Lucy Letby


Lucy Letby is a British former neonatal nurse who was convicted of the murders of seven infants and the attempted murders of seven others between June 2015 and June 2016. Letby came under investigation following a high number of unexpected infant deaths that occurred at the neonatal unit of the Countess of Chester Hospital three years after she began working there.
Letby was charged in November 2020 with seven counts of murder and fifteen counts of attempted murder in relation to seventeen babies. Prosecution evidence included Letby's presence at a high number of deaths, two abnormal blood test results and skin discolouration interpreted as diagnostic of insulin poisoning and air embolism, inconsistencies in medical records, her removal of nursing handover sheets from the hospital, and her behaviour and communications, including handwritten notes interpreted as a confession. In August 2023, she was found guilty on seven counts each of murder and attempted murder. She was found not guilty on two counts of attempted murder and the jury could not reach a verdict on the remaining six counts. Letby was sentenced to life imprisonment with a whole life order. An attempted murder charge on which the jury failed to find a verdict was retried in July 2024, and she was found guilty.
Management at the Countess of Chester Hospital were criticised for ignoring warnings about Letby. The British government commissioned an independent statutory inquiry into the circumstances surrounding the deaths, which began its hearings in September 2024. Letby has remained under investigation for further cases.
Since the conclusion of her trials and the lifting of reporting restrictions, various experts have expressed doubts about the safety of her convictions due to contention over the medical and statistical evidence. Medical professionals have contested the prosecution's interpretation of the infants' records and argued that they instead show each had died or deteriorated due to natural causes. Two applications for permission to appeal have been rejected by the Court of Appeal. The Criminal Cases Review Commission is considering an application to refer her case back to the Court of Appeal.

Early life and education

Lucy Letby was born on 4 January 1990 in Hereford, the only child of a furniture salesman and an accounts clerk. Letby was educated at St. James Church of England primary school, Aylestone School and Hereford Sixth Form College. A friend who knew her since secondary school told the BBC, that Letby wanted to become a neonatal nurse because "she'd had a difficult birth herself, and she was very grateful for being alive to the nurses who helped save her life".
Letby received 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. Letby initially failed her final year student placement, but passed a retrieval placement after requesting a new assessor. In 2011, Nicola Lightfoot, her first assessor, reported she was lacking in clinical and medication knowledge and needed more experience in "picking up on non-verbal signs of anxiety/distress from parents"; in a 2024 inquiry, Lightfoot said she had found Letby to be "cold". Letby was the first member of her family to study at university and graduated with a Bachelor of Science in Nursing with a speciality in child nursing in September 2011. She completed a placement course at the Liverpool Women's Hospital by December 2012.

Career

Letby got an appointment as a registered nurse at the Countess of Chester Hospital and started working in the neonatal unit from 2 January 2012. She lived a normal life living in several rented apartments until she bought a house near the hospital, a 20-minute walking distance from her ward, in 2016. 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." Letby also took part in a campaign to raise funds for a new neonatal unit at the hospital. She told others that she found non-intensive care work "boring".
Letby completed a specialisation course in neonatal caring in March 2014. She went for another training placements at Liverpool Women's Hospital in early 2015, and qualified to work with infants in intensive care. Her time there came under investigation after her conviction.
In July 2013, Letby and a more senior nurse set the infusion rate for a newborn's morphine at 10 times the correct amount, leading to a suspension from administering controlled drugs by the unit's deputy ward manager. Letby, who was upset by the decision, was required to undergo extra training. Her suspension was lifted a week later, after she complained to the unit manager, who had been on leave during the incident. Letby told colleagues the suspension was an over-escalation, which the deputy ward manager disputed. In 2015, she qualified to work with infants in intensive care, and in April 2016, she administered antibiotics to an infant that was not prescribed them, which she misclassified as a "minor error". She was reassigned by the ward manager from night shifts to day shifts.
In June 2016, Stephen Brearey, lead neonatologist, asked management to remove Letby from clinical duties pending an investigation into her conduct. 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.

Initial investigations

In June 2015, four collapses occurred in the same neonatology unit of Countess of Chester Hospital, three leading to infant deaths. The unit typically saw only two or three deaths a year. Eirian Powell, the unit manager, and Stephen Brearey conducted an informal review, and reported the incidents to the committee of the NHS Foundation Trust responsible for addressing serious incidents. Upon review, the committee classed the deaths as medication errors. Brearey observed that Letby had been on shift for all of the incidents, but considered it an unsurprising coincidence; there was only one other qualified junior nurse in the unit, and Letby often worked extra shifts to cover for staffing shortages. He stated, "Nobody had any concerns about her practice." In 2023, reports from The Guardian and The Times stated he was suspicious of Letby beginning in 2015 and accused the hospital of negligence for ignoring his concerns.
During a hospital visit in February 2016, the Care Quality Commission 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 "taff felt well supported, able to raise concerns and develop professionally." In May 2016, the executive team deemed the spike in deaths to be coincidental and no substantial action was taken. Reports by the nationwide MBRRACE-UK project 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.
Brearey phoned the duty executive on 24 June 2016, following two more deaths shortly after Letby returned from a holiday in Ibiza, demanding that she be removed from the unit. The duty executive insisted that Letby was safe to work. The Trust's executive directors convened at the end of June and discussed involving the police, but decided against it. The medical director and chief executive instead organised a review through the Royal College of Paediatrics and Child Health. Letby was removed from the unit, working her last shift there on June 30. The unit's services were scaled back by hospital managers on 7 July 2016, cutting cot space numbers and increasing the gestational age limit for admission from a minimum of 27 to 32 weeks.
The RCPCH was tasked with a general review of the unit's service, which was initiated in September 2016. In October 2016, they reported they could not find a definitive explanation for the increase in mortality rate at the unit, but found insufficient staffing and senior cover. They praised Letby's nursing skills and argued that the concerns about her came from a "subjective view with no other evidence". The medical director asked neonatologist Jane Hawdon from Great Ormond Street Hospital to carry out detailed case reviews recommended by the RCPCH, but Hawdon said she did not have the time and instead did a brief review of the medical notes relating to 17 deaths and other incidents and produced a five-page report. She concluded that 13 of the incidents could be explained and "may have been prevented with different care", while the remaining four could "potentially benefit from local forensic review as to circumstances, personnel etc". Records of the hospital board meeting show the 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. The chair later said he had been misled about the depth of the Hawdon review and its findings.
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. This grievance was upheld by the board in January 2017, which determined her removal had been "orchestrated by the consultants with no hard evidence". The medical director commented in the report that the trust's intention was to "protect Lucy Letby from these allegations". 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". He later ordered the consultants to send a letter of apology to Letby, which they did in February 2017.
In March 2017, four consultants, including Stephen Brearey and Ravi Jayaram, asked management to involve the police after receiving advice for further investigation from the regional neonatal lead. 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. Brearey and Jayaram told the Cheshire Constabulary that infant collapses are "nearly always explainable". In May 2024, staff writer Rachel Aviv for The New Yorker reported that a study of infant deaths in southeast London, published in the Journal of Maternal-Fetal and Neonatal Medicine, found that about half of unexpected infant collapses remain unexplained after an autopsy.
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." The investigation, designated Operation Hummingbird, lasted a year. 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."
Reading about the investigation in the news, Dewi Evans, a retired paediatrician and professional expert witness, contacted the National Crime Agency in May 2017 offering to help on the investigation. During the police investigation which followed, Evans was instructed to review clinical records of the babies in the unit who had died or collapsed suddenly, in total 61 cases. Evans produced a large number of reports for Cheshire Police including a general statement dated 17 April 2019, a review of published literature regarding air embolus in newborn infants dated 3 July 2019 and a series of reports "considering" the events surrounding the deaths or collapses of babies. Letby's trial opened on 10 October 2022 and Evans also remained lead expert witness during the trial. Evans' conclusions were peer-reviewed by Dr Sandie Bohin, a practising consultant neonatologist from Guernsey. Evans advised the police on the instruction of experts from specific specialisations, including:
Initially 61 cases of sudden infant collapse or death at Letby's ward were investigated by Evans, but this was narrowed down to a total of 22 counts during the trial.