A hospital executive has told the public inquiry over the crimes of child serial killer nurse Lucy Letby that she “didn’t get everything right” but she had the “best intentions”.
Alison Kelly was director of nursing at the Countess of Chester Hospital during the period when Letby attacked babies on the neonatal unit between June 2015 and June 2016.
Letby was moved off the unit in July 2016 to an administrative role after consultant paediatricians told Ms Kelly and other senior managers at the end of June that they were concerned she may be deliberately harming infants.
I would like to express my condolences to all the families and I’m really sorry for all the distress that the families have experienced over the last few years, and are currently experiencing as we sit here today
But police were not called in to investigate until May 2017 after the hospital bosses opted to commission a series of reviews into the increased mortality on the unit.
At the start of her evidence on Monday at the Thirlwall Inquiry, Ms Kelly said: “I would like to express my condolences to all the families and I’m really sorry for all the distress that the families have experienced over the last few years, and are currently experiencing as we sit here today.
“I didn’t get everything right. However the decisions I made were with the best intentions.”
Ms Kelly, who as part of her role was the executive lead for safeguarding children, told the hearing she never regarded the increase in deaths as a safeguarding matter which could have led to contact with the police earlier.
Peter Skelton KC, representing some of the families of Letby’s victims, asked: “When you were presented with the concerns that raised an issue of potential deliberate harm you didn’t take the appropriate steps and trigger the safeguarding process, did you?”
Ms Kelly said: “Yes, that is one of the things that I have spent a lot of time reflecting on but at the time it didn’t feel obvious.
“There were lots of things going on and now I know so much more information it seems obvious to me that that should have happened.”
She agreed that one of the consultants, neonatal clinical lead Dr Stephen Brearey told her in a meeting on May 11 2016 about his concerns over the rise in deaths but said he did not mention fears of deliberate harm.
Letby was discussed, she said, but she had “assurances” from her nursing team there were no concerns about her as a nurse practitioner.
Ms Kelly said: “There was nothing clearly articulated in that meeting. We all felt by the end of that meeting that we could review the situation in a number of weeks’ time.”
She said there continued to be “no articulation of actual issues” from the consultants following the deaths of two triplet boys, on successive days in June 2016.
Ms Kelly said: “There was never any clarity again. Nobody had seen her do anything. There were terms used like gut feeling… which did not pinpoint any particular issues with Letby.”
Consultants went on to tell Ms Kelly and senior managers that there had been a pattern of six out of nine deaths occurring at night and the pattern stopped when Letby was moved to days, and that some babies had not responded to resuscitation as expected.
But Ms Kelly said management were “balancing that” with the “nursing views of her practice and how highly regarded she was thought of”.
She said: “We needed to get more facts, we needed to pull more things together to see what the fuller picture was at the time.
“We had no actual evidence as in nobody had seen her do anything. There was broadbrush statements, there was no evidence provided to us at that time.
“I think we needed to look at everything in the round in terms of clinical outcomes as well as looking at one individual.
“I didn’t take the hearsay of consultants as evidence at the time.”
Ms Kelly denied she had not taken the concerns “seriously enough”.
Counsel to the inquiry Nicholas de la Poer KC asked: “Do you think there is any possibility that things had become so acrimonious with doctors versus nurses and with you backing the nurses, that a culture of fear had developed?”
Ms Kelly said: “I would not say a culture of fear. I think there were challenges with the relationships, I think the trust had broken down and I think on reflection we could have done more to support the clinicians, certainly in a pastoral perspective.
“There was lots of engagement, it was just tense at times which is why we gained advice from external agencies and the police eventually.”
She said: “It became divisive between the nurses and the doctors, and that’s not conducive to good working.”
She agreed it was “not unheard of” for a nurse to deliberately harm patients, but said that was “not in the forefront of my mind”.
Ms Kelly went on: “I think at the time I was relying on my senior nursing team to give me assurances on Letby, particularly Eirian Powell (unit ward manager) who knew her best. I would not know individual nurses on an individual basis.”
She said the consultants were still not expressing clearly why they thought Letby was murdering babies, which she found “quite frustrating”.
Explaining why police were not called in by the hospital to investigate in the summer of 2016, she said: “I think we had a general conversation about the fact that we all personally needed to know and understand what was actually going on in our organisation so that we could clearly articulate to the police what the problems were.
“At the time, we didn’t really have a sense of what was going on.”
Last week Dr Brearey gave evidence that he said “oh no, not Lucy, not nice Lucy” at a meeting with Ms Kelly in July 2015 after it was discovered she was present for the deaths of three infants weeks earlier.
However, Ms Kelly told the hearing: “That was not said at the meeting. Lucy Letby’s name was not mentioned at all.”
The inquiry heard Ms Kelly sent an email to Dr Brearey following the July 2015 meeting in which she stated it was “reassuring to know that each case had been looked at in such detail” and she invited him to speak to her if he had any further concerns.
Ms Kelly told her barrister Kate Blackwell KC that she did not hear from Dr Brearey again until May the following year when he notified her there was a nurse on the unit who was present for “quite a few of the deaths and other arrests” and that “sensibly” she had been moved to day shifts.
She said: “The impression I got from the email is that it was to provide support and welfare for Letby as we would with any nurse who was struggling.”
Ms Kelly said the executive team were “constantly asking questions” of the clinicians about evidence and more information before she learned in March 2017 from consultant Dr Ravi Jayaram he had witnessed an incident in February 2016 involving a baby girl, Child K, and Letby who was beside her cot and had “moved valves”.
She told the inquiry: “We were shocked that we had not been told that before.”
She said she was also “shocked” to hear at that time both Dr Brearey and Dr Jayaram both “felt like battered wives” and that the executives were “the abusers”.
Ms Kelly said: “It was an inappropriate comment to make.”
Dr Jayaram has told the inquiry that he “should have had more courage” in flagging up the incident but did not because of fears of not being believed and that he would be accused of bullying.
Letby, 34, from Hereford, is serving 15 whole-life orders after she was convicted at Manchester Crown Court of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims, between June 2015 and June 2016.
The inquiry, sitting at Liverpool Town Hall before Lady Justice Thirlwall, is expected to sit until early 2025, with findings published by late autumn of that year.
