What we learnt from Lucy Letby hospital bosses

Eleven weeks in, the Thirlwall Inquiry might just have had its most important week.

It was set up to investigate how Lucy Letby was able to murder seven babies and attempt to murder seven more on the neonatal unit at the Countess of Chester Hospital in 2015 and 2016.

We understand the hearings take their branding from the public inquiry’s chair, Lady Justice Thirlwall, so that her name – not Letby’s – is given profile.

Many in the room here in Liverpool Town Hall would prefer not to hear Letby’s name uttered again – but more than a year after her trial ended, questions remain.

Despite weeks of controversy, the inquiry isn’t looking at the question of her guilt, but rather: how were concerns on the ward handled? And where does accountability lie?

This week was crucial to answering that second question.

Beneath chandeliers in the hall’s grand ballroom, the Countess of Chester’s respective former directors of nursing Alison Kelly, medical Ian Harvey, HR Sue Hodkinson, and ex-chief executive Tony Chambers spoke in public for the first time.

Unlike other inquiry witnesses such as the hospital consultants, these bosses were not asked to give evidence at the criminal trials – and have resisted media interviews – so they are revealing new information.

When she opened the public inquiry, which isn’t a criminal proceeding, Lady Justice Thirlwall said Cheshire Police were investigating whether there may be a case of corporate manslaughter against the hospital trust.

Perhaps mindful of it, the executives seemed to choose their words carefully. All had the same legal representation and opened their evidence with an apology to the victims’ families, some of whom were in the room.

“There isn’t a day that doesn’t go by that you’re not in my thoughts,” Ms Hodkinson told the hall.

And Ms Kelly spoke of not getting “everything right at the time, however the decisions I made were done with the best intentions”.

We don’t know what those families thought of those overtures, but their lawyers asked some of the questions.

Much of the evidence focused on the way the bosses handled the warnings of consultants who were trying to raise the alarm about Letby – and who knew what, when.

The nurse has been convicted of crimes spanning the year between June 2015 and June 2016 – but months passed between doctors’ concerns being raised, and her being taken off duty, and it was nearly another year before the police became involved.

All of the managers were asked about failings and missed opportunities, but concessions were hard to come by.

Former chief executive Mr Chambers was asked four times what his most significant personal failing had been. He answered in the plural, about the way the executives had communicated with the babies’ families, and was challenged on it.

Counsel to the inquiry Nicholas de la Poer KC observed: “You use the word ‘our’ not ‘my’. You’re not advancing any personal failure on your part?”

Mr Chambers replied: “Thank you for pulling me up on the language there. I accept that as the accountable officer for the trust I must take some responsibility – must take responsibility – for that.”

He wasn’t the only former boss to cite poor communication with the babies’ parents as a failure. Mr Harvey admitted sending them a letter in April 2017 which he now acknowledged was “crass, inappropriate… unthinking and insensitive”.

The former medical director accepted the bosses hadn’t shared information openly enough, but denied a cover-up.

Several of the managers said they were trying to balance a duty of candour, with a duty of care to Letby.

The executives were all asked about their relationship with Letby, and some interesting new details emerged.

Ms Kelly accepted it was a conflict of interest to have had a meeting with the nurse, after she had raised a grievance complaint for being taken off duty.

“I have reflected a lot on the conversations I had with Lucy Letby, and if I knew then what I know now, that would not be my normal practice,” she said.

Mr Chambers met Letby and her parents in December 2017, after the grievance complaint was upheld, and assured her she’d be allowed to return to nursing duty.

He told her her resilience astounded him and remarked, “don’t worry Lucy we’ve got your back.”

An interesting detail to emerge is the role played by Letby’s parents after she was removed from duty – particularly her father.

Former HR director Ms Hodkinson told how John Letby made agitated phone calls, putting pressure on those handling his daughter’s case.

And Mr Chambers said a “very angry” Mr Letby had threatened to refer the consultants to their regulator, the General Medical Council, and “was threatening guns to my head and all sorts of things”.

The executives were also pressed on their lack of support for consultants who were trying to make their suspicions known – and accepted they hadn’t been given protection as NHS whistleblowers.

Hearing directly from the bosses for the first time shone a light on what the atmosphere was like at the Countess of Chester Hospital during that period.

At times the questioning became very personal as the managers were asked about the tone they’d set.

Ms Kelly denied that she had created a “culture of fear”, but accepted there was acrimony between doctors who suspected Letby and nurses who backed her.

Meanwhile, Mr Chambers insisted he had behaved professionally, after some witnesses claimed he had acted in an oppressive, overbearing and bullying way,

Mr Harvey was asked about his behaviour and said of the consultants: “If they felt that they were intimidated then that certainly wasn’t the intent or the purpose, but I would apologise to them for that.”

Hearing what the bosses had to say, before a packed public gallery and benches of lawyers, was fascinating.

What ultimately matters though is what Lady Justice Thirlwall made of it – and we won’t find that out until she publishes her report next autumn.