Why the medical world was ‘terrified' to speak out over Letby case

Telegraph

20 hours ago

The Lucy Letby case seized my attention from the very start. A young nurse with the world at her feet accused of the most heinous crimes. It seemed so dreadful and hard to fathom.
I followed coverage of the trial closely and noticed that, despite the police having investigated Letby for several years, they never found a motive. There were no red flags in her character or past that might point to her being a serial killer in the making. The tabloid and broadsheet fascination with the case was clear: an attractive female nurse killing babies makes headlines.
Through my work over the years as a journalist I have made documentaries about the NHS and specifically about how easily things can go wrong in maternity and neonatal units when staffing is short and teams are dysfunctional.
In 2007 I made a Panorama for the BBC called Midwives Undercover, which highlighted the poor care many women were experiencing giving birth in the NHS. We interviewed a number of women who had tragically lost babies owing to poor care and we highlighted how staffing issues were impacting standards. These heartbreaking stories and their avoidable causes stuck with me.
Multiple investigations into maternity and neonatal units in Morecambe Bay, East Kent, Shrewsbury and more recently Nottingham, returned damning conclusions. Women were not getting the care they needed giving birth in the NHS with many suffering traumatic experiences and too many babies and mothers dying as a result.
Sadly, the programme did not prove to be a catalyst to significant change. No doubt because the problems within maternity services were too complex. Many years later I worked with Donna Ockenden, heading up her communications team for a period on her inquiry into maternity services at The Shrewsbury and Telford NHS Trust.
It was at this point that I first considered the Letby case. After the trial I learnt that there were in fact a total of 18 deaths of babies that had been cared for at the Countess of Chester and Letby had been convicted of murdering seven of them. So what, I wondered, had happened to the other 11?
The average number of deaths a year at the hospital prior to 2015 was between two and three so even without the seven indictment babies, it looked like the unit had a serious problem. I then asked myself how likely it was that the unit was in crisis and there was a serial killer at work?
During the trial I was struck by the fact that most of the evidence was circumstantial or down to medical interpretation. I waited to hear what Letby's defence team would come back with after many months of hearing the prosecution side. My reaction was similar to that of the Guardian's north of England editor who told our ITV documentary programme how astonishing it was that the defence decided not to call any expert witnesses.
I managed to acquire transcripts of the whole trial and discovered that Letby's defence had robustly challenged the credibility of the prosecution's leading expert witness, paediatrician Dr Dewi Evans, something that went largely unreported by journalists.
I also learnt that several months into the trial something extraordinary had happened. Another Judge, Mr Justice Jackson, sent an email to the judge in the Letby case, alerting him to a decision he had made in a different case in which he was extremely critical of a report Dr Evans had written as an expert witness.
'No effort to provide a balanced opinion'
Justice Jackson concluded in that case that Dr Evans ''makes no effort to provide a balanced opinion'. He added the report ''has the hallmarks of an exercise in working out an explanation that exculpates the applicants' with 'partisan expressions of opinion that are outside Dr Evans' professional competence and have no place in a reputable expert report'.
He went on to describe the evidence Dr Evans had provided for that case as 'worthless'.
Letby's defence team argued there was evidence of Dr Evans doing the same at her trial, citing examples of how they felt he had constructed theories to support allegations on the indictment rather than to form and present independent opinion on the basis of facts. They put to the judge he had given evidence in a manner that was ''improperly subjective, emotive, dogmatic and biased'' and he had essentially directed the whole investigation.
The judge in the Letby case, Mr Justice Goss, refused the application to throw out Dr Evans' evidence, instead allowing the jury to hear some of the criticism and letting Dr Evans defend himself in court.
I noted in Letby's trial that Mr Justice Goss also allowed something called cross admissibility of evidence, meaning that if the jury found Letby guilty of one of the counts then they could use that as evidence to inform their decisions for the other counts. He also instructed the jury that they did not need to be sure precisely how Letby had killed or harmed babies as long as they were sure she had.
The defence team had tried to get evidence that was undisclosed by the prosecution put before the jury – but the judge refused.
One example of this was the report carried out by the Royal College of Paediatrics and Child Health, commissioned by the management of the Countess of Chester Hospital. It found serious issues with understaffing and consultant cover at the hospital which could, they said, be impacting safety. The report has been referred to so much since the trial, it is hard to understand why the jury was prevented from hearing about it. But the judge refused to admit it as evidence.
By the end of the trial, there were enough questions in my mind that I was motivated to investigate further. I started digging to see if any experts were raising concerns, privately or publicly. They were.
It started with statisticians criticising the now infamous staffing chart shown to the jury, which selected deaths and collapses, at which Letby was present but failed to show the fuller picture. Then there were scientists, followed by doctors and specialist neonatologists.
I spoke with many of these experts over several months. One told me about two nurses in Europe, Lucia de Berk in the Netherlands and Daniela Poggiali in Italy, who were wrongly convicted of harming patients after flawed trials. In both cases the finger was pointed at them initially because they seemed to be on shift whenever something went wrong. Both had been completely exonerated, but only after years in jail. I spoke to Daniela. She could see in the Letby case strong parallels with what happened to her.
It was fascinating hearing the concerns of experts, many of whom were eminent in their fields, but frustrating as well. The reporting restrictions were in place for a full nine months after the trial meaning there was nothing I could do with the information I was hearing. That was because of the decision by the prosecution to retry Letby for one of the counts the jury had failed to agree on, the case of Baby K.
At the Appeal court for Letby's first application for leave to Appeal, reporting restrictions were still in place and the three judges had to decide whether or not to allow journalists to report the detail of that hearing. I was given the opportunity to address the j udges ahead of their decision. I asked them to allow reporting in the interests of fair and open justice.
They spent half an hour considering my request – and one from the Press Association on behalf of a number of newspapers – but decided to block any reporting other than the fact the Appeal hearing was taking place and the judgment that would come many weeks later. That meant that no details could be reported.
No-one got to hear from Prof Shoo Lee, an eminent neonatologist, who told the court a scientific paper of his had been misunderstood by the defence expert Dr Evans. Nor could the public hear the defence counsel's detailed criticism of Dr Evans.
By the time the appeal judges came back with their judgment, refusing leave to appeal, Letby had been found guilty at retrial of the attempted murder of Baby K. The same judge presided over that retrial as had the main trial. The defence tried to persuade the judge that a fair trial was impossible given the publicity, but Mr Justice Goss went ahead, ruling that the jury could take into account Letby's previous convictions when reaching their verdict.
By the time that trial ended and Letby was found guilty of a seventh attempted murder, no one was interested in the details of the appeal court hearing or in the concerns raised by a Prof Shoo Lee.
I knew there would be a fascinating documentary to be made after hearing from the experts raising concerns about the evidence used in the original trial, many of whom, just this time last year, were terrified to put their heads above the parapet. But I also knew it would take time to convince commissioners that a film needed to be made. So I started writing news articles for The Telegraph, teaming up with science editor Sarah Knapton.
I also set out to find people close to Letby who might be willing to talk to me. Most were too fearful of repercussions. But one or two, her childhood friend Dawn and Karen Rees, the former head of urgent care nursing from the Countess of Chester, were prepared to speak out in defence of a young woman widely described as Britain's worst child serial killer.
In February this year came a big development: a high-profile press conference, which we feature towards the end of our ITV documentary, where Prof Shoo Lee presented the findings of his independent scientific panel of experts. They came to a shocking conclusion. 'Ladies and gentlemen, there were no murders,' they said. The team had pored over the medical notes of the babies and proclaimed that they found no evidence of malfeasance.
Not long after that press conference, ITV commissioners realised it was in the public interest to examine the questions being raised about the evidence presented in the case, and that's what we do in the ITV documentary, Lucy Letby: Beyond Reasonable Doubt?
It was never going to be an easy film to make. We had to balance the huge sensitivities around the case and the immense pain and suffering of the families who have lost babies, with the public interest of hearing very serious and credible concerns being raised about the evidence heard at the trial.
One of the key points that we feature comes near the end of the film and is expressed by Prof Neena Modi, a senior neonatologist, who told us that some of the babies who died or suffered collapses in 2015 and 2016 should not have been cared for at that unit. They should have been at a level 3 unit where there are specialist neonatologists not paediatricians, she said, and where there is better staffing with constant consultant presence.
'On a knife-edge'
Prof Modi said: 'This was a neonatal unit that was being required to look after babies who should not have been cared for there. Some of them were demonstrably on a knife-edge.'
We know from the Royal College of Paediatrics and Child Health report, the jury was never told that there were too may cots crammed together in the unit and that there were serious issues with staffing. Consultants on the unit were only doing two ward rounds a week and there was 'insufficient senior cover'.
Prof Modi was clear that, having poured through the babies medical notes, she could see the babies in question were very vulnerable and in some cases the doctors who were looking after them failed to spot that they were deteriorating until too late.
She told us that 'problems went unrecognised until the point at which a baby deteriorated very abruptly. So babies might not have died had their difficulties been addressed earlier'.
This is a picture that was not painted in court and one that I believe the public has a right to hear.