Lucy Letby: Focus shifts to type of inquiry needed to find out why NHS managers ignored warnings over killer nurse

The British government seems to be preparing the ground to upgrade to a full statutory footing its inquiry into how neonatal nurse Lucy Letby was allowed to go on killing babies, even after concerns were raised by doctors but ignored by hospital management.

Pressure has been mounting since the government first announced a private inquiry last week, after Letby was convicted of seven murders and six attempted murders of babies at Countess of Chester hospital. Letby, who is aged 33, was sentenced on Monday to spend the rest of her life in jail.

When it announced an inquiry last Friday after the final verdicts, the department of health said it favoured a non-statutory private one because it would be quicker than a full public inquiry, while victims’ families could also be more involved.

This, however, led to an avalanche of calls from the victims’ families, clinicians involved in the case and politicians, such as former home secretary Jack Straw, for a full statutory inquiry instead. This would be chaired by a judge and have the legal power to compel testimony from witnesses, such as NHS managers accused of acting too slowly.

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A full public inquiry would also take longer to report. Sensing a backlash, the government has started signalling that it is now open to the idea of an upgrade. Gillian Keegan, the education secretary, has said a statutory inquiry is “on the table”.

[ Kathy Sheridan: What exactly did we expect the parents of Lucy Letby to do? ]

Meanwhile, a report in the i newspaper says the upgrade may be on its way but only after the government has consulted with victims’ families. Tamlin Bolton, a solicitor for the families of seven of Letby’s victims, said a statutory inquiry is “exactly” what her clients want.

There is precedent for such a decision: the inquiry into serial killer doctor Harold Shipman was upgraded to a statutory footing in 2000, after a private inquiry was first established.

The conviction of the most prolific serial killer of children in British history has thrown a spotlight on claims NHS managers protected Letby and ignored warnings from doctors, who had suspicions about her from early in her killing spree.

Letby was convicted of seven murders and 13 attempted murders committed over a one-year period from June 2015. She injected some of the babies with air, causing catastrophic collapses, while others were poisoned with insulin or through overfeeding via tubes. She was found not guilty of two attempted murders. No verdicts were reached on six further counts.

It emerged during the case that Letby’s link to the unexplained collapses of babies in her care was first commented upon by doctor Stephen Breary in June 2015, just after her spree began. Other doctors, including paediatrician Ravi Jayaram, formally raised concerns about Letby with management in October 2015 but their warnings were dismissed. Letby went on to attack five more newborns in the hospital’s neonatal ward after the October complaints were made, killing two babies.

A focus has developed on the leadership of managers such as Alison Kelly, who was director of nursing at the hospital; its now-retired former medical director Ian Harvey; and the hospital’s former chief executive, Tony Chambers. He denied that warnings were not taken seriously by the management team. Some victims’ parents say they were “fobbed off”.

Ms Kelly, who later moved from the Countess of Chester to a similar role in an NHS trust in Manchester, was suspended from her new job following the Letby trial.

Emma Norris of the Institute for Government think tank said “only a full statutory inquiry would do” due to the apparent “failings of institutions such as the NHS” in the case. She also warned that, due to the possibility of disciplinary action against managers, if they were found to have acted improperly, the legal powers of a full inquiry would be needed to compel them to testify.

[ Lucy Letby: ‘Malevolent’ serial killer nurse will die behind bars in UK ]

Breary has also called for a new regulatory structure similar to the General Medical Council or the Midwifery Council to oversee NHS managers, whose decisions can ultimately impact patients.

A further aspect of the fallout from the case arises from Letby’s refusal to leave her holding cell on Monday to hear her sentencing or to face victims’ families, who made statements in court. Prime minister Rishi Sunak said he will change the law to force criminals to appear for sentencing.