Consultant says he should have had 'more courage' to raise concerns about Lucy Letby

• A report from ITV Granada Reports' Emma Sweeney

A consultant paediatrician has told a public inquiry he "should have had more courage" and voiced his concerns about nurse Lucy Letby after he had to resuscitate a baby girl.

Letby was later convicted of the attempted murder of Child K, by dislodging her breathing tube, before Dr Ravi Jayaram walked into a nursery room in the Countess of Chester Hospital's neonatal unit in February 2016.

Giving evidence on Wednesday 13 November at the Thirlwall Inquiry into the events surrounding Letby's crimes, Dr Jayaram said he had been sitting outside the nursery reading medical notes when he realised the nurse was alone with Child K and felt "significant discomfort", but also thought he was being "completely irrational and ridiculous".

He decided to go in "just to make sure everything was fine", he said.

The prosecution at Letby's trial said she was caught "virtually red-handed" by Dr Jayaram, although he did not tell anyone at the hospital, or the police, about the incident at the time.

He said: "There has been a lot of speculation but I didn't walk in and see anything. What I walked in and saw was a baby clearly deteriorating and when I went to assess Baby K the ET (endotracheal tube) was dislodged.

"My priority was to resuscitate Baby K, which I did successfully. I will take this with me to my grave. At that point I thought ‘How has that happened?'"

Explaining why he said nothing about the incident at the time, Dr Jayaram said: "It is something of a mea culpa. Why didn't I? I lie awake thinking about this.

"It's the fear of not being believed. It's the fear of ridicule. It's the fear of accusations of bullying.

"I should have been braver and should have had more courage because it was not just an isolated thing. There was already a lot of other information.

"I should have had more courage."

Dr Jayaram said he first became aware that Letby could be causing "inadvertent or even deliberate harm" to infants when he returned from leave after the death of a baby girl, Child I, in October 2015.

He recalled conversations in corridors with fellow consultants about the repeated associated presence of Letby and sudden and unexplained deaths on the unit.

He said: "I can't recall who among us was the first to articulate possibilities of deliberate harm but when expressed openly it became clear that I was not the only consultant with those concerns."

He added: "My impression was that all of us began to consider whether her presence was of significance rather than coincidence or bad luck… We were still finding it difficult to think the unthinkable but once that's on your radar it's very hard to shut it away and you run the risk of confirmation bias as well and whether you are seeing things that aren't there."

Following the incident with Child K, Dr Jayaram said the fears of Letby causing deliberate harm had become "an elephant in the room which was becoming bigger and bigger".

He said: "We felt completely impotent to know how to deal with it."

An external thematic review around the same time identified that Letby was on duty at or just prior to nine out of 10 deaths on the unit in 2015, the inquiry has heard.

Dr Jayaram said: "I naively assumed that the nursing director and the medical director would look at that, see the pattern and act."

He told the inquiry he felt the consultants did not have enough information to raise their suspicions until the third week of June when he passed on his concerns to Karen Towsend, divisional director of urgent care nursing, in a hospital cafe.

He said: "I said, as a group of consultants, we were extremely concerned about these events and we were all at a point, as a group, where we felt natural causes had been excluded as far as they could be, and we were really concerned about her being on the unit.

"My intention was to get some help and support as to what to do because we were not comfortable with Letby continuing to work unsupervised on the unit.

"I could have been more forthright. I could have have specifically said ‘You must remove her from the unit' and I didn't say that."

Letby went on to murder Child P, a baby boy, before she was finally moved from the neonatal unit to clerical duties in July 2016 after the consultants expressed similar concerns to the hospital's executive team.

Hospital bosses then opted to carry out a number of reviews into the increased mortality and did not call in Cheshire Police to investigate until May 2017.

At the start of his evidence, Dr Jayaram told the hearing: "I would like to say to the parents and families of the babies affected by this awful tragedy… I would like to apologise for any personal failings and omissions I may have made in the period leading up to June 2016 and afterwards that might potentially have made a difference to avoiding problems.

"I want to acknowledge that I will take personal responsibility for things that I could have done better and in retrospect some fairly obvious (things) that could have been done better.

"And I would like to apologise as well for the systemic failings that could have contributed to this not being picked up as soon as it could."

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, is expected to sit until early 2025, with findings published by late autumn of that year.

Gamal Fahnbulleh joins Mel Barham and Emma Sweeney to take a look at how Lucy Letby managed to slip under the radar for so long, carrying out her attacks unchallenged for a year at the Countess of Chester Hospital.