Inside Lucy Letby hospital hit by 'string of failures' from staff shortages to superbug

Concerns were repeatedly raised about shortcomings at Countess of Chester (CoC), the hospital were neonatal nurse Lucy Letby was found guilty of murdering babies, according to reports.

Letby was convicted across two trials of killing seven babies and trying to kill seven others between June 2015 and June 2016, and has been sentenced to 15 whole life terms in total.

On Tuesday, the Thirwall Inquiry will begin at Liverpool Town Hall, probing Letby's time CoC, which will include an examination of whether the nurse should have been suspended earlier and if the police could have been contacted sooner.

A Guardian investigation claims the unit were Letby worked was "understaffed and suffering from low morale, lacking the expertise to deal with babies with serious needs, and operating from a tired building struggling with a superbug and with sewage backing up into its rooms".

The outlet says the assessment is supported by sources familiar with the hospital, as well as leaked documents and emails.

In 2015, when the hospital began to see an increase in the number of deaths among premature babies, its neonatal facility was classed as a level-two local unit, meaning it could provide care for newborns with medical needs from 27 weeks.

The unit had experienced four deaths in the previous year, but between June 2015 and July 2016 at least 13 babies died - an unusually high number, according to the outlet.

Suspicions about Letby were reportedly raised with management after it was noticed she was present when many of the babies died or collapsed.

Following two further deaths at the end of June 2016, she was suspended from nursing duties and arrested two years later after a lengthy police probe. She was then charged in November 2020.

Hospital bosses took action, and various reviews were conducted following the cluster of deaths, including one by the Royal College of Paediatrics and Child Health (RCPCH).

Two other reports seen by The Guardian, the first produced by a nursing manager, the second a review by an independent neonatologist into 17 deaths and collapses, did not find foul play, but did identify serious concerns about the quality of care at CoC.

In March 2015, Eirian Powell, the nurse manager of the neonatal unit recorded one of a number of entries on the internal register of risks to patient safety - which alerts managers to serious issues - saying: “We are currently understaffed and underskilled.."

Another entry in late October 2015 recorded an evening four nights after another baby had died. Powell wrote that there had been no senior doctor there overnight, with only a middle-grade doctor and a junior doctor - who was still in training - on duty.

The pair were trying to cover five separate areas where infants and children might get into difficulty: the paediatric ward, the neonatal unit, the labour ward, casualty, and the ante and postnatal ward, she said, as per the outlet.

The middle-grade doctor had to spend time in casualty with a child who was seriously ill, meaning the junior doctor was to cope with the rest of the patients.

The issue of doctor shortages had reportedly been raised by others. One of the consultant doctors wrote to the CEO Tony Chambers in December 2015 raising that staff were “chronically overworked” and “stretched thinner and thinner”, according to the report.

A lack of nurses was also a concern at the time - both in the hospital and across the national as a whole - with the neonatal unit operating with nursing staff a fifth lower than what is required by national standard, the newspaper claims.

Powell also said taps at the unit had been contaminated with an antibiotic-resistant bug, Pseudomonas aeruginosa, which they struggled to get rid of.

The potentially legal bug didn't show up in blood tests carried out on the babies, but it was said to be an indication of falling standards.

Sewage had backed up repeatedly into the unit from the drains – a problem that had been continuing for years.

Michele Worden, who was an advanced neonatal nurse practitioner (ANNP) at the CoC before being made redundant in 2007 long before Letby's time there, recalled a unit “falling to pieces, ceiling tiles dropping off.

"We regularly had sewage coming up in sinks. Any source of infection on a neonatal unit should be the highest priority because it can kill.”

The hospital was approached by The Guardian for a response, but said it could not comment while the inquiry and police investigations continue, as did the RCPCH.

Powell did not respond to questions when contacted by the outlet.