Lucy Letby could have seen reports linking her to baby deaths

Lucy Letby may have had access to patient notes and reports linking her to baby deaths after she was moved off the neo-natal unit, the public inquiry was told today.

Annemarie Lawrence, who worked as the lead midwife for risk in the Risk and Patient Safety Office at the Countess of Chester Hospital, said she told bosses it was 'not appropriate' that the nurse was moved to a clerical role in her department when she was suspected of killing and harming patients.

She said she was unsure of the level of access Letby had to computer records but on at least one occasion she knew about a clinical incident before she did.

Letby, 34, was convicted of murdering seven babies and attempting to murder seven more between June 2015 and June 2016. Consultants demanded her removal from frontline nursing the following month.

Nicholas de la Poer KC, counsel to the inquiry, asked Ms Lawrence: 'So far as you were aware did Letby have access to patient notes, such as the thematic review had she wished to look at them?'

She replied: 'If she wanted to look at them she absolutely could have because she had access to the risk and patient safety team S-drive. Now I don't know whether her access was limited in terms of what folders she could or couldn't access, but you will notice from my statement I talk about her having access to information I didn't have at that point, so if you were to ask me was she able to access these things it would be a possibility, yes.'

The barrister added: 'Did you think it was appropriate?'

'Absolutely not,' Ms Lawrence said.

She said on one occasion, around autumn 2016, a few months after Letby had been moved off frontline nursing, she came to work to find her 'very distressed.'

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'She almost jumped down my throat (saying), 'there's been a collapse and a baby's been transferred out, does that mean there is going to be an investigation and I can go back to work?'

Ms Lawrence said she hadn't been aware of the collapse and no-one had reported it on the hospital's clinical incident computer system at that point.

'She knew this information and it hadn't reached me,' she added.

Ms Lawrence was so concerned that she emailed Karen Rees, the director of nursing for urgent care, saying she was worried Letby had 'access to information she shouldn't have' or that someone in the neo-natal unit was 'feeding' information to her.

But instead of sending her a personal reply, Ms Rees and the unit manager, Eirian Powell, sent a 'generic, circulatory' e-mail warning staff to be 'mindful of professional conversations' and not to discuss things outside work.

Ms Rees has told the inquiry that she got 'too close' to Letby but, at the time, thought the decision to keep Letby away from the unit was 'wrong and immoral.'

Ms Lawrence, who had worked as a midwife at the Countess for two years before moving into the risk role, said she was just weeks into her new job when she overheard Dr Stephen Brearey and Mrs Powell talking about the thematic review – the report into the baby deaths conducted by an external neonatologist, which also had a chart attached showing which members of staff were on duty.

She asked for a copy, but claimed Dr Brearey told her it 'wasn't for sharing' and only when she pressed him did he agree to send her one. She said Letby's name was 'really, really obvious' and 'jumped' off the page as being present for all ten deaths, so she immediately highlighted it with a yellow pen and took it to her boss. She, in turn, told her to take it to Ruth Millward, the head of risk and patient safety.

But, Ms Lawrence said Ms Millward 'didn't want to look at it'.

'She said something along the lines of, 'you need to be really careful Annmarie, you can't come in here and start throwing accusations around about an individual nurse being present for all of these deaths, you need to have evidence. You need to have something proper to raise alarms.'

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Ms Lawrence, who has since worked at several large hospitals and was appointed the head of midwifery to turn around Shrewsbury and Telford Hospitals Trust following a scathing report into maternity care, in 2022, said she was inexperienced at that time and left Ms Millward's office feeling 'embarrassed' and didn't raise it again.

But she admitted she thought about it a few weeks later when she heard about the deaths of the two triplets, who Letby murdered on consecutive shifts, in June 2016.

Afterwards, Ms Lawrence said she was forced to listen to 'regular conversations' in the corridors between Letby and some of her nursing managers about how she was 'being made a scapegoat for poor medical care and a lack of teamworking'.

And she appeared to choke up as she explained how she had reflected on that difficult time since.

'I was working alongside somebody who originally I had thought had done some terrible, terrible crimes and I felt ashamed for raising them,' she said.

'And then I spent some time thinking if I'd have just raised them a little bit louder then potentially I could have prevented the deaths of two of those babies – and I didn't.

'Then I had to work with her, alongside her and listen to conversations about perhaps she might have been innocent – and it was really difficult. A lot of the deaths were avoidable.'

The inquiry has heard that the Risk and Patient Safety office was stretched during the first half of 2016 because a member of staff left and wasn't replaced for several months.

Ms Millward has told the inquiry in a statement that, although records show she was sent the report into the baby deaths in March that year, her meeting with Ms Lawrence in May was the first she had heard about a nurse being associated with them.

Ms Lawrence described her department as 'one of the most under resources risk and patient safety teams I've ever known' in my career.

She said she had a difficult relationship with Dr Brearey when she started in the risk post, which she assumed was because of the lack of support he had received from the department during 2016 when he was raising concerns, and because he hadn't been consulted about her appointment.

But Ms Lawrence said there was a 'hierarchy' among the consultants and she named Dr Brearey and Dr Ravi Jayaram, the lead for children's services, as the 'least respectful.'

She also said they didn't report when things went wrong with patient care until they 'had no choice' and that all the doctors and nurses on the unit viewed reporting such incidents as 'punitive.'