Judith Moritz
Special correspondent, reporting from the inquiry

Alison Kelly is asked about her dealings with Letby’s regulator, the Nursing and Midwifery Council (NMC).

On 4 June 2016 Kelly contacted the NMC. She told them that there was no evidence of Letby causing deliberate harm.

Picking up on this, de la Poer asks: "From 27 April 2017 you knew the police were going to be involved. You didn't contact the Nursing and Midwifery Council to tell them that did you?"

Kelly says that she doesn't recall whether she did, and de la Poer suggests that the NMC found out through a press release and called Kelly after.

"I think we communicated with everybody - unless the NMC was inadvertently left off that list," Kelly responds.

After this, Kelly agrees that in March 2017 her belief was that the likely explanation for all the babies' deaths was poor care on the neonatal unit.

Judith Moritz
Special correspondent, reporting from the inquiry

Kelly is asked about the decision not to involve the police at this point at the end of June 2016 – after all of the murders and attempted murders for which Letby was later convicted.

Kelly responds: "It didn’t feel like the right thing to do at that time, we felt we needed to get more information."

"We all personally had to understand what was going on so that we could then clearly articulate to the police what the problem was, because at that time we didn’t really have a sense of what was going on," she adds.

Judith Moritz
Special correspondent, reporting from the inquiry

Alison Kelly is now being asked about the process that hospital bosses went through when deciding whether to involve the police.

This takes us to the end of June 2016, in the timeline of events - so after all of the murders and attempted murders that Letby has been convicted of, had happened.

Image source, Thirlwall Inquiry

Nicholas De La Poer asks: "Here you have extremely credible, knowledgeable, people telling you that that is what they think the risk is, and you don’t even appear to be talking about how you might address that risk?"

"I was relying on my senior nursing team to give me assurances on Letby and I made an assumption that everything was OK," Kelly replies.

Kelly is then asked how the nursing manager Eirian Powell would know that Lucy Letby was murdering anybody.

She explains that Powell wouldn't have known, but would have raised concerns should she have had any doubts about an individual.

"Is this meeting an example of how it degenerated into doctors versus nurses?" De La Poer presses.

Kelly responds: "No not at all. Throughout this process we were really keen to hear from doctors and nurses and this was a team that before all this worked really well together, and it’s unfortunate that it became divisive between us and that’s not conducive to good working ."

The counsel to the inquiry is still pushing Kelly on why more was not done to prevent Letby from working after concerns had been raised about her.

He says: "The one action that could have addressed the consultants’ concerns – that Lucy Letby had committed murder – would have been to stop Lucy Letby from working that week."

Kelly says: "I was under the impression she wasn’t at work, but I have found out since from this inquiry that she actually was."

"I suppose I found it quite difficult to comprehend... I was in charge of over 1,000 nurses and midwives and the last thing on my mind is that one of my nurses is deliberately harming children or babies or adults," she adds in response to another question.

Put to her that such a thing is not unheard of, Kelly says: "It’s not unheard of, but that was not at the forefront of my mind."

Judith Moritz
Special correspondent, reporting from the inquiry

On the following day - Monday, 27 June - the executives, and nursing managers, had a meeting but the consultants were not invited to be present.

An action plan regarding Letby was formulated at this meeting of managers, without input from the consultants.

Counsel to the inquiry de la Poer asks "were they being excluded from it so a plan could be formulated without reference to them?"

"No'" Kelly replies.

Judith Moritz
Special correspondent, reporting from the inquiry

Dr Brearey had repeated his request for Letby to be suspended from duty - but this wasn’t immediately granted.

The second triplet died on a Friday, 24 June 2016. That Sunday (26 June) Dr Brearey invited Kelly and medical director Ian Harvey to a meeting so that the consultants could put their concerns to them directly. Neither executive went. Asked why, Kelly says she does not have access to her diary as part of this inquiry.

Judith Moritz
Special correspondent, reporting from the inquiry

The counsel to the inquiry is continuing to probe Kelly on how she acted when she heard concerns that Letby was harming babies, and he asks Kelly if she was taking those concerns seriously.

Kelly responds: "I was taking it seriously, as a director you did not do every single action that is required of you. You have a team to do that."

She says she was satisfied with the approach of the director of nursing for urgent care, adding: "I recognise I didn’t ask the specific question 'is Letby working tomorrow'? On reflection I could have done something differently and maybe that was a missed opportunity."

The counsel to the inquiry says: "This is exactly the sort of situation that calls for an executive director to be involved directly and personally, isn’t it?"

Kelly says: "What we know now compared with what we knew then… you could say yes, but we don’t have capacity as executives to do every single action."

Counsel de la Poer responds by asking what was "more pressing than the suggestion by two consultants that a member of staff may just have committed murder?"

Kelly says she felt like she needed "some concrete evidence", adding: "It just felt like they were being quite blasé about the statements that they made and it was a very difficult thing to hear, so maybe I didn’t process it as I should have done at the time."

She's asked if it was simply that she didn't believe the consultants, and Kelly says: "I didn’t not believe them, I just wanted some evidence."

"I think it was just really, really difficult and looking back perhaps I could have done something differently but at that time myself and Karen Rees felt we were taking the right action," she says.

It's put to her that that action did not include taking steps to protect babies if Letby did pose a risk, and Kelly adds: "That is difficult to hear, but maybe I should have done something differently at that time, yes."

Judith Moritz
Special correspondent, reporting from the inquiry

On 24 June 2016 two consultants - neonatal unit lead Dr Steve Brearey and paediatric lead Dr Ravi Jayaram - told the director of nursing for urgent care, Karen Rees, that they were concerned that Letby was intentionally harming babies.

Rees passed that on to her boss, Alison Kelly.

Kelly is asked what she did with this information. She says: "Personally, I didn’t do anything.”

Counsel to the inquiry De la Poer asks "this is a concern of the highest degree of magnitude wasn’t it?"

Kelly replies: "Well there were concerns being raised."

De la Poer presses her: "No listen to my question please. This was a concern of the highest degree of magnitude, wasn’t it?"

Kelly replies: "It was a serious concern, yes."

De la Poer then asks: "You don’t accept the characterisation that it was a concern of the highest degree of magnitude? You don’t accept that it was very, very serious?"

Kelly replies that it was "serious but I felt we were doing the right things".

De la Poer then asks: "Did you discover that Lucy Letby was due to work that weekend?" to which Kelly says she was "unaware of that".

De la Poer presses further: "Did you ask Karen Rees to find out if Lucy Letby was due to work?"

"No I didn’t at the time," Kelly replies.

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, Thirwell Inquiry

We're now back from a break.

Letby has been convicted of murdering seven babies, and attempting to murder a further seven between June 2015 and June 2016.

The last of the deaths were two triplet brothers, baby O (23 June 2016) and baby P (24 June 2016).

Kelly is now being asked about events on that last day – 24 June 2016.

Today we've been hearing from Lucy Letby's former manager, Alison Kelly, as she gives evidence at the Thirlwall Inquiry. It's the first time the former director of nursing at the Countess of Chester hospital has spoken about the events publicly.

The inquiry is on a break now, so here's what we've heard so far:

• Kelly accepted that concerns were first raised with her about Lucy Letby and the rise of mortality rates on the neonatal ward in March 2016
• Kelly was safeguarding lead at the hospital and said when concerns were brought to her, she didn't consider it a "safeguarding concern" and described it as "hearsay"
• Asked why she didn't inform NHS England in July 2016 of the concerns that Letby was to blame, she said "I don't know"
• She also said "we should have perhaps" mentioned the worries about Letby during a meeting with the Care Quality Commission in February 2017
• She waited until 2018 to make a safeguarding referral about Letby because she was trying to "balance" the welfare of the nurse and what was happening within the organisation
• But, she says this referral "lacks detail"

• She denied that there was a "culture of fear" at the hospital when this is put to her, but said they "could have done more" to support clinicians

Stick with us for more coverage and analysis.

Judith Moritz
Special correspondent, reporting from the inquiry

De la Poer: Did you say to Dr Brearey, ‘I need to see what’s in that evidence drawer?’

Kelly: No not directly

De la Poer: Why didn’t you do that?

Kelly: It was a very random thing to have shared and I didn’t know what to think because I didn’t know if it was a figure of speech, or whether it actually was a drawer of documents that weren’t being shared.

De la Poer: Did you think he was lying? Dr Brearey? When he said he had evidence in his drawer?

Kelly: I didn’t know what to think. It just seemed a very unusual thing to say.

De la Poer: Was it an unusual thing that you never asked to see it?

Kelly: I didn’t know if it was actually a physical drawer or a figure of speech.

Image source, Thirwell Inquiry

Judith Moritz
Special correspondent, reporting from the inquiry

De la Poer: If there really was a murderer on your unit why would the clinicians necessarily have seen or heard anything? Because such a person is going to act in a covert way…

Kelly: Yes but when you have things reported to you as in, ‘we have a gut feeling’, ‘I have a drawer of doom’ - it’s not giving you confidence that you have the information that you need.

De la Poer: You were an executive director. If that was troubling you, did you ever say to Dr Brearey, I need to see in your ‘drawer of doom’? You had the authority to do that.

Kelly: I could have done, yes in conjunction with the medical director.

For context - the Inquiry has previously heard that Dr Brearey told another executive, Karen Rees, that he had a ‘drawer of doom’ filled with information about Letby.

Judith Moritz
Special correspondent, reporting from the inquiry

Prior to the break at lunch, we also heard a couple more exchanges at the inquiry. Alison Kelly is asked about a meeting on 11 May 2016. Those present include herself, the Medical Director Ian Harvey, Letby’s line manager Eirian Powell, and the lead neonatal consultant Dr Steve Brearey.

De la Poer: Do you think there’s a possibility that you went into the meeting on 11 May closed minded?

Kelly: No

De la Poer: Was it adversarial?

Kelly: No not adversarial, I think we felt at the time there was still a view that nobody had seen anything, there had been no results provided to us, there was nothing that suggested that there was anything serious going on.

The inquiry is breaking for lunch. It will resume again at 13:35.

In the meantime we will catch you up with some of the last moments of the inquiry we didn't get to.

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, Thirwell Inquiry

The questions are still focusing on an email sent to Kelly which highlighted concerns about Letby, and the counsel to the inquiry asks: "To put it bluntly were you too slow to acknowledge and act upon these concerns?"

Kelly says: "It does feel that it was a big delay. It could have been looked at in a much more timely way."

The counsel to the inquiry asks Kelly if she was "too slow".

"I don’t think I was to be honest. I think if somebody’s got something so urgent that they want me to see, then why not come to my office? Or why not phone me up? Unfortunately, everything gets lost in hundreds of emails," Kelly says in response.

She's asked if she should have been more attentive than she was.

"Looking back, maybe I should have been yes," she says.

In response to another question, Kelly says that she didn’t open the email attachment which showed that Letby had been a common present at babies’ deaths because “the workload of an executive director of a 600-bedded hospital is huge”.

Judith Moritz
Special correspondent, reporting from the inquiry

On 4 May 2016, Alison Kelly forwards the updated staffing analysis which shows Letby’s name in red, to another executive - Karen Rees, director of nursing in the urgent care division.

She writes: “Please see attached, Lucy Letby highlighted in red!! I have not noticed this when I first reviewed.”

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry hears that on 21 March 2016 Letby’s line manager, Eirian Powell, sent an email to Kelly, which contained a staffing analysis which showed Letby was a common presence at the babies’ deaths until that point.

Kelly didn't respond to the email, so on 14 April 2016 Powell chases, with an updated version of the attached document – this time with Letby’s name highlighted in red.

It was then another 14 days before Kelly’s secretary arranged a meeting – not scheduled until 4 May 2016.

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry is shown handwritten minutes of a meeting of the hospital executives on 14 February 2017 where the consultants are noted to have raised concerns that the deaths of babies on the neonatal unit were “not natural causes”. Three days later, Alison Kelly was at the ‘engagement’ meeting with the CQC, and this was not mentioned to the regulator.

Counsel to the inquiry De la Poer asks Kelly: "You needed to tell the CQC about what was going on in your trust and that didn’t happen did it?"

Kelly replies that "we did tell the CQC but we didn’t give them that level of detail because we didn’t know ourselves at that time".

De la Poer continues: "What other external bodies are being told is everything apart from the consultants' concerns - do you think that’s a fair characterisation of the period up until the end of April 2017?"

Kelly replies that "looking back we should have perhaps mentioned that as well at the time. However we were really keen to fully understand what was going on but perhaps those consultant concerns should have been mentioned in the beginning."

De la Poer asks if "finding out absolutely everything that’s going on is the opposite of the correct approach to a safeguarding issue, do you agree?"

Kelly responds: "Yes but we were not considering this as a safeguarding concern."

Judith Moritz
Special correspondent, reporting from the inquiry

The questioning is centring on what information and documentation was – or wasn’t – provided to the Care Quality Commission (CQC) before and after an inspection which rated the hospital as “good” in 2016.

Kelly denies misleading the CQC at an engagement meeting in 2017.

She says: "It may have been helpful to share more with our regulators at the time, but it was a really complex set of circumstances… and at that time nothing was leading down a route to somebody deliberately harming babies."

She adds: "Perhaps we should have shared a bit more information at the time, but we were still gathering information internally."