Between June 2015 and June 2016, several parents of newborn infants were badly let down by the Countess of Chester Hospital in northern England. An ensuing murder trial, one of the longest-ever in British criminal history, ended on Monday, 21 August 2023, when Mr. Justice Goss imposed 14 whole-life orders- the severest sanction possible under the laws of the land-on Lucy Letby, a 33-year-old former children’s nurse. Letby chose to stay away from the dock at the time of her sentencing for what the judge described as “a cruel, calculated, and cynical campaign of child murder involving the smallest and most vulnerable of children”, thereby escaping face-to-face contact with grieving parents as they read out their victim impact statements in court. As Britain’s most prolific serial child killer, it is expected that she will be sent to top-security HMP Low Newton in the village of Brasside, near Durham, where the only two other whole-life female detainees in the country have both spent time. It is also likely that the nature and extent of her crimes will require Letby to be segregated for her own safety while in prison. The government has meanwhile announced a non-statutory inquiry into her misdeeds, although many feel that this does not go far enough as witnesses cannot be compelled to give evidence if they not wish to do so.
Lucy Letby was born in Hereford in January 1990, an only child, and attended a comprehensive school and sixth form college before qualifying as a children’s nurse from the University of Chester in 2011. She joined the neonatal unit at the Countess of Chester Hospital in January 2012, shortly before her 22nd birthday. Despite a promising start, during which she was featured in the Chester Standard on 28 March 2013, she was to be later linked to an unusual spike of deaths in the unit. Concerns about Letby’s possible involvement in this spike of unanticipated deaths and catastrophic collapses was raised by consultants in the neonatal unit as far back as 2015. These early warnings failed to elicit an appropriate response from management, who treated Letby as a victim of unwarranted accusations. The complaining consultants were accordingly made to undertake mediation with Letby and to even write her a formal apology.
Persistent efforts by the consultants eventually paid off when the Cheshire Constabulary began investigating events in the neonatal unit from May 2017 onward. Operation Hummingbird was set in motion after December 2017. The police undertook a systematic review of written and digital medical records, and interviewed thousands of witnesses to build up their case. Letby was declared a suspect and first arrested in June 2018, only to be bailed. She was re-arrested in June 2019, and bailed yet again. Letby was formally charged in November 2020 and remanded in custody thereafter, having been accused of murdering seven newborn infants and attempting to murder six more between June 2015 and June 2016. Some of the survivors were left with long-term and life-changing disabilities. Letby’s fate was decided by a jury of seven women and four men, who sat through 145 days of evidence during a ten-month trial at Manchester Crown Court, from 10 October 2022 onward. It was shown that Letby resorted to a variety of methods to harm the infants in her change. She was eventually convicted on 14 out of 22 possible counts on 18 August 2023.
Health care professionals have a unique responsibility to help people under their care, but this relationship is inevitably compromised when they seek to actively harm their patients instead. The breach of trust can occur for all kinds of reasons, including a feeling of omnipotence, an attention-seeking ploy, financial gain, or personality disorder, all of which can sometimes overlap in varying degrees. Rarely, compassion is cited as the reason for the “mercy killing” of a terminally ill person. While the opportunity may readily present itself, along with access to methods that can harm, the underlying motives are often difficult to discern, as in the case of Lucy Letby, whose persona and clinical competence aroused no concerns when she first began work.
Serial murders in hospitals, nursing homes, or in the community are often first suspected by the occurrence of clusters of unexplainable deaths. Hard evidence to implicate the killer is often lacking, as there are no eyewitnesses and the victims usually do not sustain physical injuries. Murderers in healthcare setting may either smother or strangle their victims, depriving them of oxygen, or inject potentially lethal medications (insulin, potassium, opiates, muscle relaxants) or air into their bloodstreams. Frequently, criminal prosecution depends on circumstantial evidence and the results of toxicological tests, unless closed circuit TV footing shows the criminal assaults actually taking place.
Serial killings by healthcare professionals are thankfully rare. Attempts have been made to profile potential killers among healthcare providers, although most of the usually mentioned warning “red flags” were not noted in the person of Lucy Letby. Those who actively harm people under their care may have a history of personality disorder, substance abuse, criminal activity, or volatile inter-personal relationships, but these traits are far from uncommon in the wider public. The work history of potential serial killers is often more revealing. These people may move from job to job, leaving a trail of disciplinary issues and incidents at other institutions behind them, which is often not picked up and acted upon. They frequently prefer to work at nights or during weekends, when there is less scrutiny by regular work colleagues.
The particular circumstances of Letby’s misdeeds are exceedingly rare and probably could not have been anticipated and recognised from the very outset. The whole episode has, however, revealed a much commoner issue within the NHS, relating to whistleblowers and how they are dealt with by hospital management. Staff members who raise concerns are frequently either ignored, sidelined, bullied, reprimanded, demoted, transferred, or even investigated themselves. A “toxic culture” in which institutional reputation supersedes the patient safety has unfortunately become embedded in sections of the NHS. The series of infant deaths at Chester may well have been prevented if only effective patient safety procedures were implemented at the time.
Ashis Banerjee
PS: On 30 August, Health Secretary Steve Barclay announced that a statutory inquiry would go ahead, in place of the initial non-statutory investigation, thereby signalling a change of direction in the government’s line of thinking.