Letby: the inquiry begins

But Lady Justice Thirlwall will not question the killer’s guilt

The Thirlwall inquiry will begin hearing opening statements this morning. That’s the inquiry’s formal name: it’s certainly not the Lucy Letby inquiry, even though the murders she committed or attempted are at the heart of the case. The neonatal nurse is serving a whole-life prison sentence for the murder of seven babies and the attempted murder of seven others at the Countess of Chester Hospital in 2015 and 2016.

Lady Justice Thirlwall

As I wrote here a year ago, Dame Kate Thirlwall is the ideal judge to chair this investigation. I also explained why it had been set up under the Inquiries Act 2015, giving the chair statutory powers.

Last November, Lady Justice Thirlwall read out an opening statement:

In it, the appeal judge said:

We all know that there have been many inquiries into events in hospitals and other health care settings over the last thirty years. The case of Beverley Allitt who murdered babies at Grantham Hospital in the 1990s comes to mind.

Everyone was determined that it would not happen again. It has happened again. This is utterly unacceptable.

I want to know what recommendations were made in all these inquiries, I want to know whether they were implemented? What difference did they make? Where does accountability lie for errors that are made?

This week

Rachel Langdale KC, counsel to the inquiry, is scheduled to address Thirlwall today and tomorrow. The rest of the week will be taken up with submissions on behalf of core participants.

An inquiry is not a court, although it may look like one. What Langdale says to Thirlwall this week will have been worked out in advance between them. As counsel to the inquiry, Langdale will set the scene for the benefit of everyone following the proceedings. Later she will take the lead in questioning witnesses.

The core participants include three groups of parents; the hospital trust; four former hospital executives; the Department of Health and Social Care; the Care Quality Commission; the Nursing and Midwifery Council; NHS England; and the Royal College of Paediatrics and Child Health.

Terms of reference

Thirlwall’s terms of reference require her to investigate three broad areas, referred to as A, B and C.

These are, in summary:

A. The experiences that the parents had of the Countess of Chester Hospital, where Letby worked. The parents include everyone whose children Letby was accused in court of killing or trying to kill.

B. The conduct of those working at the hospital in relation to Letby’s actions. This includes:

• whether suspicions should have been raised earlier; whether Letby should have been suspended earlier; and whether the police should have been informed sooner;

• the responses from hospital managers to concerns raised about her;

• whether the trust’s culture, management and governance structures and processes contributed to the failure to protect babies from Letby.

C. The effectiveness of NHS management and governance structures in keeping babies in hospital safe; what changes may be necessary; whether accountability of senior managers should be strengthened.

The inquiry has formulated 30 questions arising from its terms of reference. But these do not cover the concerns raised in recent months by leading statisticians. As a report in today’s Telegraph puts it, many doctors and scientists have questioned whether the spike in deaths at the hospital while Letby worked there was actually unusual, given the prematurity and ill health of the babies and chronic understaffing at the neonatal unit.

Thirlwall has not been asked to examine Letby’s trial or her retrial, the juries’ verdicts or the ruling delivered in July by Thirlwall’s colleagues in the Court of Appeal. Whether there has been a miscarriage of justice is not an issue that she has been asked to consider. The inquiry will proceed on the basis that Letby was properly convicted. Few of the scientists who have raised doubts about the evidence since Letby’s second trial and the Court of Appeal ruling have asserted that Letby did not try to murder even a single baby.

Watching the evidence

The inquiry will sit at Liverpool town hall, a venue that was chosen for the benefit of parents living in the area. It will be open to members of the press and public who have registered to attend.

Even so, reporting restrictions remain in force. The parents cannot be identified. Some witnesses and parents will not be seen by the press or public. To maintain these requirements, Thirlwall has restricted public access to video coverage of oral evidence.

Unlike public inquiries that can be seen on television news networks or watched on YouTube from anywhere in the world, the Letby inquiry will not be live-streamed. That facility had been requested by counsel for the three parents’ groups at a preliminary hearing in May. But the chair was unimpressed with one of the reasons they advanced.

Conspiracy theories

Peter Skelton KC argued that seeing and hearing witnesses giving evidence would be one of the most effective antidotes to the “proliferation of conspiracy theories which sprout, spread and fester on social media blogs and on websites”.

Louis Browne KC agreed. And Richard Baker KC said that not allowing the normal live broadcasts “will hand to conspiracy theorists a sense that there is hidden information and it will lead to increased speculation and worsen those theories”.

The request for live-streaming was opposed by the hospital and not supported by media groups. It was robustly rejected by Thirlwall.

She said:

I entirely understand, as counsel for the parents submitted, that the parents want people (as well as Letby) to be held publicly accountable for what happened to their children…

Those involved have received very searching requests for statements with which they must comply… They will be subject to detailed scrutiny, giving evidence in public. Where they are accountable I will hold them accountable, publicly.

Whether I direct live-streaming worldwide, or live links, or neither, will have no effect on the rigour of my approach, nor on the approach of all who have responsibility for helping me to get to the truth…

The final submission from all three counsel for the parents was the most eye-catching. It was to the effect that livestream broadcasting would reduce or dispel toxic and offensive conspiracy theories.

This submission was unsupported by evidence and I reject it. Searching for truth is not a characteristic of conspiracy theorists. Like those who promulgate fake news, they search for information which supports their world view.

When they find none, they manufacture it, often using and distorting video footage to be found on the internet. I say no more about their activities.

However, Thirlwall authorised live links, allowing accredited news outlets and core participants to follow the proceedings remotely. And the chair has permitted accredited media organisations to broadcast short extracts from the oral evidence.

Despite objections from the broadcasters, clips will generally be limited to five minutes a day for each witness. However, legal submissions, including opening and closing statements, can be broadcast in full.

The inquiry’s website will also carry a daily transcript.

Update 11 September: Here are some selected extracts from Thirlwall’s opening remarks yesterday:

The inquiry bears my surname so that the parents do not see repeatedly the name of the person who has been convicted of killing and maiming their children in every reference to the inquiry, in the hearing room, on the website, in the media…

After the hearings, it will be for me to write the report. I cannot tell now precisely how long that will take; much depends on the nature and volume of the evidence. I can say that I expect the report to be published by late autumn next year…

In the months since the Court of Appeal handed down its judgment, there has been a huge outpouring of comment from a variety of quarters on the validity of the convictions. So far as I’m aware, it has come entirely from people who were not at the trial. Parts of the evidence have been selected and criticised, as has the conduct of the defence at trial, about which those defence lawyers can say nothing.

All of this noise has caused enormous additional distress to the parents who have already suffered far too much. I make it absolutely clear that it's not for me as chair of this public inquiry to set about reviewing the convictions. The Court of Appeal has done that, with a very clear result.

The convictions stand.

As counsel to the inquiry, Langdale added this:

For ordinary, decent, right-thinking people, the actions of Letby will remain unfathomable. We will not be inviting speculation from witnesses about her motive or mindset. We will be examining why detailed, rigorous, medical analysis of sudden, unexpected deaths and collapses did not take place earlier, and why attacks on babies were able to continue to hospital for a year.

We will be questioning whether and how bias in favour of Letby, conscious or otherwise, influenced the hospital's response that the sudden and unexpected deaths did not need timely, in-depth, forensic investigation, independent from the hospital, and those who worked there.