Lucy Letby: hospital did not act on senior paediatricians’ warning about Letby, inquiry hears – as it happened

4.11pm BST

Summary of the day …

• Comments on the validity of Lucy Letby’s convictions for murder and attempted murder have created “an enormous amount of stress” for the parents of her victims, Lady Justice Thirlwall has said on the opening day of a public inquiry into events surrounding the deaths

• Thirlwall said the inquiry bore her name to avoid the bereaved parents having to repeatedly see the name of the person convicted of killing and harming their infants. “It is not for me to set about reviewing the convictions,” she said, adding “The court of appeal has done that with a very clear result”

• Rachel Langdale KC, counsel to the inquiry, has said that the purpose of it is “keeping babies safe in future from a healthcare professional who seeks to harm them”

• The inquiry has already heard of what are now considered missed opportunities to have halted Letby, with warnings by a senior consultant dismissed, and a failure to take into account similar near fatal collapses when looking at the pattern of deaths in the neonatal unit

• The inquiry was told it was a year between the first mention of maybe involving police and them being contacted over Letby. For months it seemed like the hospital was treating the situation like a HR issue rather than a potential criminal case

• Langdale suggested that Letby had utilised the grievance process at the hospital in order to evade scrutiny

• Counsel to the inquiry also said it was of “considerable concern” to the inquiry that evidence given to it suggests that a report by Dr Hawdon sent to the senior hospital management may have been altered after it was written, but before it was sent to them

• The inquiry at Liverpool town hall will examine events at the Countess of Chester hospital’s neonatal unit where Letby was a nurse between 2015 and 2016. The 34-year-old, was sentenced to 15 whole-life orders after she was convicted across two trials of murdering seven babies and attempting to murder seven others

• It will cover three broad areas: the experiences of the parents of the babies who featured on the criminal indictment that Letby faced, the conduct of those working at the Countess of Chester and how Letby was allowed to repeatedly kill, and the wider NHS culture and governance

• The inquiry resumes tomorrow at 10am

4.11pm BST

Rachel Langdale KC has finished the session for the day by asking a long series of questions that the inquiry will have to consider about the grievance process used by Lucy Letby and the whistleblowing procedures in place in Countess of Chester hospital.

In particular she asks whether undue pressure was applied to consultants who had raised issues about Letby, including the suggestion complaints might in turn be made about them to the GMC. Langdale also asked whether the person running the process – a nurse from a neighbouring trust – was truly independent and empowered to carry out an independent investigation.

She also questioned why so little legal advice was taken during the process, and why the advice that was taken appears to have been commissioned by the HR department on an ad hoc basis rather than by the legal department.

Langdale ended by asking the inquiry whether the evidence in fact reveals what she called an “abject failure” by those investigating the case to engage with the most basic safeguarding requirements and the need to keep babies in the care of the hospital safe.

3.54pm BST

In a lengthy section Rachel Langdale KC has been outlining how Lucy Letby received professional help in setting out her grievance against being taken away from duties on the neonatal ward, and that she felt she had been told she could not socialise normally with colleagues.

Langdale says later oral testimony at the inquiry will explore this process, and how it came to be that when there was a meeting over the case Letby appears to have been left unaware that there were external reviews being carried out.

3.38pm BST

The Thirlwall inquiry has beed told by Rachel Langdale KC that she will now talk about whistleblowing in the NHS. She says the inquiry will investigate whether the Countess of Chester hospital was implementing its stated whistleblowing policy.

3.36pm BST

Rachel Langdale KC has suggested that it may have just been “chance” that prevented Lucy Letby having more access to babies after she was removed from duty. Langdale reminded the inquiry that it was originally the plan that Letby should be “supervised” on the ward, but due to staffing issues this did not happen. Langdale said it was only the vociferous lobbying of the consultant paediatricians that continued to advocate for being kept out of the direct care of children.

3.27pm BST

In a strong use of language, the Thirlwall inquiry has heard that Karen Rees, head of nursing, described it as “immoral” that Lucy Letby was not being allowed to work directly with patients during this period.

She appears to have suggested that any concerns about Letby were based on “gut feeling” from the senior paediatricians and not evidence, and that “this allegation against Letby is massive and if anyone is of this belief then why have the police not been called?”

One issue for the inquiry to examine is that it appeared a decision had been made to return Letby to duties in the neonatal unit in January 2017 before the external investigations into the unit were completed.

3.21pm BST

At the Thirlwall inquiry, counsel Rachel Langdale KC has picked up that senior management at the hospital at some point seemed anxious to “draw a line” under allegations against Lucy Letby.

The trust’s chief executive, Tony Chambers, has said in his evidence, the inquiry heard, that he does not recall being “emphatic” about it, but it also appears that he said Letby had been “exonerated” when her grievance was partially upheld.

Langdale stressed to the inquiry that the grievance process had not involved any investigation of Letby’s actions.

2.45pm BST

We have reached the point in the timeline when Lucy Letby raised a grievance against her treatment. It was partially upheld and as a result consultants who had raised questions about her were told they needed to apologise to her.

“The abuse of a greivance process to evade scrutiny is,” Rachel Langdale KC says, “something that an organisation must be able to recognise”. She said the inquiry has seen evidence that suggests the grievance began to dominate the thinking of management.

The inquiry is breaking for 15 minutes and will start again at 3pm BST.

2.41pm BST

Rachel Langdale KC has flagged up that it is of “considerable concern” to the inquiry that evidence given to it suggests that a report by Dr Hawdon sent to the senior hospital management may have been altered after it was written but before it was sent to them.

2.27pm BST

The upshot of this section of Rachel Langdale KC ’s opening statement at the Thirlwall inquiry is that for months it appeared that the hospital was treating Lucy Letby and whether she should be allowed direct contact with patients as a HR issue, attempting to manage her return to work in the neonatal unit in a “supportive” environment, rather than escalating the suspicion around her to the police.

2.25pm BST

In his statement to the inquiry, Ian Harvey , the hospital medical director at the time, has said “My recollection is that the clinicians became more vociferous about [Letby] being removed, while the nurses wanted her to remain.”

2.22pm BST

Rachel Langdale KC has said that the inquiry will seek to determine whether internal reviews after the deaths of two of the triplet in the summer of 2016 were reflected in a “balanced and accurate summary” when management were told “nothing of significance was identified” in what was described as a “thorough internal review”.

2.19pm BST

The Thirlwall inquiry has been told by Rachel Langdale KC that during 2016 it was the deaths of Child O and Child P that first led the senior management to discuss “unexplained instances of infant mortality” in the department.

By the end of June 2016, Langdale says, “senior paediatricians were in agreement, Letby should be removed from the ward on the grounds of patient safety.”

2.06pm BST

Hospital did not act on senior paediatricians' warning about Letby, inquiry hears

Rachel Langdale KC has read out an email from Dr Brearey in which he conveyed in strong terms that the senior paediatricians did not believe Lucy Letby should have continued access to patients. This was again not acted on upon by the hospital.

Langdale is also saying the inquiry will be investigating why the first mention of involving the police in the case was in July 2016, but no action was taken to do so until a year later.

Updated at 2.52pm BST

1.58pm BST

After one of a set of triplets unexpectedly died in June 2016, the inquiry is told concerns were raised about Lucy Letby’s presence, but this was not escalated and she was not taken off duty. A second of the triplets subsequently suddenly died, and the parents of the triplets have told the inquiry they believe it was only their insistence that the third child was moved to a different hospital that saved its life.

Rachel Langdale KC explains that there is some dispute in the timelines given by staff at the hospital in their evidence of the precise timing of who raised issues when with Letby’s presence over that weekend. She says the inquiry will examine this in oral testimony.

1.50pm BST

The Thirlwall inquiry has now resumed after lunch. Counsel to the inquiry Rachel Langdale KC is continuing to give the opening statement. She is running chronologically through the events at the Countess of Chester hospital. This morning she suggested that the evidence given to the inquiry so far indicates there were missed opportunities to prevent Lucy Letby from murdering and harming babies, and that the inquiry will address this.

12.57pm BST

Key moments from the first morning of the Thirlwall inquiry

• Comments on the validity of Lucy Letby’s convictions for murder and attempted murder have created “an enormous amount of stress” for the parents of her victims, Lady Justice Thirlwall has said on the opening day of a public inquiry into events surrounding the deaths

• Thirlwall said the inquiry bore her name to avoid the bereaved parents having to repeatedly see the name of the person convicted of killing and harming their infants. “It is not for me to set about reviewing the convictions,” she said, adding “The court of appeal has done that with a very clear result”

• Rachel Langdale KC, counsel to the inquiry, has said that the purpose of it is “keeping babies safe in future from a healthcare professional who seeks to harm them.”

• The inquiry has already heard of what are now considered missed opportunities to have halted Letby, with warnings by a senior consultant dismissed, and a failure to take into account similar near fatal collapses when looking at the pattern of deaths in the neonatal unit

• The Thirlwall inquiry has been told that doctors admitted that the process for reviewing child deaths at the Countess of Chester hospital was “disparate and inconsistent”

• The inquiry at Liverpool town hall will examine events at the Countess of Chester hospital’s neonatal unit where Letby was a nurse between 2015 and 2016. The 34-year-old, was sentenced to 15 whole-life orders after she was convicted across two trials of murdering seven babies and attempting to murder seven others.

• It will cover three broad areas: the experiences of the parents of the babies who featured on the criminal indictment that Letby faced, the conduct of those working at the Countess of Chester and how Letby was allowed to repeatedly kill, and the wider NHS culture and governance.

12.46pm BST

The Thirlwall inquiry has risen for a lunchtime break.

12.42pm BST

The Thirlwall inquiry is hearing about a chain of messages about staffing at the hospital discussing Lucy Letby being moved on to day shifts, after some staff at the hospital had noted her presence at all of the deaths and the near fatal collapses in question. Rachel Langdale KC says the inquiry will be examining whether people at that point were more concerned with pressing issues of filling the staffing rota rather than escalating why Letby had been moved.

The inquiry is told that consultant Stephen Breary raised specific concerns about Letby in October 2015. These appear to have been dismissed by the neonatal unit ward manager, who seemed to have taken a view that it was “unfortunate” that Letby had been present.

Langdale told the inquiry that this appears to be the tone of the hospital response, that regardless of them being raised by a senior figure, the concerns were not seen as “urgent”.

12.35pm BST

Rachel Langdale KC has pointed out that non-fatal unexpected collapses were not included when there were review meetings into neonatal deaths, and that had that happened, it may have become clearer that Lucy Letby was on duty on all these occasions.

She points out that the Clothier report into the deaths of children at the hands of Beverley Allitt in the 1990s had recommended they be recorded.

12.29pm BST

The Thirlwall inquiry has been told that the death of Child E was another “missed opportunity”, and that the death of Child F should have been flagged up because of a test result indicating the presence of synthetic insulin.

The death of Child E was the fourth unexpected death in the space of two months, and the inquiry was told that head of risk and patient safety at Countess of Chester hospital Ruth Millward accepts it should have been flagged as a serious incident, which would have triggered an investigation.

In a statement given to the inquiry, one of the doctors involved in the cases, who has been granted anonymity, said it was assumed the test on Child F’s blood was inaccurate because it would have been “absurd and ridiculous unlikely” that anybody would have administered it to the baby. “The test being wrong seemed the only possible explanation,” they said.

Consultant Dr John Gibbs has, the inquiry heard, described it as a “collective failure”.

12.23pm BST

Rachel Langdale KC has said to the inquiry that one of the questions the Thirlwall inquiry is seeking to answer is whether the structures and processes at the hospital contributed to the failure at the Countess of Chester to protect the babies in its care.

She says it is “striking” that when there was a July 2015 meeting held to discuss the deaths there was only one doctor present, and that they, Dr Brearey, “had not personally been involved” in any of the attempts to resuscitate the babies.

Langdale says the inquiry will look at the hospital’s processes around recording infant deaths, its holding of risk registers, and the governance structure.

12.15pm BST

The Thirlwall inquiry has been told that at a July 2015 meeting at the Countess of Chester hospital after the deaths of three babies in quick succession it was decided that “no further investigation was warranted”.

Addressing the inquiry, counsel Rachel Langdale KC said the inquiry would examine if this was an “opportunity missed”.

She said that as well as not recommending further investigation, the meeting did not examine which staff had been present on each occasion, nor did it include the sudden near fatal collapse of Child B in the cases it was examining, despite it falling into the same period and staff at the time having noted similarities between Child B, who survived the collapse, and Child B’s twin Child A, who died.

Langdale suggests that had consideration been given to the collapse of Child B, and to the staffing make-up during the incidents, then it could have been noticed in that July that Letby had been present “at each sudden and unexpected death.”

The inquiry was told that the issue of which staff were working was not looked at again until a further two children had died.

11.47am BST

The inquiry has been hearing about the death of Child D. It was, Rachel Langdale KC says, “the third neonatal death in under two weeks.”

“This exceeded the total number of deaths in 2013, two deaths, and equalled the total deaths in 2014, three deaths,” she says, adding that there had also been the near fatal collapse of Child B during the same period of time. She noted that Lucy Letby had been present on each occasion.

On-call consultant Dr John Gibbs has said in a statement to the inquiry “it was recognised that Letby had been present on each occasion, and this was also noted at the serious incident meeting.”

He went on to say in his statement “Letby worked more shifts than other neonatal nurses and I felt, as did my consultant colleagues at the time, that she was merely unfortunate to have been involved in the cluster of deaths. I was not suspicious of deliberate patient harm.”

Langdale says Child D had an unusual rash, as had Child A. She says there appears to have been a desire to arrange a staff debrief after the death of Child D, but “there do not appear to be minutes.”

Langdale says that in later oral evidence the inquiry will seek to find out more information about what was raised at contemporary meetings.

Updated at 11.50am BST

11.33am BST

Rachel Langdale KC said one of the key questions before the inquiry was whether a “bias” towards Lucy Letby influenced the hospital’s response.

She said the inquiry would examine why detailed medical analysis of the deaths and collapses of babies did not take place earlier, and noted that “It was not until April 2017, almost two years after the first murder, that the hospital made a referral to the police and detailed multi-disciplinary medical scrutiny and analysis was finally conducted.”

The third part of the Thirlwall inquiry will consider wider NHS culture, governance and management structures.

11.19am BST

The Thirlwall inquiry has been told that doctors admitted that the process for reviewing child deaths at the Countess of Chester hospital was “disparate and inconsistent.”

Rachel Langdale KC, counsel for the inquiry, has told the chair Lady Justice Thirlwall that the death of Baby A was “not just unusual, but also unexpected” and had left doctors and nurses shocked. Nobody at the time, Langdale said “considered the death of Baby A to be anything malicious.”

Langdale explained that the death of Baby A and the collapse of Baby B happened within a 36 hour period. They were twins. She said that Child A’s death was not reported as a “sudden unexpected death in childhood” as it should have been.

Langdale says that of the seven babies murdered by Lucy Letby, only Baby C had a doctor attend a sudden unexplained death in childhood meeting. Baby C died six days after Baby A, and four days after the collapse of Baby B.

“The deaths of Baby A and Baby C were unexpected,” Langdale explains, adding that the clinical signs around the deaths were considered “unusual”.

But she tells the inquiry medical staff did not link all the cases, and says to the chair that she might want to consider that other deaths could have been prevented if a different course of action had been taken at this point.

11.02am BST

Jamie Grierson is attending the Thirlwall inquiry for the Guardian:

Rachel Langdale KC made reference to serial killer nurse Beverley Allitt, who was convicted of four counts of murder, three of attempted murder, and a further six of grievous bodily harm on children at the Grantham and Kesteven hospital, Lincolnshire, in the 1990s.

She told the inquiry a statement had been received by the inquiry from former secretary of state for health Baroness Bottomley, who ordered an inquiry be conducted to establish the facts after Allitt’s crimes.

Langdale said: “Nevertheless, and distressingly, 25 years later another nurse working in another hospital killed and harmed babies in her care.”

She said the inquiry would hear the crimes of Allitt formed part of the training course Letby underwent at the University of Chester.

10.52am BST

Rachel Langdale KC has said that the purpose of the inquiry is “keeping babies safe in future from a healthcare professional who seeks to harm them.”

She tells the inquiry that it and the presiding chair, Lady Justice Thirlwall, expect “witnesses to tell the truth, no matter how difficult that might be.”

She goes on to say:

You will hear heartbreaking and thoughtful evidence about the experiences of parents whose babies were named in the indictments. You will hear how their lives have been impacted forever.

She says it is important that each of them should be able to tell the inquiry “what happened from their own unique perspectives” in either oral or written evidence.

There are court-ordered reporting restrictions in place to protect the anonymity of the babies murdered by Lucy Letby, or those she attempted to murder. This anonymity extends to their families. The restrictions apply to the inquiry itself, as well as media reporting.

10.44am BST

In her opening statement, the counsel to the inquiry, Rachel Langdale KC , said failure to take into account all the evidence could be damaging.

There is a requirement in every case to take into account all of the evidence and to consider each piece of evidence in the context of all the other evidence. Medical or scientific evidence in the case should never be compartmentalised or examined in isolation. Those who do this will be less likely to see the picture as a whole, and if they do not see the picture as a whole, they may reach conclusions that are not only wrong, but are speculative and damaging.

The comments at the start of the long-awaited inquiry come after reports highlighting doubts over Letby’s convictions . Legal representatives for the bereaved families have said reports calling into question the convictions had been upsetting.

In her opening remarks to the Thirlwall inquiry, Lady Justice Thirlwall described the speculation as a “noise that has caused an enormous amount of stress for the parents.”

10.39am BST

Thirlwall inquiry 'unwavering focus will not be on examining Letby conviction' but on the hospital's response at the time

Rachel Langdale KC, the legal counsel to the Thirlwall inquiry, has said the inquiry’s “unwavering focus” will not be on examining the conviction of Lucy Letby for the murder and attempted murder of babies, but on what the response at the Countess of Chester hospital should have been to the deaths.

She told the opening morning of the hearing at Liverpool town hall:

We will consider whether Letby’s crimes could’ve been prevented and whether she should’ve been removed from the unit sooner. The inquiry’s unwavering focus will not be examining the conviction but what the responses were at the time. What people knew or should have known.

We will be investigating whether individuals had at their forefront the need to keep babies safe.

History tells us that medical serial killers are deceptive, manipulative and skilled at hiding in plain sight. For ordinary decent right thinking people the actions of Letby will remain unfathomable.

Langdale said “We will not be inviting speculation about her motive,” adding “We will be asking why detailed rigorous medical analysis of sudden unexpected deaths and collapses did not take place earlier and why [the] attacks were allowed to continue for a year.”

10.29am BST

Thirlwall: final report into Lucy Letby killings expected next autumn

Lady Justice Thirlwall has told the Thirlwall inquiry that she expects to publish her final report in the autumn of next year.

The inquiry has opened today in Liverpool for four days of opening statements, with hearings expected to continue into early next year.

Thirlwall said in her opening statement “At the heart of this inquiry are the babies who died who were injured and their parents. I do not presume to describe the feelings and emotions that those parents experienced.”

10.24am BST

Thirlwall: 'outpouring of comment' on Letby convictions has been 'noise' causing 'enormous stress for parents' of victims

Jamie Grierson is attending the Thirlwall inquiry for the Guardian:

An “outpouring of comment” on the validity of Lucy Letby’s convictions for murder and attempted murder has created a “noise that has caused an enormous amount of stress for the parents” of her victims, Lady Justice Thirlwall has said on the opening day of a public inquiry into events surrounding the tragic deaths.

Thirlwall told the inquiry that doubts cast on Letby’s convictions have come “entirely from people who were not at the trial” as she opened the inquiry at the Countess of Chester hospital’s neonatal unit where Letby was a nurse between 2015 and 2016.

Thirlwall said it was not for her to review the convictions, adding the court of appeal had done that with a clear result. “The convictions stand,” she said.

Thirlwall added that the inquiry bears her name, rather than the name of Lucy Letby, so parents do not see the name of the person convicted of killing and harming their infants. She said the guilty verdicts did not “ring immediate closure on what happened to their babies.”

The first day of the Thirlwall inquiry will hear opening statements from legal counsel at Liverpool town hall. The three key areas being looked at by the inquiry are: the experiences of the victims’ parents; the conduct of staff at the hospital with regard to Letby when she was employed at the hospital; and the effectiveness of NHS management.

Unlike other recent public inquiries, like that into the handling of the Covid pandemic or the Post Office Horizon IT scandal, the Thirlwall inquiry is not being streamed live to the public. At a preliminary hearing in May, Rachel Langdale KC , counsel to the inquiry, said court orders that prevented the identification of a number of people involved, including all of the babies, had to be complied with, and Thirlwall subsequently ruled against live broadcasts. Core participants and limited sections of the media have been granted remote video access.

Letby, 34, was sentenced to 15 whole-life orders after she was convicted of murdering seven babies and attempting to murder seven others across two separate trials.

10.15am BST

The core participants names by the inquiry include the families of the babies who were killed, and various organisations involved in their care. They are named on the inquiry’s website as:

• Families of children named on the indictment

• Royal College of Paediatrics and Child Health

• Department of Health and Social Care

• Countess of Chester hospital NHS foundation trust

• Nursing and Midwifery council

• Care quality commission

• NHS England

In addition, four former members of staff at the Countess of Chester hospital are listed as core participants. They are:

• Antony Chambers, former chief executive

• Ian Harvey, former medical director

• Alison Kelly, former director of nursing

• Sue Hodkinson, former HR director

10.07am BST

What will the inquiry focus on?

The inquiry’s terms of reference are available on the website, and as stated earlier, the three areas it will focus on are:

• The experiences of the Countess of Chester hospital (CoC) and other relevant NHS services, of all the parents of the babies named in the indictment

• The conduct of those working at the CoC, including the board, managers, doctors, nurses and midwives with regard to the actions of Lucy Letby while she was employed there as a neonatal nurse and subsequently

• The effectiveness of NHS management and governance structures and processes, external scrutiny and professional regulation in keeping babies in hospital safe and well looked after, whether changes are necessary and, if so, what they should be, including how accountability of senior managers should be strengthened. This section will include a consideration of NHS culture

The inquiry published what it described as a “non-exhaustive” list of 30 questions to examine, which can be found here . Key among them are questions about what happened in the hospital at a time when questions were being raised, including:

What concerns were raised and when about the conduct of Letby? By whom were they raised? What was done?

Should concerns, including about hospital or clinical data, have been raised earlier than they were? When? What should have been done then?

Were existing processes and procedures for raising concerns used, including whistleblowing and freedom to speak up guardians? Were they adequate?

What the inquiry will not be doing is re-examine the convictions of Letby for murder and attempted murder.

Updated at 10.12am BST

9.47am BST

Speaking ahead of the hearing, Tamlin Bolton , a senior associate solicitor at Switalskis, which is representing families of the victims, said: “The families that Switalskis represent have been through unimaginable heartbreak and distress. The facts and issues to be investigated in this inquiry are of deep concern to each individual family whose baby or babies were killed or attacked by Lucy Letby.

“Their babies were born, harmed and died in 2015 and 2016 and they have already endured many years of anguish, yet this inquiry will be the first time that they will hear evidence as to how Letby was allowed to harm as many as 18 babies before she was removed from the neonatal unit at the Countess of Chester hospital.

“The facts and issues in this inquiry should also be of profound concern to every family who has used or will use NHS maternity, neonatal or paediatric services and to the wider public who need to have confidence in patient safety. For the families we represent, that confidence has been shattered.”

Related: Lucy Letby: inquiry into how former nurse was able to murder babies begins

Updated at 9.50am BST

9.41am BST

Nine months ago, Lady Justice Thirlwall and the inquiry published her opening statement, which is available on video.

In it, she said:

We all know that there have been many inquiries into events in hospitals and other health care settings over the last thirty years. The case of Beverley Allitt who murdered babies at Grantham hospital in the 1990s comes to mind. 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?

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. The barriers to change must be identified if that hasn’t been done already and those barriers must be removed. Where there is good practice, that must be shared. 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 inquiry relies on that cooperation as we work on this profoundly important task.

The parents of the babies who were murdered or suffered injuries, some lifelong, live with the consequences every day. On top of their grievous loss they endured years of uncertainty about what had caused death or injury. And for some, uncertainty remains. All 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. I’ve already mentioned one of the suggestions they have made as to how this may be achieved. With the help of the inquiry team and all those who will contribute to the inquiry I will do all I can to make sure that no one else suffers as they have. It is unconscionable that this situation would ever occur again.

A full transcript of the opening statement from November 2023 can be found here .

9.40am BST

There have been some calls for the inquiry to be postponed or for its terms of reference to be changed. Felicity Lawrence reported this for the Guardian in August:

A group including some of the UK’s leading neonatal experts and professors of statistics is calling on the government to postpone or change the terms of a public inquiry over concerns about the conviction of the neonatal nurse Lucy Letby.

In a private letter to ministers, seen by the Guardian, the 24 experts said they were concerned that the inquiry’s narrow terms could prevent lessons being learned about “possible negligent deaths that were presumed to be murders” in the neonatal ward of the Countess of Chester hospital (CoC).

Despite the convictions and court of appeal decision, there has been a small but growing number of experts raising concerns about the evidence presented at trial. Several came forward in an article published by the Guardian in July , expressing concerns that Letby’s conviction was unsafe.

Read more here: Lucy Letby inquiry should be postponed or changed, experts say

Related: Lucy Letby inquiry should be postponed or changed, experts say

9.38am BST

Unlike other recent public inquiries, like that into the handling of the Covid pandemic or the Post Office Horizon IT scandal, the Thirlwall inquiry is not being streamed live to the public.

Core participants and limited sections of the media have been granted access. At a preliminary hearing for the inquiry in May lawyers for the families of the victims argued that the proceedings should be livestreamed to the public , in part to “combat conspiracy theories”. However, in a judgment later that month Lady Justice Thirlwall ruled against it .

Part of the reasoning given in the judgment was that there was a risk of court orders being breached during the proceedings. At the preliminary hearing, Rachel Langdale KC , counsel to the inquiry, said court orders that prevented the identification of a number of people involved, including all of the babies, had to be complied with.

9.34am BST

Jamie Grierson and Josh Halliday have this explainer on the inquiry :

The Thirlwall inquiry has been set up to examine events at the Countess of Chester hospital and their implications after Lucy Letby’s trial and subsequent convictions for murdering seven babies and attempting to kill seven more.

The three key areas being looked at by the inquiry are: the experiences of the victims’ parents; the conduct of staff at the hospital with regard to Letby when she was employed at the hospital; and the effectiveness of NHS management.

The inquiry is chaired by Lady Justice Kathryn Thirlwall, a senior court of appeal judge. The counsel to the inquiry is Rachel Langdale KC. Formerly the leading counsel for a core participant in the Mid-Staffordshire NHS foundation trust public inquiry, she has also acted for local authorities and individuals in inquiries relating to safeguarding and children in care.

Among the core participants are the families of the children named on the indictment, who will be represented by legal teams. Others include the Royal College of Paediatrics and Child Health, the Department for Health and Social Care, the Countess of Chester hospital NHS foundation trust, the Nursing and Midwifery Council, the Care Quality Commission and NHS England.

The first week will see opening statements from the counsel to the Inquiry and from legal representatives on behalf of the core participants.

Related: What is the Thirlwall inquiry, set up after Lucy Letby’s murder convictions?

9.32am BST

Welcome and opening summary …

Today at Liverpool town hall the Thirlwall inquiry will begin a week of hearing opening statements, as it seeks to examine how former nurse Lucy Letby was able to murder babies over a period of two years at the Countess of Chester hospital’s neonatal unit.

Letby, 34, was sentenced to 15 whole-life orders after she was convicted of murdering seven babies and attempting to murder seven others across two separate trials.

The inquiry, chaired by Lady Justice Thirlwall, will consider the experiences of the parents of Letby’s victims, look into the conduct of staff at the hospital and assess whether suspicions should have been raised earlier, whether Letby should have been suspended earlier and whether the police should have been brought in sooner.

The inquiry will examine wider NHS culture and consider the effectiveness of its management and governance structures. It is expected to last about four months, with a report to be released next year.

We will bring you updates from the opening day of the inquiry here.

Related: Lucy Letby: inquiry into how former nurse was able to murder babies begins