The third day of the inquiry looking at Lucy Letby's crimes at the Countess of Chester Hospital has come to a close and we will now be pausing our live coverage.

But before we go, let's take a look back at one of the key lines which emerged from Liverpool Town Hall today.

Earlier, we heard that babies' breathing tubes were dislodged at an unusual rate during Letby's work placements at another hospital in late 2012 and early 2015.

Richard Baker KC told the inquiry an audit by Liverpool Women’s Hospital found that a "dislodgement" of breathing tubes occurred in 40% of the shifts that Lucy Letby worked on there.

"It is unusual, and you will hear that it occurs generally in less than 1% of shifts," Baker said.

A reminder, this inquiry is examining what happened at Chester following Letby's conviction of the murders of seven infants and the attempted murder of seven others there between June 2015 and June 2016.

Tomorrow, we'll hear three opening statements on behalf of former senior managers, the Care Quality Commission (CQC) and NHS England.

• You can read more about today's inquiry here.

Today's page was edited by Sophie Abdulla and me, with Judith Moritz and Michaela Howard reporting from the inquiry.

The writers in London were Ali Abbas Ahmadi and Jake Lapham.

Today, the inquiry heard from legal representatives for the families of the victims, as well as other organisations including the Royal College of Paediatrics and Child Health (RCPCH) and Nursing and Midwifery Council (NMC).

Here are some of the key lines:

• Richard Baker KC, representing the families of 12 children, said babies' breathing tubes were dislodged at an unusual rate during Lucy Letby's placements at a second hospital, the Liverpool Women's Hospital
• Baker also said anyone doubting Letby's conviction should be "ashamed"
• Peter Skelton KC, representing some of the families of other children, said “vital information was overlooked with fatal consequences" at the Countess of Chester Hospital, where Letby worked
• Victims' families believe they were "kept in the dark" by the hospital and failed to provide them adequate bereavement support
• A barrister for the hospital apologised"without reservation" for its "inexcusable" failures in communication, and promised changes had been implemented
• The Nursing and Midwifery Council (NMC) said it accepts it wasn’t right to wait to apply for an interim order until Letby was charged, which would have prevented her from practising as a nurse
• Royal College of Paediatrics and Child Health apologised for not sharing an unredacted report with paediatricians into why more babies were dying in the neonatal unit

Michaela Howard
Reporting from the inquiry

Cohen questions whether the the culture within the NHS contributed to the failures at the Countess of Chester Hospital.

He says "various reviews and inquiries have over many decades identified persistent issues of culture, painting a broadly consistent picture of incurious boards, unresponsive to key patient safety concerns…and some cases bullying.”

Cohen adds that since Letby's crimes came to light, there has been a renewed focus within the government to look at whether additional measures are needed to enhance the accountability of senior NHS managers.

The Department of Health and Social Care has also looked at whether extending regulatory powers to senior managers would help ensure patient safety, he says.

Michaela Howard
Reporting from the inquiry

The inquiry has resumed after a lunch break and we're now hearing from Robert Cohen, representing the Department of Health and Social Care (DHSC).

He says: "NHS England has introduced changes to the investigatory reporting and review process to improve patient safety in maternal and neonatal care."

Cohen concedes it would have been better at the time if there had been more been more robust arrangements to share information between NHS England and the government.

Turning to whistleblowing procedures in the NHS, Cohen says: "It is vital that any staff member who is worried about the safety of a baby is able to voice concerns and that these concerns are thoroughly considered and, where appropriate, investigated by the trust."

• Richard Baker KC, a lawyer representing the victims' families, told the inquiry that the hospital overlooked vital information, which had "fatal consequences"
• The hospital was accused of investigating the deaths through "un-minuted meetings, informal conversations and emails" that amounted to "more whisper than practical investigation into the deaths"
• The parents of some victims were only told there had been any issues with their children’s care on the morning of Letby’s arrest in 2018, the inquiry heard
• Baker spoke about an audit of Letby's time at Liverpool Women's Hospital, where she did placements in 2012 and 2015, which he says showed the dislodgment of breathing tubes occurred on 40% of shifts she worked, while the usual rate was 1%
• Baker said those questioning Letby's conviction "should be ashamed" and that "factual and expert medical evidence" demonstrated her guilt "beyond reasonable doubt"

Stay with us for more.

Image source, PA Media

This inquiry began as the result of the actions of former neonatal nurse Lucy Letby, 34.

In August 2023, Letby was convicted of killing seven babies in her care and attempting to kill seven others between June 2015 and June 2016.

She has been sentenced to 15 whole life terms and will die in prison.

Letby’s murder trial last year was one of the longest in British legal history, following a six-year police investigation. A jury was unable to reach a verdict on one count of attempted murder, but a subsequent retrial on this count found her guilty.

Two separate applications from Letby to appeal against her convictions have been denied.

You can read more about her case here.

Judith Moritz
Reporting from the inquiry

Scolding adds that the Royal College of Paediatrics and Child Health (RCPCH) accepts it was a mistake to interview Letby as part of its review.

Scolding says that nursing staff had praised her work and she’d been on shift at the times of the deaths.

However, she says, the RCPCH accepts it should have recommended that the police were called and it was a mistake not to do so.

The Royal College also accepts that it didn’t contact regulators and other bodies about what it had found, and it should have done so, Scolding says.

Judith Moritz
Reporting from the inquiry

Up next is Fiona Scolding KC representing the Royal College of Paediatrics and Child Health (RCPCH) - the professional body representing paediatricians. The RCPCH was commissioned by the hospital to conduct an external review into why more babies were dying in the neonatal unit.

On Wednesday, the inquiry was told that there were two versions of the review report - a "confidential report" which included references to the allegations made against Letby, and a second "dissemination copy" in which the references to the allegations were removed.

Scolding says that the RCPCH accepts that it did not share its unredacted report with paediatricians or the families of the children.

She says the RCPCH is "profoundly sorry" to the consultants at the Countess of Chester Hospital.

Judith Moritz
Reporting from the inquiry

Jones says that the NMC had no power to investigate ward manager Eirian Powell, chief executive Tony Chambers and senior nurse Karen Rees because they had come off the nursing register.

She explains that the organisation's fitness to practise investigation into director of nursing, Alison Kelly, was put on hold at the request of Cheshire Police while the force's criminal investigation into Letby was under way.

She moves on to say the NMC has been "struck by the repeated and numerous occasions when the consultants raised concerns".

"They didn’t contact the NMC directly, though we make no criticism of them.

"We seek to understand what we can do to encourage those with such concerns to contact us directly."

Judith Moritz
Reporting from the inquiry

Jones says Letby's bail conditions after her arrest factored into the Nursing and Midwifery Council's decision not to apply for an interim order - which would have prevented her from practising as a nurse until she was charged.

The NMC says it has "seriously reflected" on this decision and accepts it wasn’t right to wait to apply until she was charged.

The fact of her arrest should have been enough, Jones says.

The NMC has now amended its internal guidance on interim orders.

Judith Moritz
Reporting from the inquiry

Jones says the Nursing and Midwifery Council fully accepts that it should have been more proactive and provided more critical scrutiny in the Letby case.

She goes on to say there is new "culture of curiosity" guidance at the NMC, which means it considers who has information that could assist an investigation when it receives a report of concern about someone's fitness to practice.

Judith Moritz
Reporting from the inquiry

Jones, speaking on behalf of the Nursing and Midwifery Council, says the regulator's ‘fitness to practice’ investigations are often put on hold while a criminal investigation is under way, though it does have the power to impose an interim order.

Jones says the NMC was first told there wasn't enough evidence against Letby to merit a referral by director of nursing, Alison Kelly.

The NMC wasn't aware there had been discussions about Letby being referred to the police, or the meetings about her being held by senior management, according to Jones.

It was also not sent the reports by the Royal College of Paediatrics and Child Health, Jones says.

She says the NMC received the press release about the start of the police investigation in 2017 at the same time as the media - after which the regulator phoned Kelly who said Letby was a witness, not a suspect.

Judith Moritz
Reporting from the inquiry

The inquiry is now hearing from Samantha Jones, a barrister actingon behalf of the Nursing and Midwifery Council (NMC) - the independent regulator for nurses, midwives and nursing associates.

Jones offers condolences to the families of the children, and says the NMC welcomes the inquiry so that the “heinous acts of Lucy Letby are never repeated".

Judith Moritz
Reporting from the inquiry

Andrew Kennedy KC closes by outlining the changes made at the hospital since Letby's criminality came to light.

They include divisional changes, bringing obstetrics, neonatology and paediatrics into one "women and children’s division", he says.

Executive and non-executive "safety champions" have been installed at the hospital, Kennedy says, and there have been changes from "ward level to board level".

Judith Moritz
Reporting from the inquiry

Kennedy says that the trust accepts that non-fatal collapses "weren't recorded" in the hospital's internal online register of incidents and risks.

The deaths of children A, C, D, E, I. O and P were logged.

Judith Moritz
Reporting from the inquiry

Kennedy is now laying out a timeline of how suspicions about Letby developed.

He highlights March 2016 as an "important date", after which "there was an opportunity to act".

It was at this point that senior executives at the hospital had received the results of the 'thematic review' - which had "clearly identified" a higher-than-expected mortality rate on the neonatal unit in 2015.

"We suggest that up to that point the reasonable focus was finding a clinical explanation for the events," he adds.

"In so far as a cause relating to a member of staff... it’s far more likely to relate to a competency issue than something criminal.

"There has been talk of being prepared to think the unthinkable…that is something which is more applicable later in the chronology than earlier."

Judith Moritz
Reporting from the inquiry

The inquiry is now hearing from Andrew Kennedy KC, who represents the Countess of Chester Hospital Foundation Trust.

He says the parents' statements "bring home the horror of these events" and the trust has "the utmost sympathy for the suffering of the parents of the babies".

"Losing a child is the greatest sorrow any parent can experience," he says.

"Those who have not experienced that loss will never truly understand the magnitude....

"The trust is committed to being open, honest and transparent to this inquiry. It will not shirk its responsibility."

Kennedy says the trust "apologises without reservation" for its "inexcusable" failures in communication with parents.

Judith Moritz
Reporting from the inquiry

The inquiry this morning has also referenced Letby's time at Liverpool Women's Hospital, where she had two work placements in 2012 and 2015.

Richard Baker KC says an audit was carried out into Letby's time at the hospital.

He says it showed that the dislodgement of endotracheal (breathing) tubes occurred on 40% of shifts that Letby was working - despite dislodgement generally happening on fewer than 1% of all shifts.

Liverpool Women’s NHS Foundation Trust has previously confirmed, external Cheshire Police is investigating Letby's time at the hospital.

Judith Moritz
Reporting from the inquiry

Baker is now turning to the emotional toll this has taken on the families.

"To them, their babies were miracles, they were often conceived against the odds," he says.

"The father of [Child] G says this has damaged his faith. He says every day he would pray to God to save her. He did. He saved her.

"But the devil found her," Baker adds.

Judith Moritz
Reporting from the inquiry

Baker moves on to talk about a meeting in February 2017 between the mother of Child C and the then medical director Ian Harvey.

Baker says Harvey told her there was nothing more that could have been done [to prevent the child's death].

"If the inquiry accepts the mother’s evidence, Ian Harvey lied to her," he says.

He adds that Harvey knew parents had only been provided with the redacted Royal College of Paediatrics and Child Health report and he "was aware at that time of concerns of Lucy Letby being involved in harming children."

The families he is representing accuse the hospital management of a "whitewash", he says.