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Thirlwall Inquiry: Questions Over How Lucy Letby’s Crimes Were Allowed to Continue
The Thirlwall Inquiry is examining one of the most serious scandals in the history of the NHS, following the conviction of former neonatal nurse Lucy Letby for murdering babies and attempting to murder others at the Countess of Chester Hospital.
Letby was convicted in 2023 and sentenced to life imprisonment with whole-life orders for seven murders and seven attempted murders. The crimes took place while she was working as a neonatal nurse.
What is the Thirlwall Inquiry?
The statutory inquiry, chaired by Lady Justice Thirlwall, was established in October 2023.
Its purpose is not to retry Letby or reconsider the criminal jury’s verdicts. Instead, it is examining the wider circumstances surrounding the events at the hospital and asking whether warning signs were missed or inadequately acted upon.
Among the central questions is whether concerns about Letby’s conduct should have been raised earlier, whether she should have been removed from the neonatal unit sooner and whether police or other external organisations should have been contacted earlier.
Were warnings missed?
The inquiry has examined the actions of doctors, nurses, managers, hospital executives and other organisations responsible for oversight.
It is considering how concerns raised by clinicians were dealt with and whether the hospital’s management and governance systems contributed to failures to protect babies.
The inquiry is also examining the culture within the hospital, including relationships between medical staff and managers and the effectiveness of procedures for raising concerns and whistleblowing.
Families at the centre
For the families involved, the inquiry represents an opportunity to seek answers about what happened to their babies and how information was communicated to them.
The terms of reference specifically require examination of the experiences of the parents, including what they were told about their babies’ deteriorating conditions, access to medical records and when they were informed about concerns surrounding Letby.
NHS systems under scrutiny
The inquiry goes beyond the Countess of Chester Hospital.
It is examining the effectiveness of NHS management, external scrutiny and professional regulation in keeping babies safe.
That includes questions about whether regulators and other organisations responded appropriately when concerns emerged and whether changes are required to strengthen accountability within the NHS.
Public hearings ran from September 2024 until March 2025, with evidence heard from families, hospital staff and management, national oversight bodies and experts.
Further allegations
The wider Letby case has continued to generate scrutiny.
In January 2026, the Crown Prosecution Service announced that it would bring no further criminal charges against Letby over additional allegations involving deaths and non-fatal collapses of babies at the Countess of Chester Hospital and Liverpool Women’s Hospital, saying the evidential test had not been met.
A subsequent review requested under the Victims’ Right to Review scheme upheld that decision in August 2026. (Crown Prosecution
Meanwhile, the Criminal Cases Review Commission has been examining an application concerning Letby’s convictions. The CCRC has stressed that it does not decide whether someone is guilty or innocent; its role is to consider whether a potential miscarriage of justice should be referred to an appellate court.
What happens next?
The central question for the Thirlwall Inquiry is not simply what Lucy Letby did, but how the healthcare system responded to concerns before her crimes were fully exposed.
Its findings could have consequences far beyond one hospital, particularly if it identifies weaknesses in NHS governance, whistleblowing, professional regulation or the way concerns about healthcare workers are escalated.
For the families affected, however, the most important outcome may be obtaining answers about what happened, why concerns were not acted upon sooner and what must change to prevent anything similar happening again.
Attached is a news article regarding Lucy Letby enquiry
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