The Thirlwall Inquiry examines Countess of Chester Hospital and NHS culture after Lucy Letby trial

A public inquiry has begun into events surrounding the crimes of child serial killer nurse Lucy Letby.

Chaired by Lady Justice Thirlwall, the investigation at Liverpool Town Hall is examining how Letby was able to attack babies on the Countess of Chester Hospital’s neo-natal unit in 2015 and 2016, and how its bosses handled concerns about her.

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.

What is the Thirlwall Inquiry and who is Lady Justice Thirlwall?

Shortly after the verdicts in the trial of Lucy Letby, the government announced there would be a public inquiry into events at the Countess of Chester Hospital and the implications of those events.

Lady Justice Thirlwall, the senior presiding judge for England and Wales, was appointed to chair the inquiry.

Referencing earlier inquiries into events at hospitals including the case of baby killer Beverley Allitt, the judge said in her opening statement that “everyone was determined that it would not happen again. It has happened again. This is utterly unacceptable.

"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?"

An annex to the terms of reference asks 30 key questions which the inquiry intends to seek answers to.

Who will be giving evidence?

The hearing is a statutory inquiry which means the chair has the power to make "any relevant person or organisation" attend or give evidence under oath.

Other recent examples include the inquiries into the Grenfell fire and the Manchester Arena bombing.

The inquiry will look at the conduct of workers at the Countess of Chester Hospital (including the board, managers, doctors, nurses and midwives) from Lucy Letby’s arrival in 2012.

The judge has also indicated that she will call experts to give evidence about the status of recommendations from previous inquiries.

Detailed requests for information have been sent to over 20 organisations.

Speaking in November 2023, the senior Court of Appeal judge said, "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.

"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.

"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.

"The parents of the babies who were murdered or suffered injuries… have made it plain to me that they want to do all they can to make sure that no one else suffers as they do."

Will the Thirlwall Inquiry look into Lucy Letby’s claims of innocence?

Letby protested “I’m innocent” as she was led from the dock when she was sentenced in July 2024 to her 15th whole-life order after a jury convicted her at the retrial of the attempted murder of a baby girl.

In May, she lost her Court of Appeal bid to challenge her convictions from the first trial which took place between October 2022 and August 2023.

Her new lawyer, Mark McDonald, has claimed that new medical evidence and expert opinion shows “flaws” in the prosecution case and that he plans to apply for the case to be returned to the Court of Appeal.

A solicitor representing the families of six victims said speculation about Letby’s case in the media and possible future appeals had been “upsetting” for her clients.

> Lawyer dismisses claims of Lucy Letby’s innocence as ‘purely speculation'

> Child killer Lucy Letby ‘plans to launch fresh appeal with new legal team'

The inquiry is looking at the circumstances around what happened, not the actual Lucy Letby case.

Over three parts, it will examine parents’ experience at the hospital, the wider culture in the NHS, and the conduct of hospital workers and how Letby was "able repeatedly to kill and harm babies on the neonatal unit”.

The terms of reference give the offences as fact. The hearing will not be reviewing evidence used in the prosecution.

A letter to government ministers from 24 signatories including neonatal experts and professors of statistics called for a rethink of the terms and warned that important lessons could be missed from a “failure in understanding and examining alternative, potentially complex causes for the deaths”.

Opening the full hearing, Lady Thirlwall said, "I make it absolutely clear that it's not for me as chair of this public inquiry to set about reviewing the convictions. The Court of Appeal has done that, with a very clear result. The convictions stand."

How long is the Thirlwall Inquiry expected to take and when will the Chair publish her report?

The inquiry began in September 2024. Evidence is likely to be heard into early 2025.

The report must be made public, although some restrictions may be made on certain details such as the names of the victims.

If appropriate, the chair may decide to publish interim reports.

She will make recommendations as she considers appropriate and is required to make any reports “as soon as is practically possible."

Lady Thirlwall told the first day of the full inquiry, "After the hearings, it will be for me to write the report. I cannot tell now precisely how long that will take. Much depends on the nature and volume of the evidence.

"I can say that I expect the report to be published by late autumn next year."