Letby inquiry: Neonatal nurses to be surveyed on culture

In a statement issued today, chair of the inquiry, Lady Justice Thirlwall, said work was starting on gathering evidence from nurses, midwives, doctors, hospital leaders and others.

“Each response will play an important part in telling the inquiry what people on the ground really think”

Lady Justice Thirlwall

The Thirlwall Inquiry was set up on 19 October 2023 to investigate how Letby was able to murder and harm multiple babies while working as a neonatal nurse at Countess of Chester Hospital.

It is also looking at the culture in the NHS at large and how this affects the safety of newborns in neonatal units.

Lady Thirlwall said, as part of her investigation, a short survey would be sent to all nurses, midwives, doctors and managers in hospitals with neonatal units in England.

The receivers of the survey will be asked to anonymously share their views on the culture in their units.

“I hope and expect that those who receive it will find the few minutes needed to complete it,” said Lady Thirlwall.

“Each response will play an important part in telling the inquiry what people on the ground really think.”

A “wide-ranging and detailed questionnaire” has also been sent to medical directors and senior non-clinical managers in these hospitals, explained Lady Thirlwall.

Further requests for information have been sent to more than 20 organisations, which are obliged to reply under public inquiry rules.

Among those that have been asked for information are the Royal College of Nursing, the Nursing and Midwifery Council (NMC), NHS England, the Department of Health and Social Care, Countess of Chester Hospital and Cheshire Constabulary.

Lady Thirlwall also revealed that she would be looking at previous inquiries into NHS failings and whether the recommendations made as a result of these inquiries were implemented.

She cited the case of Beverley Allitt who murdered four children, and attempted to murder or harm others, while working as a nurse at Grantham and Kesteven Hospital in Lincolnshire in 1991.

“Everyone was determined that it would not happen again. It has happened again. This is utterly unacceptable,” added Lady Thirlwall.

“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?”

However, the inquiry is not expected to hear evidence via hearings until September 2024, due to ongoing police work in the Letby case.

The police work includes an ongoing investigation into the actions of Letby, and whether there may be a case of corporate manslaughter against Countess of Chester Hospital NHS Foundation Trust.

Lucy Letby’s police mugshot

In addition, Letby is due to stand retrial for one count of attempted murder, on which her previous jury could not reach a verdict, around the end of June 2024.

Letby has also lodged an application to appeal her convictions – a decision on which is not expected to be made before spring 2024 at the earliest.

In the meantime, the inquiry team would focus on gathering evidence and identifying key witnesses who will be called to give oral evidence, said the chair.

“It’s imperative that we maintain the significant momentum we have achieved in this last month so that we are ready to start the hearings as soon as we can,” said Lady Thirlwall.

However, she said work to address culture issues in neonatal units would start now, and she appealed for the cooperation of all relevant nurses and nurse leaders.

“No one can argue with the proposition that babies in neonatal units must be kept safe and well cared for. What is needed is the practical application of that proposition everywhere,” she said.

“In many units it will require profound changes in relationships and culture. This may not be easy to achieve but it is necessary and long overdue.

“The barriers to change must be identified if that hasn’t been done already and those barriers must be removed. Where there is good practice, that must be shared.”

She added: “Bringing about necessary change will require the cooperation and will of all those who are involved in and who are responsible for the babies in our neonatal units – from the ward to the boardroom.”

Letby, 33, is currently serving a whole-life prison sentence for the murder of seven babies and the attempted murder of six others – crimes she committed between June 2015 and June 2016, while working as a neonatal nurse at the Countess of Chester Hospital.

She was convicted and sentenced in August 2023 following a 10-month trial at Manchester Crown Court.

The NMC is due to hold a fitness-to-practise hearing for Letby next month and is seeking to strike her off the register permanently. She is currently suspended from practising.