The case against Lucy Letby

Perhaps it is all the fault of reporting restrictions. When the Crown Prosecution Service (CPS) announced that serial-killer nurse Lucy Letby – convicted in 2023 of seven murders and eight attempted murders of babies – would be retried for the attempted murder of Baby K last autumn, there was a nine-month media blackout in the UK that only came to an end in July 2024. By the time the reporting restrictions were lifted, a one-sided, pro-Letby article published in the New Yorker (technically blocked online in Britain but easy enough to access) had achieved cult status and unleashed a gaggle of armchair detectives, armchair pathologists and armchair barristers. Doubts about the verdicts were no longer confined to crank websites, but started appearing in the Telegraph, the Guardian, the Independent, Private Eye and elsewhere. ‘Letby is innocent’ may not yet be the opinion of the majority, but it will not get you thrown out of many parties. It has been allowed to flourish because those of us who accept the verdicts see little point in challenging claims that have already been rejected by the courts, but perhaps we should.

Nothing has done more to sow confusion about the case than the idea that it was ‘all about statistics’. A spreadsheet showing that Letby was present during all the murders and attempted murders was used by the prosecution and widely circulated in the media after her first conviction. Those who knew little else about the case assumed that this was what had persuaded the jury. Concerns were raised about the Texas sharpshooter fallacy – where a man shoots at the side of a barn and then paints a target centred around the tightest cluster of bullet holes. Was it not possible, they said, that the police had looked at the spike in deaths that took place at the Countess of Chester Hospital (CoCH) in 2015 and 2016, cherry-picked the ones at which Letby was present and ignored the rest? As the normally sober Economist asserts in the current issue: ‘The target was painted around the arrow. She was convicted.’

It is a basic task of the prosecution to establish that the accused was at the scene of the crime. It is true that Letby’s invariable presence on the ward when babies suffered unexpected collapses raised concerns among some of her colleagues, although the concerns were initially more about poor practice than foul play. It is also true that the prosecution case largely depended on her being the only nurse on duty when the alleged attacks occurred. No other nurse was present on more than seven occasions, whereas Letby was there for all 22.

If you accept that all 22 incidents involved deliberate harm inflicted on babies, Letby is clearly the prime suspect. This is not a statistical argument. It is about opportunity. Once the court had established that someone was killing children in the CoCH, it could only have been Letby because everybody else had the watertight alibi of not being in the hospital at the time. This logic holds even if you think that only half the incidents involved deliberate harm, since none of her colleagues was present even half the time.

The Texas-sharpshooter fallacy only comes into play if all the deaths and collapses had a natural cause. In that scenario, it is possible that there were unexplained deaths that Letby was never charged with because she was not present. This is pure speculation because we do not know what caused the deaths of the other babies during the relevant period (nor do we know whether Letby was present), although it is at least possible.

But for this possibility to be entertained, the deaths and collapses must have an innocent explanation. That is why Letby kept mentioning understaffing and plumbing problems on the ward (the latter supposedly spreading infectious disease). There were indeed staffing shortages and there had been at least one incident of sewage backing up into a sink, but Letby was never able to explain how these issues caused deaths and collapses. None of the babies died from sepsis and neither the collapses nor the recoveries were consistent with infection. One of the unusual features of some of the cases was that the babies recovered as suddenly and unexpectedly as they collapsed, which is not what you see with a standard infection or natural deterioration. As for staffing, there was usually one nurse per baby in Nursery 1 (where the sickest babies were kept) and when a baby died that nurse was usually Lucy Letby. There were undoubtedly shortcomings at the hospital, as there are across the NHS, but in almost none of the cases could these problems explain healthy babies suddenly dying in ways that staff had never seen before.

The Poundshop Poirots who unwittingly regurgitate Letby’s talking points have been no more able than she was to explain how dodgy plumbing and occasional understaffing caused the events of 2015 and 2016, let alone how it caused two babies to be poisoned by insulin. They blithely claim that the hospital was ‘badly run’ and talk vaguely about a ‘spike’ in deaths that could have happened in any hospital. They talk about babies dying in neonatal wards as if it were a regular occurrence and that Letby was, in effect, simply in the wrong place at the wrong time.

But the death of early neonates at the CoCH was unusual – there were only three a year in 2013 and 2014 – and most of the babies that Letby was convicted of murdering were relatively healthy. None of them was expected to die, but they all suddenly collapsed, often shortly after their parents had left their bedside or after Letby came on duty. For Letby’s defenders, it is important that people do not look carefully at how the babies died. They want you to focus on the so-called statistics rather than the details. Their cause has been aided by the court transcripts not being publicly available, although an enlightening judgement from the Court of Appeal is available and some transcripts have been narrated on the Crime Scene 2 Courtroom YouTube channel. This material, alongside newspaper coverage of the two trials, is no substitute for being on the jury, but it provides ample evidence of foul play.

Take the last of Letby’s victims. When Letby was in Ibiza in June 2016, the CoCH took in three naturally conceived triplets. They were premature but were described by a consultant at the CoCH as ‘completely normal triplets who were expected to run a healthy course’, until Letby returned from holiday and became the designated nurse for two of them in Nursery 2. The first to die was Baby O, who weighed four and a half pounds and was ‘born in good condition and made good progress’. On 23 June, Letby’s first day back at work, she was alone with Baby O when he suffered a collapse. Dr Andreas Marnerides, the reviewing pathologist, said that the cause of death was ‘inflicted traumatic injury to the liver, profound gastric and intestinal distension following acute excessive injection / infusion of air via a naso-gastric tube and air embolism due to administration into a venous line’. He said that the damage to Baby O’s liver was so extensive that it was like that of a victim of a road-traffic accident. As with many of the babies who collapsed during Letby’s tenure, Baby O had an unusual rash that came and went. Numerous medics who saw these babies collapse said they had never seen this type of skin discolouration before.

Professor Owen Arthurs, a radiologist, said that X-rays of Baby O showed gas in the heart that was consistent with severe trauma or air embolus. Dr Dewi Evans, a retired consultant paediatrician who reviewed all the cases for the police, said that Baby O’s death was ‘likely to be the result of air embolus together with bleeding within the liver and into the peritoneal cavity’. Dr Sandie Bohin, a practising consultant neonatologist who also reviewed all the cases, agreed with this opinion. Blood tests found no trace of infection. Letby accepted in court that the liver injury happened ‘on her watch’ and ruled out staffing levels as a contributory factor.

Letby is incriminated not only by her presence at the crime scene, but also by various actions that were characteristic of how she went about her killing. She falsified a medical note, writing that Baby O had been on breathing support when he was not, thereby making it look as if he was sicker than he was. After he died, she told another nurse that Baby O ‘had a big tummy overnight but just ballooned after lunch and went from there’, as if his full abdomen the night before Letby started her shift was somehow responsible for his collapse. A week after the death, she wrote ‘Peripheral access lost’ on a Datix form (used by staff to report clinical incidents), but this was immediately contradicted by Dr Stephen Brearey, the neonatal lead who had tried to resuscitate Baby O, who insists that intravenous access was not lost at any point. Why would Letby lie about this? Because if intravenous access was lost, the child could not have been injected with air. She was covering her tracks.

This is typical of what the prosecution called Letby’s ‘gaslighting’. She would portray babies as sicker than they were so their deaths would seem less suspicious. After the death of Baby O, she planted seeds for her next murder by texting a colleague about Baby P, saying: ‘Worry as identical.’ The next day, Baby P collapsed at 3.14pm just after doctors had examined him and Letby was alone by his cot. He died at 4pm. The cause of death was listed as ‘sudden unexpected postnatal collapse’ and the coroner was unable to identify the underlying cause. There was no evidence of infection. Letby texted a colleague to say: ‘Just blew tummy up and had apnoeas, downward spiral. Similar to [Baby O].’ She was creating a narrative that the triplets had a mysterious genetic condition that would kill them all. But they didn’t. We know this because the third triplet survived, despite being the sickest of the three at birth, because his parents pleaded with a paediatrician for him to be transferred to Liverpool Women’s Hospital. The paediatrician agreed because, by this time, she had concluded that Letby was ‘a mortal danger’ and that transferring the last triplet was ‘the only way he was going to live’.

Two days after texting a colleague from Ibiza to say that she would ‘probably be back in with a bang lol,’ two triplets had died without an adequate explanation. During Baby P’s collapse, Letby said to another nurse, He’s not leaving here alive is he?,’ a comment that was at the very least unprofessional. On the first anniversary of Baby O’s death, she looked up the family on Facebook and drafted a strange note, saying: ‘Today is your birthday but you are not here and I am so sorry for that.’ This could be interpreted as the outpourings of a sensitive nurse, except that it was addressed to all three triplets, despite one of them being alive and well. Did she get confused or was she fantasising about having killed them all? It is idle to speculate, and her personal jottings and offhand comments were not central to the prosecution, but her peculiar behaviour is worth noting since part of the disbelief about her guilt stems from her supposed normality.

Babies O and P are just two of the 14 children Letby was convicted of attacking, but even a brief overview of their cases should be enough to dispel the notion that there was a random spike in the number of run-of-the-mill deaths of ultra-sick infants at the CoCH, which the police rebadged as murders and arrested whoever was most often on duty. If the jury had been bewitched by the staff-rota spreadsheet they would have convicted Letby on all counts. Instead, the first jury acquitted her of two counts and failed to reach a verdict on a further six.

The evidence of foul play is so overwhelming that Letby’s supporters have to disregard almost everything said by countless medics who were at the hospital at the time – as well as the opinions of pathologists, neonatologists, radiologists and haematologists, not to mention the views of two juries and three appeals-court judges. The doctors who raised the alarm? They had a grudge against Letby for some reason! Dr Dewi Evans? He’s a grifter! Numerous experts who agreed with Evans? Groupthink! The forensic evidence showing that someone was poisoning babies with insulin? The tests were wrong! Letby’s lawyer? He was useless! On and on they go, these Letby simps who imagine they could have destroyed the prosecution’s case in five minutes if only they had been allowed to take the stand.

Letby’s fanclub complains that the defence called no expert witnesses to counter the evidence from the prosecution, although at least one expert had made himself available. They suggest that this alone is enough to deem the trial unfair and the convictions unsafe. Her lawyer, Ben Myers KC, is one of the best silks in the land. He represented Letby as well as he could and she was happy enough with him to have kept him on for her appeal. There is only one rational reason why he would choose not to call an expert to discuss the science: it would have damaged her defence. If a medical expert had been called, the cross-examination from the prosecution would likely have gone something like this:

‘Could the death of Child A have been air embolism?’
‘Yes.’
‘What else could it have been?’
‘I don’t know.’

In the end, the defence called no witnesses apart from a plumber who was supposed to shore up Letby’s risible theory about sewage. This slightly pathetic detail is not a sign that Myers was incompetent, rather it indicates that Letby did not have a leg to stand on. Letby seems to have believed that her best chance of wriggling out of her crimes was to take the stand herself and sweet-talk the jury. It didn’t work. By all accounts, she came across as shifty, cold and evasive, caught up in her own web of lies and claiming to have forgotten things that anyone would remember.

The possibility of Letby’s innocence cannot be completely discounted, but if it was a miscarriage of justice, it was one of the most elaborate and unlikely miscarriages of justice in history. For all practical purposes, it comes down to this. If no one was killing children at the CoCH in 2015-16, Letby is obviously innocent. But if anyone was killing children at the CoCH in 2015-16, it was her. Why? Because she was the only person who had the opportunity on the dates in question. Therefore, for Letby to be innocent there can have been no murders or attacks on babies, but that can only be true if there has been an extraordinary concatenation of circumstances that can only be plausibly attributed to a conspiracy involving a large number of doctors, nurses, medical experts and, quite possibly, her own defence team. And for there to be a conspiracy, there must be a motive.

Letby apologists – like Letby herself – are broadly aware of this, but the only motive they can find requires the preposterous belief that NHS managers wanted to avoid the bad publicity that comes from having a high mortality rate due to poor plumbing and medical incompetence, and so decided to throw Lucy under the bus. In other words, they callously condemned an innocent young woman to die in prison because they thought that making the Countess of Chester Hospital world famous for harbouring Britain’s most prolific child-killer was preferable to taking the indirect blame for a spike in neonatal deaths. Even if you disregard the fact that it was the doctors who raised suspicions about Letby and the NHS managers who shielded her, this is a mental thing to believe.

But you had better get used to hearing such theories, because as long as Letby is in prison, there will be people prepared to beclown themselves by defending her. And she is never going to get out of prison.

Christopher Snowdon is director of lifestyle economics at the Institute of Economic Affairs. He is also the co-host of Last Orders, spiked’s nanny-state podcast.