Episode 28 /Lucy Letby trial
Off the Ward---The fallout after Baby Q collapse
It was after the attack upon Baby Q that Lucy was removed from the ward. The jury was shown dozens of text messages and emails which we’ll focus on today
She was initially asked not to come in for her night shift after Baby Q’s collapse—then told she was switched to day shifts and then a couple of shifts later, was told she was moved to clerical duties—but was not told at that stage, exactly why she was being moved.
This all starts on June 27th, 2016, which is just 2 days after the collapse of Baby Q .By this point suspicions had been building amongst consultants on the ward about the number of collapses and unexpected deaths of babies on the unit.
Dr John Gibbs, Dr Stephen Breary and Dr Ravi Jayrahm had all voiced their concerns. Dr Jayrahm told the court he was uncomfortable leaving Lucy alone with a baby. Dr Breary asked a doctor from another hospital to carry out an independent review.
The deaths of Baby O and Baby P who were 2 of 3 triplets were then described as a tipping point and Dr Breary asked for Lucy to be removed from the unit —a request which was initially refused by hospital managers.
And then Baby Q collapsed which prompted Dr Gibbs to ask which nurse had been looking after him. So this all seemed to be the catalyst for what happened next.
Lucy Letby had been working a day shift on June the 25th, when Baby Q collapsed and she was next due to be on duty for a night shift on June 27th. She intended to arrive to her shift around 7 pm. But shortly before 6 pm she received a call from the Neo-natal unit manager, Aryan Powell, who asked her not to come in.
Now we will hear a series of What’s App messages between LL and another nurse [who cannot be named for legal reasons]
June 27th 5:41 pm
L: E just phoned telling me to do days this week and not go in tonight, as trying to protect me [sad face emoji]
N: what’s that mean?
L: I don’t know - asked if there was a problem and she said no, just trying to protect me, has had a difficult run just before holidays
Less people on nights, etc and we can have a chat etc tomorrow but I’m worried I’m in trouble or something
L: I know but worrying, in case they think I missed something or whatever Why leave it all now to ring ?
N: It is very late, I agree , maybe she’s getting pressure from elsewhere
L: She said it’s busy so more support for me on days and can look at paperwork bits, etc
She was nice enough I just worry— this job messes with your head
N: Yeah it does. Do you want to come over after?
L: yeah maybe, would that be okay?
N: Yeah, shall we say 7:30 ish?
L: okay, thanks
N: No worries, can have proper chat , as not had the a chance to
L: Thank you it’s late isn’t it?
N: yeah, very
L: wish she had done this earlier because I’d have just gone in and spoken to her
N: yeah, not been given opportunity and naughty to leave till tomorrow’s
L: Messes with your head a bit to be told that at this time—would have sounded more
reasonable if had done it earlier which is why I wonder if it’s come from higher up as
she usually finishes at 4 . anyway we’ll chat later
N: Yeah, try not to worry too much, at the end of the day there’s been no common factors in any of it and a lot of other people involved
L: I know, I think everyone works tirelessly and I don’t see how any of that could be questioned.
I imagine she may want to know why I had triplets back the next day and why I had Baby Q Sat, but there are reasons for that and wouldn’t have prevented me from being part of resource
N: yeah
L: Perhaps she waited so long to ring as was waiting to see if could find cover
N: if was that bothered could always work herself
L: that’s true
Around the same time Lucy was also messaging a doctor that she’d become close to via Facebook. We refer to him as Dr A and as you’ll hear she was voicing the same worries about being asked not to come into work that night.
The messages start with Lucy Letby at around 5:41 pm:
L: Ariane just phoned telling me not to come in tonight and to do days instead. I asked if there was a problem and she said no, just trying to protect me a bit, and we can have a chat about it tomorrow but now I’m worried
Dr A: Please don’t worry, I’m expecting the same conversation tomorrow as the medical lead for Thurs/Fri, I’m expecting they’ll want to chat
LL: I can’t do this job if it’s going to be like this. My head is a mess. Why is she ringing at this time? There must be a problem.
Dr A: Lucy, you did nothing wrong at all. It is an odd time to ring but you’ve had a rough few days and a good manager would realise that. There is no problem. I suspect my head is in about the same place.
The management was appropriate and your recognition of an unwell baby was spot on. The care delivered was quick and accurate. I can’t fault your care for either baby last week.
If there was anything I would have said so. Ariane knows you. Has there ever been a reason for you not to trust her?
LL: I can’t talk about this now.
LL: Sorry, that was rude. Felt completely overwhelmed and panicked for a minute. We all worked tirelessly and did everything possible.
I don’t see how anyone can question that . E has always been very supportive
Dr A: No it wasn’t rude it was unexpected and that’s never very nice. Okay now?
LL: I’m having a meltdown but think that’s what I need to do , anyway, I’ll be OK
You have enough on your plate too
Dr A: When I said it was unexpected, I meant the phone call There isn’t anything to question. You’ve already done what anyone with Neo-natal knowledge would do —look at the situation, look at the intervention, and look at the response
You didn’t give any drugs that haven’t been checked or made by anyone else
You didn’t delay any treatment and your suggestions were all perfectly appropriate
There is nothing that could have been done differently
E was a good manager when I was here last time
There isn’t a high staff turnover which suggests the unit is well run.
There is nothing to be gained by not addressing how your staff has been hit by an event.
You didn’t look well Sat. Maybe that was noticed.
LL: It’s just hit me a bit as was an unexpected call. If she had phoned earlier I wouldn’t have worried
So these messages were all taking place on June 27th.
Lucy then worked a series of day shifts ——the messages are between herself and Dr A---
The following conversation took place from around 1 am on July the 6th:
Dr A: You need to keep this to yourself. The meeting this afternoon looked at everything with baby O and baby P from birth onwards. We reviewed everything. Room/meds/medical reviews and actions. We looked at all documentation.
If you’ve any doubt about how good you are at your job STOP now.
The documentation was perfect. Everybody commented about the appropriateness of your request for a review of Baby O following vomit.
There is absolutely nothing for you to worry about. Please don’t.
There are going to be some recommendations based on staffing/kit he had nothing but good things to say about you.
LL: Okay. I really appreciate you telling me. It won’t go any further. I was one member of a huge team effort but you know I’ve been carrying the worry of the what if I wasn’t enough. It’s reassuring to hear that it doesn’t appear that anything could have been done differently
Or that I didn’t act on or do something that I should have , thank you
Dr A: I was invited to attend because SB and A thought it was good consultant preparation for me. There were a few questions which were easy to answer. I felt proud for both of us
LL: That’s good to hear. I’m glad you’ve had positive feedback too. You were fantastic. It was an awful situation but I wouldn’t have wanted anyone else to be there
I now feel confident thagt we did absolutely everything and it’s reassuring to know that the documentation reflects that.
Dr A: There was a liver capsule [?] haemorrhage in Baby O. It’s not considered by SB and A to be significant. There will be an inquest. We may have to attend
LL: Would he have died from that?
Dr A: I don’t think so. He collapsed. The liver on the 1st x-ray looked normal and looked abnormal on the 2nd x-ray but CPR was needed for something— it doesn’t explain why liver changed appearance
LL: Okay
Dr A: I wouldn’t have wanted anyone else but you to be looking after Baby O or Baby P
We do work well together
After this, Lucy Letby had a number of days off. On July 15th an email was sent to all the nurses on the Neo-natal unit , letting them know that as part of an external review, nurses would be subject to individual clinical supervision
In the email, Mrs Powell explained the supervisions would start with staff involved in many of the acute events and she said for that reason Lucy Letby had agreed to be the first to undergo the supervision.
The email goes on to say this is not meant to be a blame or a competency issue but a way forward to ensure our practice is safe.
Later that same day, Lucy messaged her friend and colleague ,we can’t name, on What’s App again. It begins with Lucy:
LL: I’ve done a timeline of this year
N: Fab
and how quite a few babies weren’t compatible with life anyway?
N: I wonder if midwives get this amount of still births?
LL: yeah and some went off within hours/on handover
N: yep
LL: Or, were already acutely unwell when I took over
N: Exactly
LL:And put that when baby Q went off no other staff able to care for him etc
N: not like all behaving fantastic, little writing ? to shift,
LL: Hoping to get as much info together as possible— if they have nothing or minimal on me, they’ll look silly , not me
Four days later, Lucy was no longer working on the ward. She’d starting working the Patient Experience Team on July 19th and then just over a month later she was moved to Risk and Patient Safety
An email sent by Mrs Powell to staff around 2:20 pm on the 9th of August
Offered opportunities for secondments and it mentioned Lucy Letby’s move. The email immediately prompted more messages between Lucy and the same nursing colleague:
LL: Bloody Hell, fumin…I’m in email and makes it sound like my choice.
N: Really?
LL: yeah, They’ve been able to facilitate me going for three months
Around a month later, on September 1st, the court heard, that Lucy attended a review meeting with her union rep and on Sept 7th she put in a formal grievance against the hospital.