later.^[20] He recovered, but suffered two further collapses and died almost exactly three hours later.^[20] The lead consultant noted that the child "should have responded better" to resuscitation.^[20] X-rays on a post-mortem showed he had an abnormal amount of gas in his body and he had liver damage that an independent pathologist would later rule had resulted from an "impact injury" similar to what would be seen in a car crash.^[30][28] 13 minutes after Child O's death, Letby was feeding his triplet brother Baby P, who also was expected to be able to soon go home, but he then collapsed after his diaphragm was somehow shattered.^{[28][46]: 4:40} Doctors attempted to recover him by preparing him to go to another hospital and Letby then remarked "he's not leaving here alive, is he?".^[28] The boy soon died.^[28] X-rays likewise showed an inexplicable amount of gas inside the baby.^[51] These deaths have been described as "exceptional" and the "tipping point" when the consultants realised that "drastic" action needed to be taken.^{[46]: 4:40 [46]: 12:35} A consultant allowed the surviving triplet to be taken to a different hospital by medics who had turned up to take Baby P (which had been expected to live).^[30] The consultant said she allowed this after her parents had begged for it, as she now felt Letby was a "mortal danger" to the surviving triplet.^[30] Before the second triplet had died, Letby had texted a doctor saying she would "be watching them both [Child P and the surviving triplet] like a hawk" and said "I'm OK. Just don't want to be here really. Hoping I may get the new admissions".^[51]

Three weeks later, in July 2016, Letby was removed from duty and the suspicious collapses stopped.^[3]: 26:00

Prosecution and conviction

Arrest and charges

On 3 July 2018, Letby was arrested by police on suspicion of eight counts of murder and six counts of attempted murder, following a year-long investigation.^[52] Letby's home at Chester was searched by police following her arrest.^[53] After Letby's arrest the investigation was widened to include Liverpool Women's Hospital, another location at which Letby had worked. Police have begun looking into Letby's entire career, including at Liverpool Women's Hospital, since her conviction.^[22][54][55]

Letby was bailed on 6 July 2018 as the police continued their inquiries.^[56] Time had to be taken to review the unexpectedly large amount of document evidence found in Letby's home.^{[14]: 20:45} In her diaries were found what appeared to be a code of coloured asterisks that marked significant events in the investigation.^{[14]: 22:18} She was rearrested on 10 June 2019 in connection with eight said murders and nine said attempted murders of babies,^[57] and again on 10 November 2020.^[58][59] She was bailed in 2019 as more time was needed to get evidence together to make sure it was as strong as possible before charges could be brought.^{[14]: 24:52} There were thousands of exhibits in the investigation, 16,571 of which were not even used as evidence and some of the items were themselves thousands of pages long.^{[14]: 37:30} The 2019 arrest and bailing had been made as by this time three further cases of attempted murder had been identified which investigators needed to question Letby further on and as Letby had been found to have written extensively about the case on her 2018 arrest, detectives wished to see whether she had written anything further in the year while she was under investigation.^{[14]: 21:30} The key aspects of the investigation, which has been described as 'painstaking', were, according to Senior Investigating Officer Paul Hughes, "always asking ourselves a) who else could it be, if not her, and what else could it be?".^[20]

On 13 March 2020, Letby was placed on an interim suspension by the Nursing and Midwifery Council.^[60]

On 11 November 2020, Letby was charged with eight counts of murder and 10 counts of attempted murder.^[59] She was denied bail and remanded in police custody.^[61] The Crown Prosecution Service were convinced to approve all of the charges Cheshire Constabulary requested against Letby after it reviewed the evidence the force collected against her.^{[14]: 30:30}

Letby denied all 22 charges against her, blaming the deaths on hospital hygiene and staffing levels.^[62]

On 18 August 2023, Andrea Sutcliffe, Chief Executive and Registrar of the Nursing and Midwifery Council, stated that Letby "remains suspended from our register, and we will now move forward with our regulatory action, seeking to strike her off the register".^[63]

Trial

Letby's trial began at Manchester Crown Court on 10 October 2022 before Mr Justice Goss.^[64][65] She pleaded not guilty to seven counts of murder and 15 counts of attempted murder.^[66] Letby's parents and the families of the victims attended the trial.^[67][68]

The child victims were referred to as Child A to Child Q.^[69] The press secrecy around the identities of the 17 babies and nine colleagues who gave evidence was "rarely seen outside proceedings involving matters of national security."^[70] Two years before the criminal trial, Mrs Justice Steyn banned the identification of the living victims until their 18th birthdays. Parents wanted their identifying information to be protected, though Steyn J ruled that one parent's profession as a physician was relevant because of his medical expertise and that it would not make that parent identifiable to the public. Several witnesses requested anonymity, including a doctor with whom Letby was reportedly infatuated. The judge approved these requests, ruling that getting testimony from the colleagues was more important than them being publicly identifiable.^[70]

The prosecutor said that Letby was a "constant malevolent presence" in the hospital's neonatal unit.^[66] There were witnesses that had apparently walked in during, or just after, Letby's attacks. A mother of one of the victims said she had walked in on Letby trying to kill her baby, with Letby saying "Trust me, I'm a nurse" when interrupted.^[71] Another mother had walked in hearing her baby screaming, to find her child had blood around his mouth with Letby in the room.^[3]: 3:30 The mother said that, despite the obvious distress the baby was in, Letby was just "faffing about, not really... not doing anything. You know when it feels like somebody wants to look busy but they're not actually doing anything?".^[3]: 3:40 Letby told the mother to go back to the ward.^[3]: 4:35 However, the baby's condition soon worsened and it later died in its parents' arms.^[3]: 5:15 No post-mortem was carried out, which might have shown what Letby had done.^[3]: 6:35 Afterwards, Letby bathed the deceased baby in front of her parents.^[3]: 6:50 Another mother of a baby, who had died in October 2015, recounted an uncomfortable experience of Letby bathing her child, recounting: "Lucy Letby and another nurse asked me if I wanted to bathe my baby. While we were bathing her, Lucy came back in. She was smiling and kept going on about how she was present at the first bath and how our daughter had loved it. I wished that she would just stop talking".^[3]: 13:30 Letby's apparent obsession with this baby and her family later continued; she sent a sympathy card to the parents after the baby's death on the day of its funeral.^{[3]: 13:55 [72]: 16:25} Upon Letby's arrest it was found on her phone that she had photographed the card before she sent it and had still kept pictures of it.^[20][40]

Police had discovered during their investigations that Letby had sent texts to others after each of the deaths.^[3]: 12:40 She asked one: "how do such sick babies get through & others just die so suddenly & unexpectedly?".^[3]: 12:50 In another, sent on 9 April 2016 during a day shift after two twin boys, Child L and M, had collapsed, she wrote: "Work has been shit but... I have just won £135 on Grand National!!! Unpacking party sounds good to me with my flavoured vodka".^[11] On 22 June 2016, on the evening before her return to work following a holiday in Ibiza, she texted: "Probably be back in with a bang".^[11] Notably, on her first shift back that next day, Child O was murdered.^[11] The texts were seen as important as they sometimes appeared to be a live blogging of events.^[13] Letby had also told a colleague that taking Child A to the mortuary was "the hardest thing she ever had to do".^[73][74] Letby had also searched for the parents of several infant victims on Facebook, in one case on the anniversary of a baby's death.^{[3]: 45:40 [75]} In total Letby had searched for 11 of the families affected.^[20] When police had asked her why she had searched up the parents of Child O on the anniversary of its death, she had responded that she "could not explain why she would be doing it".^[76] The prosecutor asserted Letby had injected air into the bloodstream of two victims and had used insulin to murder others. It was also revealed during the trial that Letby had to be told more than once not to enter a room where the parents of one of the victims were grieving.^[77] Letby said, "It's always me when it happens."^[3]: 15:35

Letby's defence lawyer said that Letby was "a dedicated nurse in a system which has failed," and that the prosecution's case was "driven by the assumption that someone was doing deliberate harm combined with the coincidence on certain occasions of Miss Letby's presence," and that there had been a "massive failure of care in a busy hospital neonatal unit – far too great to blame on one person."^[78] The defence argued that "extraordinary bleeding" in a baby boy murdered by Letby could have been caused by a rigid wire or tube.^[79][80] The therapeutic use of insulin was denied by Letby's colleagues.^[81] No baby on the unit was being prescribed insulin and so there was no reason why any baby should have been given it.^[20] The insulin was kept in a locked fridge next to a nurses' station.^[20]

A key piece of evidence was also given by a consultant who recounted that in February 2016 he had walked in and seen Letby standing over a baby and watching when they seemed to have stopped breathing.^[3]: 22:45 Letby was not doing anything despite the baby desaturating.^[3]: 22:55 When he asked her what was going on, she responded that he had only then just started declining.^[3]: 23:05 This baby went on to survive their collapse.^[3]: 23:20 By this stage all seven of the paediatrician consultants who worked on the neonatal ward agreed something was seriously wrong in the department.^[3]: 23:25 The deaths and near-deaths that were happening on the unit could not be medically explained.^[3]: 24:30 All the babies involved had been expected to live and so their deaths came out of the blue.^{[72]: 11:17} Previously, in the majority of times the premature babies had collapsed it had already been expected and in the very rare cases it was not already expected it could still be medically explained, unlike in all of these cases.^{[72]: 11:30} A paediatrician testified that he and other clinicians had previously raised concerns about Letby, but were told by hospital administration that they "should not really be saying such things" and "not to make a fuss." Another doctor testified that Letby commented an hour before one victim died, "He's not leaving here alive, is he?"^[82][83][84]

Between March and June 2016 another three babies almost died while under Letby's care.^[3]: 26:00 Towards the end of June, she was helping to care for triplets.^[3]: 26:05 One died at 6 pm one evening and peculiarly another of the triplets died less than 24 hours later, both under Letby's watch.^[3]: 26:10 Both of them had been in very good health and the deaths on consecutive days were causing staff considerable distress and shock, with the notable exception of Letby, who merely told one consultant that she would be back on shift the next day when she was asked if she was upset after the events of the two days.^[3]: 26:25 This was not the first time that twins/triplets had collapsed within 24 hours of each other while under Letby's care, as two twins had experienced collapses on consecutive days in August 2015.^[3]: 37:00 Only hours after one of the twins had died that month, the other became seriously unwell and it was only during the police investigation and after analysis of a blood sample that it was found that someone had intentionally poisoned the baby with insulin.^[3]: 37:05 This evidence had been missed for two years.^[3]: 40:35 The insulin, which had not been prescribed to the child, was identifiable as exogenous pharmaceutical insulin as C-peptide would be present in the specimen if the insulin had been produced by the baby^{[3]: 39:45 [28]} Laboratory analysis also showed that 'Baby L' had been poisoned with insulin.^{[72][72]: 9:40 [85]} This was also significant as only hours later his twin brother, 'Baby M', inexplicably collapsed while under Letby's care but managed to survive after thirty minutes of resuscitation.^[72]: 9:40 It was believed that Letby had injected air into the latter's bloodstream.^[85] The prosecution also noted that, although by this point she was not supposed to work night shifts, Letby was caring for Child L as she specifically volunteered to do an extra shift to care for it, the prosecution arguing that she had seen an opportunity here to kill Child L where she had failed previously with Child F.^[39] Letby herself accepted at trial that the results showed that some victims had been deliberately injected with insulin and did not contest that someone must have administered it to them.^[86] The night after Letby tried to murder Child F she went salsa dancing.^[87]

Although the consultants made their desire to have Letby removed from duties known to hospital staff after the triplet incident, this was refused and the next day another baby almost died under Letby's care.^[3]: 26:20 As well as in the two cases in which insulin poisoning had been proved, evidence provided by medical experts indicated that all the babies had been harmed intentionally.^[3]: 42:05 This evidence was given by experts specialising in areas of paediatric radiology, paediatric pathology, haematology, paediatric neurology and paediatric endocrinology, with two main medical experts who were consultant paediatricians.^[88] Letby was the only staff member on duty for every one of the 25 suspicious incidents.^[3]: 43:00 As soon as she was removed from duty, the suspicious incidents stopped.^[3]: 26:10 Importantly, it was discovered that Letby had falsified patient records, covering her tracks by changing the times some babies collapsed to make sure she could not be placed at the scene.^{[72]: 16:00} Criminal psychologist Dr David Holmes states that the varied methods she used to attack her victims, such as insulin and air injections and overfeeding milk, would all have been specifically chosen as things that would dissipate and not be easily detected afterwards.^{[89]: 34:10}

On the fourth day of trial, the prosecution presented a handwritten note from Letby which said "I am evil, I did this," and that she "killed them on purpose" because she "couldn't take care of them."^[90] It further stated "I killed them" and "I'll never marry or have children, I'll never know what it's like to have a family".^{[3]: 46:00 [91][6]} The defence argued that the note was "the 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 Letby had written it when she was dealing with employment issues, including a grievance procedure with the NHS Trust. Several other notes from Letby were shown in court, two of which said, "Why/how has this happened – what process has led to this current situation? What allegations have been made and by who? Do they have written evidence to support their comments?" And, "I haven't done anything wrong and they have no evidence so why have I had to hide away?", both of which were Letby expressing frustration about not being allowed back to work in the neonatal unit.^[92] However, police had also discovered that Letby had secretly kept medical documents at home relating to the care of the children.^[3]: 44:00 257 confidential hand-over sheets, resuscitation sheets and blood gas readings were taken from the hospital and it was later concluded that she'd kept these as some sort of trophy, with her trial judge stating that she had kept these as 'morbid records' of her murders.^{[72]: 12:40 [20][46]: 7:00} The sensitive documents, which should never have left the hospital, contained the names of the babies and the documents had been stuffed and hidden away in shopping bags under her bed.^{[20][14]: 24:15 [46]: 7:00} One note of medications given to a baby boy who had managed to survive after being on the brink of death, written on a paper towel, was found under Letby's bed.^[11] Letby claimed at trial that she had no means of destroying the confidential notes, yet the court heard a paper shredder which could have done so was found in her home.^[20] Her diary was also found to be marked with the initials of the babies she killed on the exact days they died.^[46]: 7:29 It was within this diary that the note that stated "I am evil I did this" was tucked inside.^[46]: 7:36 Furthermore, more notes were discovered that contained phrases such as "I'm sorry that you couldn't have a chance at life" , "I don't want to do this anymore", "how can life be this way?", "hate my life" and "help" in capital letters.^[20][93] The prosecution said the notes were evidently confessions of guilt, rather than just the words of a woman in "distress".^[20] These notes and documents had been found in searches of Letby's home in Chester and of her parents' house in Hereford.^[20]

Letby herself gave evidence 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."^[94] When asked why she wrote the "I am evil, I did this," Letby said, "I felt at the time that if 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."^[95] Letby said that the allegations had negatively impacted her mental health, saying, "I don't think you can be accused of anything worse than that. I just changed as a person, my mental health deteriorated, I felt isolated from my friends on the unit. From a self-confidence point of view, it made me question everything about myself." It was observed that Letby eventually began to lose her composure in the witness box, asking for a number of unplanned breaks.^[3]: 51:00 It was also observed that she only broke down when talking about herself and the impact it had on her, which the prosecution said was "telling".^{[72]: 15:00} She had not shown any emotion in relation to the fate of the babies.^{[72]: 15:05} It was also noted that she repeatedly contradicted herself, muddled up her story and became more and more frustrated with the prosecution's questions, which was unlike her usual calm demeanour.^[96]

Verdicts and sentencing

On 10 July 2023, after a nine-month trial, the jury was sent to deliberate.^[97] Verdicts were returned by the jury on several days starting on 8 August, but it was not until the final verdicts were returned on 18 August that the verdicts were made public.^[98]

Letby was found guilty of seven counts of murder of seven babies. She killed them by injecting them with air, overfeeding them, poisoning them with insulin and assaulting them with medical tools. She is the most prolific serial killer of children in modern British history.^[62][99]

Letby was also found guilty of seven counts of attempted murder of six infants. Letby was found not guilty on two counts of attempted murder.^[62] The jury was unable to reach verdicts on six further attempted murder charges.^[62] Nicholas Johnson KC asked the court for 28 days to consider whether a retrial would be sought for these six counts.^[100]

On 21 August 2023, Letby was sentenced to life imprisonment with a whole life order, the most severe sentence possible under English law; she is the fourth woman in UK legal history to receive such a sentence.^[101] Goss said that Letby committed "a cruel, calculated and cynical campaign of child murder involving the smallest and most vulnerable of children." In closing, he stated, "there was a deep malevolence bordering on sadism [...] you [Letby] have no remorse [...] there are no mitigating factors [...] the offences are of sufficient severity to require a whole life order."^[102][103]

Letby opted^{[72]: 18:50} not to attend the sentencing hearing and as such heard neither the various victim impact statements which were read out, nor her sentence being passed.^[104][105] In response, Alex Chalk, Secretary of State for Justice, wrote that the government will "look at options to change the law at the earliest opportunity" to compel defendants to attend their sentencing.^[106] Letby's parents, who had been present throughout her trial, also did not attend her sentence hearing.^[107] On 30 August 2023, Prime Minister Rishi Sunak announced that the UK government would introduce legislation to Parliament that would compel convicted criminals to attend their sentencing hearings, by force if necessary, or face the prospect of more time in prison.^[108]

After the trial, Lucy Letby was transferred to HMP Low Newton, a closed prison for women in County Durham.^[109]

Appeal

On 15 September 2023 the Court of Appeal Criminal Division confirmed that Letby had lodged an appeal against all her convictions.^[110][111]

Retrial

A hearing to decide on a retrial for six outstanding counts of attempted murder has been set for 25 September 2023.^[111]

Motives

During Letby's trial, the prosecution suggested several possible motives for the killings including boredom, that she "got a thrill" from the events surrounding the deaths and that she enjoyed "playing God". The prosecution told the jury that "[s]he was controlling things. She was enjoying what was going on. She was predicting things that she knew was going to happen." Another possible motivation suggested by the prosecution was that the killings were to gain the attention of a married doctor with whom Letby allegedly had a secret relationship. She had texted this doctor 'non-stop' during some night shifts, minutes before attacking babies.^[3]: 14:30 He was one of the doctors called when a baby rapidly deteriorated. Letby denied all these suggestions, including the allegation that she had a relationship with the married doctor.^[112] However, upon the notes that were found in Letby's home in police searches were declarations of love for the colleague.^[93] Some of the notes read "I trusted you with everything and loved you", "you were my best friend" and "please help me".^[113] During her trial it was noted that Letby broke down for the first time only when this doctor who she allegedly had a crush on gave evidence and she tried to leave the dock without permission at this point.^{[72]: 14:30} When questioned why she did this Letby said she had "felt unwell" and when questioned, she claimed she "didn't know" what 'go commando' meant, even though the doctor she allegedly fancied had sent it to her in an apparently flirtatious text, to which she replied to with laughing emojis.^[114]

The Guardian, in its reporting after the verdict, said that "[t]he closest the prosecution had to a confession" were post-it notes found in Letby's handbag after her arrest. The notes bore hand-written jottings, one of which read, "I killed them on purpose because I'm not good enough to care for them." During the trial Letby denied this was a confession and that it was merely a reflection of her mental turmoil written while she was being investigated.^[112] The Telegraph also noted though that she had also suggested another motivation was her fear of never finding love or having children of her own, writing on the note: "I'll never marry or have children, I'll never know what it's like to have a family".^[6][91]

A former detective superintendent, the lead detective on the Beverley Allitt case of the 1990s, said that the amount of parallels between the cases made him think that "it's almost as if somebody's read the Allitt book" and that Letby's crimes may have been copycats.^{[72]: 17:30} Allitt had attacked over a dozen infants in her care while working as a nurse in Grantham, England, and the methods used in the cases were apparently identical, with Allitt having also injected some victims with air and insulin and physically assaulting them.^{[72]: 17:30} It was believed that Allitt may have been motivated by what was then called Munchausen's by proxy, in which she harmed others to gain attention for herself and it may be that this also explains Letby's attacks.^{[72]: 18:00} Criminal psychologist Dominic Wilmott subscribes to this theory, commenting: "She wants to be involved in this case. She actually has the perfect opportunity not to be, right? So we expect most offenders to not want to get caught and to distance themselves from their offending behaviour. Beverley Allitt and Lucy Letby seemed to be injecting themselves into the inquiry, into the circumstances, so it shows that there's something else going on here".^{[72]: 18:10} Just like in Letby's case, the hospital in Allitt's case was criticised for its slow speed of response.^[115] Fellow criminal psychologist Dr David Holmes agrees that Letby was motivated by Munchausen's.^[89]31:15 Criminologist David Wilson agrees that in Letby's case, Letby seemed to have a "hero complex".^[115] Witnesses had testified that Letby indeed looked for action, saying she found the less non-intensive care of babies "boring" and always wanted to be treating the most serious cases in the intensive care unit.^[12]

According to Wilson, healthcare killers like Letby "[have] already developed the desire to kill before they join the healthcare setting".^[115] Speaking on Newsnight, he said: "If you want to kill, of course you are going to identify people who are vulnerable. People whose deaths won't be noticed. And so guess what? The people that serial killers target, by and large, are older people, or they target very very young people, specifically in a neonatal unit in this case, where again small babies with chronic underlying healthcare where their deaths won't be commented upon or seen as being suspicious".^[115]

Post-conviction

Further investigations

Following the verdict, it was reported that police were investigating whether Letby harmed other babies. There was a continuing investigation of suspicious incidents at the Countess of Chester Hospital involving around 30 other infants. Altogether, the records of 4,000 children are being looked into.^{[72]: 24:55} Although the jury was only asked to consider seven murder charges against Letby, there were a total of 13 baby deaths on the neonatal unit in Letby's final year working there and Letby was on duty for all of them.^[3]45:45 Since Letby stopped working at the Countess of Chester Hospital, there has only been one death in seven years in the unit, which has not since cared for such sick babies.^[3]: 55:45 Even when it had cared for these sick babies, the ward had usually only seen two or three deaths a year.^[3]: 7:25

Letby also worked at Liverpool Women's Hospital from 2012 through 2015 and police are investigating all neonatal admissions at that hospital during that time. Notably, two babies died while Letby was training there.^[3]: 55:05 The families of several babies have been told that their child's birth at the hospital is within the scope of the investigation.^[116][117] Cheshire Police have said that further charges could "possibly" be brought against Letby as a result of these further investigations.^[3]: 55:20

Independent inquiry

After Letby's conviction the UK government ordered an independent inquiry into the circumstances surrounding the murders.^[118] 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."^[119] It was affirmed that 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 they would fully cooperate with the inquiry.^[120][7] The medical director retired in August 2018 and the chief executive resigned in September 2018 after signing a non-disclosure agreement.^[7]

Slater and Gordon, a law firm representing two of the victims' families, issued a statement calling for the inquiry to have the power to compel witnesses to participate, since a non-statutory hearing "must rely on the goodwill of those involved to share their testimony."^[121] The need for a statutory inquiry was a view echoed by, among others, Sir Robert Buckland, former Secretary of State for Justice,^[122] Samantha Dixon, MP for the City of Chester,^[121] Steve Brine, chair of the House of Commons Health and Social Care Select Committee,^[123] Sir Keir Starmer, Leader of the Opposition.^[124] and the Parliamentary and Health Service Ombudsman.^[125]

The education minister Gillian Keegan said that the type of inquiry would be reviewed after the chair was appointed.^[126][127] On 30 August 2023, Health Secretary Steve Barclay announced that the inquiry had been upgraded to a statutory inquiry, describing it as the best way forward and meaning that witnesses would be compelled to give evidence.^[128] Lady Justice Thirlwall will chair the inquiry.^[129]

Calls for regulation and reform

The British Medical Association, which represents doctors, called for a process for NHS managers and healthcare administrators to be held accountable for mismanagement, in a similar way to how the General Medical Council may strike off doctors who harm patients.^[130] A neonatal consultant who alerted administrators about his suspicions about Letby also called for regulation of healthcare management.^[131]

The Parliamentary and Health Service Ombudsman Rob Behrens, called for radical change to NHS management in order to prevent future similar occurrences.^[132][133]

Doubt about conviction

Richard D. Gill, a retired professor of statistics from Leiden University, has raised doubts about the verdict, pointing out that Letby was not present at all deaths on the unit. Gill had previously participated in the campaign to free Lucia de Berk, and wrote a report for the Royal Statistical Society on medical professionals falsely convicted of murder.^[134]

The Telegraph reported that some people have attempted to spread doubt and conspiracy theories about Letby's conviction, and a campaign to raise money for an appeal was started.^[135] The Telegraph said that the theory Letby was innocent was "extremely hard to entertain" and "sounds like the kind of mad claim that swirls around dark corners of the internet long after a case is closed".^[135] The New Statesman criticised the large amount of 'true crime' content produced on the case and drew parallels with the events surrounding the recent disappearance of Nicola Bulley, stating: "The Letby case has demonstrated a trend of people believing – despite having zero expertise – that their personal opinions on a stranger’s innocence, guilt or appropriate punishment are relevant".^[136]

On 27 August 2023, the Independent reported that a number of Letby's former hospital colleagues and friends do not believe that she is guilty.^[137] One close friend and colleague of Letby, who had always maintained her innocence, revealed she had actually become convinced by the end of the trial that Letby was guilty and felt 'duped' by her, saying: "I have no doubt at all that she was guilty of these despicable crimes, having seen the reports of the evidence. I did not attend the trial so I had an incomplete picture until the verdicts were announced, and more detail provided".^[138] She added: "I was deceived, as were so many others".^[138]

Other reactions

Dewi Evans, a retired consultant paediatrician who served as a prosecution witness, has called for an investigation into the possibility of charges of corporate manslaughter in relation to the Letby case.^[139]

The Royal College of Paediatrics and Child Health stated, "We must learn from these crimes and how Lucy Letby was able to bring harm to these babies so that no situation like this can ever happen again" and welcomed the independent inquiry.^[140] NHS England's Chief Nursing Officer Dame Ruth May issued a statement saying, "The NHS is fully committed to doing everything we can to prevent anything like this ever happening again, and we welcome the independent inquiry announced by the Department of Health and Social Care to help ensure we learn every possible lesson from this awful case."^[141]

On 21 August 2023, it was announced that the nursing director at the Countess of Chester Hospital at the time Letby was based there had been suspended from her job as a senior nursing officer at Northern Care Alliance NHS Foundation Trust with immediate effect, because of information that came to light during the trial.^[142] The Nursing and Midwifery Council subsequently announced she would face an investigation into her fitness to practice.^[143] She and other executives at the hospital have been accused of ignoring warnings about Letby.^[142]

It was reported that the British government were examining how Letby's pension can be stopped.^[144] The NHS pension scheme regulations provide for a forfeit of pensions after a conviction of certain crimes.^[145]

The Government announced that it would introduce new powers to compel convicted criminals to attend sentencing hearings.^[146]

On 5 September 2023 at a football match between Chester and Hereford United Chester fans chanted "Lucy Letby, she's one of your own". The club described this as "appalling" and said that they would review footage of the match to identify those responsible. The Crown Prosecution Service described the chant as a "tragedy-related abuse" and stated that the fans could be prosecuted for a public order offence.^[147][148]

See also

• List of prisoners with whole life orders
• List of serial killers in the United Kingdom
• 2011 Stepping Hill Hospital poisoning incident – saline poisoning deaths in Greater Manchester, England
• Beverley Allitt – British nurse convicted of murdering, attempting to murder and causing grievous bodily harm of infants and children in 1993
• Benjamin Geen – British nurse convicted in 2006 of murdering two patients
• Genene Jones – American nurse responsible for the deaths of up to 60 infants and children in her care during the 1970s and 1980s
• Colin Norris – British nurse convicted of murdering four patients with insulin in 2008
• Barbara Salisbury – British nurse convicted in 2004 of attempting to murder patients to "free up beds"
• Harold Shipman – British general practitioner convicted in 2000 of 15 murders but suspected of as many as 250

References

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