The Countess of Chester Hospital’s neonatal unit head consultant, Dr Stephen Brearey, first raised the 33-year-old’s association with an increase in baby collapses in June 2015 and, with another consultant, Dr Ravi Jayaram, continued to express concerns to management as more sudden and unexpected collapses followed.
Dr Brearey told the Guardian that deaths could arguably have been avoided from as early as February 2016 if executives had “responded appropriately” to an urgent meeting request from concerned doctors.
“Discussing with police at that stage would seem to be a sensible action to take,” he told the newspaper.
“If that had happened, it’s reasonable to conclude that [two] triplets, Child O and Child P would be alive today.”
Police were only contacted in 2017.
Dr Jayaram told ITV News: “It’s a horrible thing to say but I do genuinely believe that there are four or five babies who could be going to school now who aren’t.”
Both consultants spoke of hospital executives’ reluctance to involve the police for fear of damaging the trust’s reputation.
Dr Brearey told the BBC that he felt as though hospital management were “trying to engineer some sort of narrative or way out of this that didn’t involve going to the police”.
Dr Jayaram told ITV News how he was warned that there would be blue and white tape everywhere if he called the police and “it would be really bad for the reputation of the trust” – calling it a “Kafkaesque situation”.
He added that police realised they had to be involved after listening to him for “less than 10 minutes” in 2017.
Letby was moved to clerical duties after two triplet boys died under her care and another baby boy collapsed on three successive days in June 2016.
Three months later she learned of the allegations against her in a letter from the Royal College of Nursing union and registered a grievance against her employers.
It emerged during legal argument at Manchester Crown Court, in the absence of the jury, that the grievance procedure was resolved in Letby’s favour in December 2016.
However a number of consultants were also required to apologise to Letby formally in writing, the court heard.
Giving evidence, Dr Jayaram told the court: “We had significant concerns from the autumn of 2015. They were on the radar of someone as senior as the executive director of nursing as far back as October 2015.
“As clinicians we put our faith in the system, in senior management to escalate concerns and investigate them. The initial response was ‘It’s unlikely that anything is going on. We’ll see what happens’.
“We said ‘OK’ – against our better judgment in retrospect.”
Dr Brearey went on to commission an independent neonatologist from Liverpool Women’s Hospital to analyse the increased mortality rate.
The thematic review, concluded in February 2016, did not identify a reason for the rise in deaths.
However, concerns remained about Letby as a “common link” during all the collapses and deaths, as Dr Brearey sent copies of the report to nursing director Alison Kelly and medical director Ian Harvey.
Dr Jayaram told the court there was no response from bosses for another three months.
He said: “We were stuck because we had concerns and didn’t know what to do. In retrospect, I wished we had bypassed them and gone straight to the police.”
He added: “We were also beginning to get a reasonable amount of pressure from senior management at the hospital not to make a fuss.”
The trial heard from fellow consultant Dr John Gibbs that a “tipping point” was reached in June 2016, with the deaths of two triplet boys, Child O and P, on successive days.
Dr Gibbs said: “This was happening again and again, over and over. It cannot be coincidence or bad luck. There must be a cause.”
Following the death of Child P on June 24 2016, Dr Brearey phoned the duty executive on call, Karen Rees, a senior nurse in the urgent care division, the court heard.
Dr Brearey said: “She was familiar with our concerns already. I explained what had happened and I didn’t want nurse Letby to come back to work the following day or until this was all investigated properly.
“Karen Rees said ‘No’ to that, and that there was no evidence.”
Child Q, a boy who was Letby’s designated child, collapsed on the morning of June 25 and needed breathing support.
The jury in Letby’s trial was not able to reach a verdict on a charge of the attempted murder of Child Q.
A meeting of the whole neonatal consultant body was held on June 29, the court was told, and on June 30 Letby worked her last shift on the unit.
Letby was reassigned to clerical duties the following month.
But Dr Gibbs told the court that consultants had to “resolutely resist” attempts by management to return her to the unit up to the point when police launched an investigation in May 2017.
He said the doctors demanded the installation of CCTV in each room in the unit if she was permitted to nurse again.
Dr Gibbs added that hospital bosses were “extremely reluctant” to involve the police.
The Parliamentary and Health Service Ombudsman has called for “significant improvements to culture and leadership across the NHS” in the wake of Letby’s trial.
Rob Behrens said: “We also heard throughout the trial evidence from clinicians that they repeatedly raised concerns and called for action. It seems that nobody listened and nothing happened.
“More babies were harmed and more babies were killed. Those who lost their children deserve to know whether Letby could have been stopped and how it was that doctors were not listened to, and their concerns not addressed, for so long.”
Tim Annett, a lawyer representing parents of Lucy Letby’s victims, said “lessons need to be learned about the early recognition of serious and avoidable harm”.
Dr Nigel Scawn, medical director at the Countess of Chester Hospital, said on Friday: “Since Lucy Letby worked at our hospital, we have made significant changes to our services and I want to provide reassurance to every patient that may access our services that they can have confidence in the care that they will receive.”