Senior nurses closed ranks around Lucy Letby, doctor tells inquiry

A doctor has blamed senior nurses for extending Lucy Letby’s time on the neonatal ward by closing ranks around her. 
The Thirlwall Inquiry into Letby is hearing from Dr John Gibbs, a paediatrician who worked at the Countess of Chester during the years she was a nurse on the neonatal unit.
Letby was convicted of the murders of seven babies and the attempted murders of seven others while working as a nurse at the Countess of Chester Hospital between 2015 and 2016.
In April 2016, Letby was moved on to day shifts after concerns were raised about a correlation between her working at night and babies collapsing unexpectedly.
Dr John Gibbs said “one aspect that made it more difficult” to “confirm his suspicions” was a “very firm pushback” from senior nurses.
He said: ”There was a very strong argument being put forward from the senior nurse on the unit, that this suspicion was totally wrong and that it was maligning nurse Letby and that she was a very competent, safe nurse.”
Dr Gibbs admitted that he should have gone straight to the police in February 2016, some four months before Letby was removed from the neonatal ward. 
He said: “I regret that we or I didn’t go to the police at this time after the thematic review. Why didn’t I go straight to the police, why didn’t we paediatricians go straight to the police? 
“I know the parents of the later babies will not thank us for this”.
The inquiry will resume at 10am on Friday morning when it will hear evidence from paediatric registrars Dr Rachel Lambie, Dr Matthew Neame, Dr Huw Mayberry, and Dr Cassandra Barrett. 
Here is a summary of what the inquiry heard from Dr John Gibbs, a paediatric consultant at the Countess of Chester hospital, today: 
Lucy Letby was not present when a baby she was convicted of killing was harmed, a BBC investigation has reported.
Letby was found guilty of killing a boy known as Baby C by injecting air into his system at the Countess of Chester Hospital in June 2016.
During the trial, prosecution experts said an X-ray of the baby showed a “marked gaseous distention of the stomach”, which they suggested was due to a deliberate pumping of gas into his feeding tube.
Read the full story here. 
On 28 February, the consultants, including Dr John Gibbs “wrote a letter of apology” to Lucy Letby. 
Dr Gibbs told the inquiry that he had not been apologising for the accusations, but for the “stress that had been caused”.
He said: “Some of my colleagues say we never accused her of anything. I think we were implying quite strongly what we were accusing her of. 
“We didn’t apologise for having raised concerns that she may have harmed patients.”
Dr John Gibbs told the inquiry that in February 2017 he contacted the British Medical Association to ask for advice.
When asked why he had done so, he said: “[Because] we were going against what the managers clearly advised that that was the end of the discussion about Letby.”
He added: “We defied what we were told and we were starting to ask questions.”
A letter was sent to the Chief Executive by the consultants urging a coronial investigation into the deaths. At this time Letby was still working in the hospital but in a non-clinical role.
Dr Gibbs said that by February 2017 “trust between ourselves and senior executives was breaking down”.
Police were not brought in to investigate the increased mortality rate until May 2017 as Letby remained at the hospital in a non-patient role until her arrest in July 2018, the inquiry has heard.
The Royal College of Paediatrics and Child Health was invited to review the spike in baby deaths by the hospital in 2016 and produced two reports.
Although one report was made public, a second “confidential” version was also written, which stated consultants had identified Lucy Letby was on shift for all deaths and had become “convinced by the link”.
The authors said that view was “quite subjective” and warned there was “no other evidence or reports of clinical concern beyond this simple correlation”.
Following the RCPCH report Dr Gibbs said his head was left “swimming” and in January 2017 senior consultants were called into a meeting to discuss Ms Letby’s future.
He said: “It was emotional, a letter was read out from Letby by one of the senior nurses in a quite emotional tone.
“Then we were told how much we’d upset Letby by the chief executive, and told firmly that the board had accepted the findings that there had been no evidence of any wrongdoing, and that Letby was exonerated, or, I don’t know if he used the word exonerated, but no evidence against her, and that a line was being drawn under this.”
He added: “It was clear that was the end of it. These reports had shown no wrongdoing, and we were to apologise to Letby.”
The inquiry heard that Dr John Gibbs had previously told colleagues “we should be cautious in necessarily attributing a causal relationship with Letby” following the case of another nurse at a nearby hospital who had been falsely accused.
He said that in that case the nurse had been wrongly accused after there was a “correlation between her being present and certain incidents”.
He said it was the parallel with the case against Letby that had raised his concerns and made him more cautious.
He added: “I think we don’t want to go there too much because of what’s been said about the Letby trials, but there are other nurses who have been accused of harming children because they seem to be around at the wrong times.”
Dr Gibbs said a review of the unit by the Royal College of Paediatrics and Child health in September left him “disappointed”.
He said: “It’s just disappointing that they didn’t pass an opinion on whether they felt the deaths were explained by pressures on the unit.”
After the death of two babies, Child O and P, on successive days in June 2016 , Lucy Letby was removed from the hospital’s neonatal unit after consultants suspected she deliberately harmed them.
Dr John Gibbs said after Letby was removed from the unit she could only be allowed to return to the ward if CCTV cameras were installed, or she was monitored by another nurse “at all times”.
He said: “I didn’t think that was likely to be possible… We’d never have got them up in time.” He said that it was just “a way of trying to make it difficult for her to come back”.
Discussing the use of air embolism to kill the babies, he said it was: “A devious and subtle way of trying to harm patients which tends to leave nothing behind afterwards for the post mortem to find”.
He said it was “a silent, hidden way of killing that leaves nothing at post mortem.”
Lucy Letby was convicted of the murders of seven newborns and the attempted murders of seven more. In August 2023, she was described by the judge as having led a “cruel, calculating and cynical campaign of child murder”.
But despite the guilty verdicts and her application to appeal being roundly rejected by judges in May, troubling questions have started to emerge about some of the scientific evidence used to convict Letby.
Read the full story here. 
The inquiry will resume at 2.05pm
Dr John Gibbs said that even after further collapses occurred in April, including those of Child L and his twin brother, Child M, he “still wasn’t clear that harm was happening to the babies”.
He said: “Despite that thematic review most of the babies had an explanation for their deaths from the post mortem.”
Dr Gibbs said that while all of the babies hadn’t had post-mortem’s the majority had done.
He continued: “Because we had explanations for all the deaths I wasn’t sure that harm had happened to these babies.”
He said that while some of the babies did “have risk factors”, there were “unusual features like strange rashes”.
“They were deaths that had explanations but they weren’t entirely satisfactory, especially when you look back at them.”
Following the collapse of Child O, on 23 June 2016, however, Dr Gibbs said his first thought was not “it’s Letby again” but just that “we have had another collapse”.
He said: “Looking back on it it sounds foolish to say I just wasn’t sure what’s happening on the unit.”
On 7 April, 2016, Lucy Letby was moved to day shifts after concerns were raised about a connection between her working at night when babies collapsed unexpectedly.
Dr John Gibbs said “one aspect that made it more difficult” to “confirm his suspicions” was a “very firm pushback” from senior nurses.
He said: ”There was a very strong argument being put forward from the senior nurse on the unit, that this suspicion was totally wrong and that it was maligning nurse Letby and that she was a very competent, safe nurse.”
Dr Gibbs admitted that he should have gone to the police following the thematic review.
He said: “I regret that we or I didn’t go to the police at this time after the thematic review. Why didn’t I go straight to the police, why didn’t we paediatricians go straight to the police? 
“I know the parents of the later babies will not thank us for this”.
He said that while there were suspicions that something might have been done to the babies “it was best managed” through senior levels in the trust. 
Dr John Gibbs has been asked about a thematic review that took place in February 2016 into the higher-than-expected mortality rate at the unit in 2015.
He said: “By 2016 [there was] definitely the realisation that Letby was involved with most of them.
“There were some deaths and collapses that I knew she wasn’t around at the time, but that association was causing concern.”
He added that it would have been “inappropriate” to tell CQC inspectors who visited the hospital that same month about their concerns.
“It is a bit inappropriate to just tell the CQC inspectors when they happen to be visiting if you haven’t tried to sort that out within your own trust management structure,” he said, adding: “It’s almost like telling Ofsted you’ve got a problem with the teacher, and you’ve never told anyone in the school.”
Discussing the death of Child I, who Lucy Letby killed with an injection of air into her stomach and bloodstream, Dr John Gibbs said he did not realise at the time that she was responsible for other attacks. 
He said this influenced his thinking as to why the baby had collapsed. “I thought this was a baby who was quite precarious, who decompensated quickly,” he said. 
Dr Gibbs denied telling the mother of Child I that her baby needed to have a post-mortem in order to clear the hospital of wrongdoing.
He said he “was sure the mother” thought he said that “so he was not going to argue with her”, but said he would never tell the family of a patient that they were being forced into having a post-mortem.
Dr John Gibbs said that with “hindsight” it was a “serious collective failure” on the part of the paediatric team not to recognise the significance of blood test results relating to Child F in 2015.
The results showed that insulin had been given to him, but Dr Gibbs told the inquiry he only became aware of them two years later.
Dr John Gibbs said that he was initially satisfied that Child C’s death had been “partly explained”. After receiving a cause of death from a post mortem, he said he felt a sense of “relief”.
He added: “It would not compensate for the tragedy of losing a child, but is likely to help a bit with an explanation for the child’s death.
“Some causes of death will have an influence or possible consequences for future children or pregnancies and so on.”
He said that in his experience of neonatal units “it was not always possible to explain a death”.
He added: “When that situation keeps arising, something very strange is happening.”
Dr John Gibbs, a consultant at the neonatal unit, said he originally felt sympathy for Lucy Letby after it was noticed she had been present at the resuscitation of four babies who had died. 
He said that he himself had experienced a ‘bad run’ where there had been a high number of incidents and deaths. 
“I felt sympathy for Letby at that time, because I felt she had been unlucky to be involved in a number of incidents,” he told the hearing. 
“It can happen to any of us, and it’s happened to me during my career, that you have a bad run when you’re on call or on duty, and in a short space of time a number of unfortunate incidents and other deaths may happen, but that stops happening, it’s just an unfortunate coincidence.
“I’m not sure how closely we considered other members of staff. Obviously Letby wasn’t the only nurse involved in all of those.”
Dr John Gibbs, a paediatric consultant at the Countess of Chester, said that he was concerned that there was an infection or medical problem behind the deaths of babies on the unit. 
He told the hearing. “There was something that was affecting these babies.
“I worried at this stage that we had some kind of medical problem on the unit, you do get superbugs or some nasty infection, or as has happened on some units, contamination of the feeding fluid for babies.”
Dr John Gibbs said that he originally had ‘no concerns’ over the death of Child C who deteriorated quickly and died in June 2015.
Letby was convicted of killing the baby just four days after its birth by injecting air into its stomach. 
Dr Gibbs said he was called to the neonatal unit at the Countess of Chester in the evening, at which point Child C had already collapsed and staff were attempting resuscitation.
He said: “When a baby suddenly collapses you would hope to get some response even if it was not sustained. 
“I attended 10 minutes into the resuscitation and there was no response onwards. I didn’t know why Child C had collapsed and died.”
Asked by Nicholas de la Poer KC, counsel for the inquiry, whether he had any concerns that there was anything ‘wildly out of the ordinary’, he replied: “Not at all.”  
Dr Gibbs also said he did not feel that Child C had the same rash as the other babies, which had been later deemed as a sign of air ambolism. 
The public inquiry into baby deaths at the Countess of Chester Hospital where Lucy Letby worked began on September 10.
The statutory inquiry – which is being led by Lady Justice Thirlwall – was ordered by Steve Barclay, the former health secretary, in August 2023.
Proceedings are being heard at Liverpool Town Hall and are expected to last around four and a half months. Here is everything you need to know about the inquiry.
It’s week four of the Thirlwall Inquiry. Today, the inquiry is hearing evidence from Dr John Gibbs, a consultant paediatrician who worked at the Countess of Chester during the years Lucy Letby was a nurse on the neonatal unit.
Dr Gibbs said: “I do deeply regret and I am ashamed that I failed to protect the babies from harm by Letby but I do understand the parents would probably prefer explanations rather than belated apologies.”
The consultant, who retired in 2019, said the unit was understaffed in nursing by around 21 per cent but not unusually so for the Cheshire and Merseyside reason, which was running at 27 per cent staff deficits.
Dr Gibbs also said that consultants were not spending enough time on the neonatal unit because of gaps in the rota.
“We should have had seven registrars, and often we only had six, and that was the case through 2015 and 2016.”