Lucy Letby

Lucy Letby
Born	(1990-01-04) 4 January 1990 Hereford, England
Occupation	Neonatal nurse
Known for	Countess of Chester Hospital baby murders
Conviction(s)	Murder and attempted murder
Details
Victims	13 (7 deaths)
Span of crimes	2015–2016
Country	United Kingdom
Date apprehended	2018

Lucy Letby (born 4 January 1990) is a British serial killer and neonatal nurse. A jury determined in 2023 that from 2015 to 2016 she attacked at least 13 babies in her care, killing seven of them. Letby denied the charges.

Letby was arrested in July 2018 in connection with a series of unusually frequent infant deaths between June 2015 and June 2016 at the Countess of Chester Hospital in Chester, where she had worked as a neonatal nurse since 2011. After being released on bail, she was rearrested in June 2019 and again in November 2020, in connection with additional infant deaths at the hospital. On the day after her final arrest she was charged with eight counts of murder and 10 counts of attempted murder.

At the conclusion of her trial, which lasted from October 2022 to August 2023, she was found guilty of murdering seven infants and attempting to murder six others during the twelve-month period, making her the most prolific serial killer of children in modern British history. She is scheduled to be sentenced on 21 August.

Early life and career

Letby was born on 4 January 1990, grew up in Hereford, England, and was educated at Aylestone School and Hereford Sixth Form College. She 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. An only child, Letby was the first member of her family to study at university and graduated in September 2011. Her father is a retired finance manager, and her mother is an accounts clerk.

Letby began working as a registered nurse at the neonatal unit of the Countess of Chester Hospital in 2012. In a 2013 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." Letby also took part in a campaign to raise funds for a new neonatal unit at the hospital. She had two training placements at Liverpool Women's Hospital in late 2012 and early 2015, which came under investigation after her conviction, but did not involve any deaths. In June 2016, consultants asked management to remove Letby 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. Letby was transferred to the patient experience team in July 2016, and later the risk and patient safety office and worked there until her arrest in 2018.

Initial investigation into baby deaths

A consultant and lead neonatologist at the Countess of Chester informally reviewed four unexplained collapses at the unit in June 2015; three of which resulted in deaths in the same month and had noted that Letby had been on shift on each occasion. The unit's consultants reported the deaths to the trust's committee for serious incidents but they were classified by the committee as "medication errors" rather than a "serious incident involving an unexpected death". If they had been classified as the latter, an immediate investigation could have followed. The ward manager had also noted Letby was the only common staff member present when she carried out her own review in October 2015 and relayed her findings to the lead neonatologist. The unit's consultants raised their concerns about Letby with the nursing director in the same month. In February 2016, he with other consultants undertook a thematic review of five unexplained deaths and other collapses on the unit and concluded the only common factor was Letby's presence on the ward. The lead neonatologist emailed his report to the trust's medical director and asked for a meeting. This occurred in May 2016 and no action was taken as the executive team felt that it was a coincidence. Reports by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquires across the UK) found a neonatal death rate at least 10% higher than expected in the period from June 2015 to June 2016 and a doubling in the 2015 total compared to 2014. The Care Quality Commission (CQC) visited the hospital in February 2016. The CQC commented that their discussions with the trust's medical director included the reports by staff of alleged challenges in raising concerns with managers but denied that the high mortality rate had been highlighted to them during the visit. The regulator's report raised "short-staffing" and "skill-mix" issues on the unit but praised the trust's "very positive culture" where "[s]taff felt well supported, able to raise concerns and develop professionally".

Executive directors at the trust met at the end of June 2016 and discussed whether to involve the police, this was the first time they had considered this option. By this time, seven unexpected deaths had occurred on the unit. They felt that the evidence of Letby's involvement as "circumstantial" and feared the doctors were carrying out a "witch-hunt". They were also concerned about "reputational" damage to the trust of a police investigation. They decided not to contact the police. The medical director and chief executive decided instead to organise an independent review by the Royal College of Paediatrics and Child Health (RCPCH) which started in September 2016 and downgrade the unit. In July 2016, the unit stopped accepting premature infants born before 32 weeks, diverting them to other hospitals in the North West of England, such as Alder Hey Children's Hospital.

The trust set a narrow scope for the review that excluded investigating Letby's actions or the deaths, but instead focused on the general service. The RCPCH reported their findings to the medical director and chief executive in October 2016. They could not find a definitive explanation of 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 consultant neonatologist Jane Hawdon from Great Ormond Street Hospital to carry out the case reviews. Hawdon told medical director that she could not conduct a detailed review due to lack of time but could provide a summary and did so after briefly reviewing the notes and sent her report to executives at the trust. Within the report she identified four cases that "potentially benefit from local forensic review as to circumstances, personnel etc". The chair of the trust has said that he was misled about the scope of that review and its findings.

In September 2016 Letby raised a formal grievance about her transfer from clinical duties. This was upheld by the board in January 2017 who found that her removal had been "orchestrated by the consultants with no hard evidence". In their report 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". The trust's chief executive had met with Letby and her parents on 22 December 2016 to apologise on behalf of the trust and assured them that the doctors who made the allegations would be "dealt with". He later ordered the consultants to send a letter of apology to Letby, which they did 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 Cheshire Constabulary on 27 April 2017 to raise their concerns; Letby was due to return to work on 3 May 2017. 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."

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 into the high infant mortality rates at the Countess of Chester Hospital. Letby's home at Chester was searched by police following her arrest. After Letby's arrest, the investigation was subsequently widened to include Liverpool Women's Hospital, another location at which Letby had worked. No evidence that patients at the hospital came to any harm was found during the initial investigation, though police have begun looking into Letby's entire career, including at Liverpool Women's Hospital, since her conviction.

Letby was bailed on 6 July 2018 as the police continued their enquiries. She was rearrested on 10 June 2019 in connection with eight said murders and nine said attempted murders of babies, and again on 10 November 2020. On 11 November 2020, Letby was charged with eight counts of murder and ten counts of attempted murder. She was denied bail and remanded in police custody.

Trial

Letby's trial began at Manchester Crown Court on 10 October 2022, before Mr Justice Goss, and was due to conclude after six months. She pleaded not guilty to seven counts of murder and fifteen counts of attempted murder relating to ten babies. Letby's parents and the families of the victims attended the trial.

The children to whom the charges related could not be named in reports and were referred to as Child A to Child Q. According to Helen Pidd of The Guardian, 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". Mrs Justice Steyn, two years before the criminal trial, banned the identification of the living children until their 18th birthdays. Parents wanted their identifying information including occupation to be protected, though Steyn ruled that one parent's profession as a physician was relevant due to his medical expertise and would not make that parent identifiable to the public. Several colleagues felt that they could not testify without anonymity, including a doctor with whom Letby was reportedly infatuated. The judge ruled that getting testimony from the colleagues was more important than them being publicly identifiable.

The prosecutor said that Letby was a "constant malevolent presence" in the hospital's neonatal unit and that Letby had searched for the parents of several babies on Facebook – two of whom were the parents of a victim – as well as sending one family a sympathy card. It was said by the prosecutor that Letby had injected air into the bloodstream of two of the victims and had used insulin to murder others. 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. 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 babies she is accused of murdering were grieving.

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". It was said that "extraordinary bleeding" in a baby boy murdered by Letby 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 use of insulin at the hospital was denied by Letby's colleagues.

The court was shown texts sent by Letby to her friends, one of which discussed the baby deaths, which Letby described as "sad and cruel" and "heartbreaking", later adding, "It's not about me or anyone else, it's those poor parents who have to walk away without their baby. It's so unbelievably sad." Letby had also told a colleague that taking Child A to the mortuary was "the hardest thing she ever had to do". A paediatrician at the Countess of Chester Hospital, said during the trial that he and other clinicians had previously raised concerns over Letby, but were told by hospital bosses that they "should not really be saying such things" and "not to make a fuss". Another doctor attending the trial said that Letby, in relation to one of the premature babies, told the doctor, "he's not leaving here alive, is he?" an hour before the child died.

On the fourth day of the trial, the prosecution showed the court 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". 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 respectively 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 at the fact that she was not being allowed back on the neonatal unit.

Letby herself gave evidence to the court in May 2023 and claimed she was made to feel as if she was incompetent but "meant no harm". When asked why she wrote the "I am evil, I did this" note, 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." 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." Letby also broke down in tears during her testimony.

Verdicts

On 10 July 2023, after a trial lasting nine months, the jury were sent to consider verdicts, after trial judge Mr Justice Goss concluded his summing up. 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 details of the verdicts were made public.

Letby was found guilty of seven counts of murder in relation to the deaths in 2015 and 2016 of seven babies by injecting them with air, overfeeding them, poisoning them with insulin or assaulting them with medical tools. She is the most prolific serial killer of children in modern British history.

In addition to the seven murders, Letby was found guilty of seven counts of attempted murder (relating to six babies) during the same time period. The jury was undecided on the attempted murder of four more babies, and she was found not guilty on two counts of attempted murder. Letby denied all 22 charges against her, blaming the deaths on hospital hygiene and staffing levels. On 21 August, she was sentenced to a whole life order at Manchester Crown Court.

Possible motives for killings

Although Letby's motivation remains unclear, the prosecution during her trial suggested several possibilities as to why she carried out the killings. These included 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 the prosecution identified was that the killings were to gain the attention of a married doctor with whom Letby, it was alleged, had a "secret" relationship. He would be one of the doctors called in the event that a baby rapidly deteriorated. Letby denied all these suggestions, including the allegation that she had a relationship with the married doctor.

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.

Post-conviction developments

Further investigations

Following the trial verdict, it was reported that police were investigating whether Letby harmed multiple other babies. There was a continuing investigation of suspicious incidents at the Countess of Chester Hospital involving around 30 other infants. Letby also worked at Liverpool Women's Hospital during 2012 and in 2015 and police are investigating all neonatal admissions at that hospital during those periods. The family of at least one baby have been told that their child's birth at the hospital is within the scope of the investigation.

Independent inquiry

As a result of Letby's 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; therefore 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, have all commented that they would fully cooperate with the inquiry. The medical director at the time had retired in August 2018 and the chief executive had resigned in September 2018 after signing a non-disclosure agreement with the trust.

Slater and Gordon, a firm of solicitors representing two of the families whose children were victims of Letby, issued a statement calling for the inquiry to have the power to compel witnesses to attend, since a non-statutory hearing "must rely on the goodwill of those involved to share their testimony". The need for a public inquiry was a view echoed by former Secretary of State for Justice Sir Robert Buckland, as well as Samantha Dixon, MP for the City of Chester, and Steve Brine, chair of the House of Commons Health and Social Care Select Committee.

Other reactions

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 to the Letby case.

The Royal College of Paediatrics and Child Health stated that "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. NHS England's Chief Nursing Officer Dame Ruth May issued a statement saying that "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." The British Medical Association, which represents doctors, has 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.

See also

• 2011 Stepping Hill Hospital poisoning incident – Saline poisoning deaths in Greater Manchester, England.
• Beverley Allitt – nurse convicted of murdering, attempting to murder, and grievous bodily harm of infants and children in 1993
• Benjamin Geen – nurse convicted in 2006 of murderering two patients
• Colin Norris – nurse convicted of murdering four patients with insulin in 2008
• Barbara Salisbury – nurse convicted in 2004 of attempting to murder patients to "free up beds"
• Harold Shipman – general practitioner convicted in 2000 of 15 murders but suspected of more than 200