The failure to report the deaths of three babies in one month at the hospital where Lucy Letby worked was a "potential missed opportunity", the former medical director say
Other instances of missed opportunities include those "where there was clear evidence of harm", Ian Harvey tells the Thirlwall Inquiry into how the Countess of Chester Hospital handled the case
He is asked why he told consultants to stop an email chain they had started over concerns, and why he did not attend a meeting following the deaths of two triplet brothers
Earlier, we heard from the hospital's former chief executive, who denied pressuring whistleblowers who raised concerns about Letby
Tony Chambers also rejected stalling the police investigation, describing the allegation as "outrageous"
The Thirlwall Inquiry is investigating how the hospital handled Letby's case - it is not a criminal inquiry. We're not allowed to broadcast it live, but our team of Judith Moritz and Erica Witherington are reporting from the room
Erica Witherington
Reporting from the inquiry
The hearing has ended today, but you can read a full summary in our latest article on the Thirlwall Inquiry.
Thanks for following along.
Your editors today were Alex Binley and Jamie Whitehead.
Your reporters were Judith Moritz and myself from the inquiry, with Jake Lapham and Imogen James in our London newsroom.
We're closing today's coverage of the Thirlwall Inquiry, which is looking at how the Countess of Chester Hospital dealt with the Lucy Letby case.
Since 10:00 GMT, the inquiry has heard from two key figures - former chief executive Tony Chambers and ex-medical director Ian Harvey. Here's a recap of some of their evidence:
Erica Witherington
Reporting from the inquiry
More now on the meeting with the hospital board in January 2017.
Harvey advised that Lucy Letby should be supported in her return to the unit, which the lawyer says is "completely unacceptable".
Harvey says "in retrospect, yes" and again says he regrets not telling the police in summer 2015.
"It was irresponsible and dangerous to return Lucy Letby to the unit as you could not be confident she would not harm a child again?" the lawyer asks.
"I accept in retrospect it was a risk," Harvey says.
He is asked again if this should have been allowed.
"Looking at this, no," he says.
Erica Witherington
Reporting from the inquiry
Following Letby's removal from nursing duty in July 2016, executives commissioned a number of reviews into the deaths in the unit.
Peter Skelton KC is referring to a meeting in January 2017 in which Harvey updated them on the findings of a review.
Skelton puts it to Harvey, that during that meeting Tony Chambers [the then hospital chief executive] repeatedly dismissed consultant concerns as “unsubstantive” - but they had not been excluded by the review.
Skelton says the hypothesis [of the consultants] was that Letby killed these children.
He continues that the "reality is the investigations you (Harvey) commissioned, although they might have found evidence of criminal activity, they were not designed to find it?".
Harvey agrees.
Erica Witherington
Reporting from the inquiry
Harvey is asked if he understands the vulnerability of patients in hospital, and that it is "relatively easy for healthcare staff to harm patients, and difficult to detect when they do so".
Harvey says there were "three opportunities that were missed where there was clear evidence of harm."
He says they "weren't fortunate enough" to have been informed about these.
Skelton asks if he is referring to the insulin test results in Baby K.
He says he is talking about babies F, K and L, and "would simply say those opportunities were missed".
Erica Witherington
Reporting from the inquiry
The lawyer now refers to Harvey's discussions with his fellow executives at the hospital, at the end of June 2016, after the deaths of Babies O and P.
"Were you treating consultant suspicions as a hypothesis to be tested?" Harvey is asked.
Harvey says he was "keen" that they could "establish what was the cause or causes of the increased mortality… not ruling out more extreme causes such as gross negligence".
Skelton asks if Harvey recognised that this was not just a hypothesis, but a risk.
"My understanding was Letby was on leave, so that aspect of risk had been removed," Harvey says.
Harvey is asked if he saw "that a clear-eyed intervention was needed?
"If you’re in a room with paediatricians - and they fear a staff member killed babies - that you need to call the police? Whether it leads to an investigation or not?"
One of his regrets is "that we didn’t contact the police in July", Harvey says.
He says he is not convinced the police would've undertaken an investigation, but "fully" accepts they could've advised and stepped in if needed.
Erica Witherington
Reporting from the inquiry
The lawyer presses Harvey over his actions with the coroner.
Peter Skelton KC highlights how coroners are intricately connected to the justice system.
He asks if Harvey is aware that a coroner must investigate if they are "told that a paediatrician suspects a child has been killed - or a series of children has been killed".
Harvey says: "I am confident that I informed [the coroner] that the paediatricians had reported an association with a member of the nursing staff."
Skelton replies: "You certainly should have given him that information shouldn’t you?"
"Yes," Harvey says.
Erica Witherington
Reporting from the inquiry
The lawyer says the consultant who treated the child [Baby A] thought he had been murdered.
"Wasn’t it your duty to correct the coroner?" Harvey is asked.
He says he wasn't aware that "it was their view that the baby had been murdered… I did nothing to obscure or withhold any evidence".
He is then asked if as far as he was concerned, the coronial process was "appropriately conducted."
"I trusted my colleagues - I do not recall having full access or any access to the [the doctors’] statements," Harvey tells the inquiry.
"I accept that we failed in the duty of contributing to the inquiry, but I did nothing to obscure or withhold any evidence."
Erica Witherington
Reporting from the inquiry
The lawyer brings up a handwritten note documenting a meeting before Baby A’s inquest in which a barrister, Mr Browne, appears to have been told about “the association with the nurse” - in respect of Baby A’s death and a general spike in deaths.
Skelton says this information was never passed to Baby A's family, and says to Harvey: "This should really never have happened, should it?"
Harvey replies, that based on the duty of candour, "no, that should never have happened."
"So your evidence today is you had no involvement in the decision to not disclose this information to Baby A’s family?" Skelton asks.
Harvey says he doesn't recall.
Erica Witherington
Reporting from the inquiry
Skelton suggests to Ian Harvey that he withheld information - in the form of two statements from doctors, including Dr Jayaram - from the coroner in the inquest for Baby A.
Harvey says he doesn’t recall being aware of those statements.
After a short break, the inquiry has resumed, and Peter Skelton KC begins his questioning of Ian Harvey on behalf of some of the babies' families.
The inquiry is on a break. When it resumes, at 16:10, Ian Harvey will be asked questions by Peter Skelton KC, on behalf of some of the babies' families.
Ian Harvey is asked to look at a press release which the hospital put out on 7 July 2016 explaining that the neonatal unit was being downgraded to only care for less premature babies.
The press release says the reason was there had been an increase in mortality amongst “some of our most poorly babies”.
Rachel Langdale KC asks Ian Harvey: “Was that a fair description of the babies that had died?”
He answers: “At that time I believed that that was a reasonable description.”
Langdale says that's what the neonatal unit manager had said, but not doctors.
"Did you take her word, rather than the experienced consultants?" Langdale asks.
Harvey says: "I believe in terms of the communications, that was the understanding at the time. That's all I could say."
The inquiry is shown handwritten notes from a meeting held between the consultants and executives on 30 June 2016.
Dr Ravi Jayaram is noted as having mentioned "air embolism" (one of the methods of murder which Letby was later convicted of).
He also mentioned difficulties with resuscitating babies.
Rachel Langdale KC puts it to Ian Harvey: “He’s saying it constantly isn’t he? This is the concern?”
Harvey replies, “I’m not sure that the notes capture the way things were discussed in the meeting."
The questioning continues and Ian Harvey is asked why he ordered the consultants that “all emails cease forthwith”.
He responds: That email, he says, is one "I had cautioned many others against sending".
He goes onto say there is a tendency for emails on hot topics to become more and more extreme, and he was trying to dampen that down.
"But I fully accept. that I got that completely wrong. That email doesn’t read as it should have done.”
Judith Moritz
Special correspondent, reporting from the inquiry
Rachel Langdale KC is now taking the inquiry through a series of emails, external which pass between senior managers in the days after babies O and P had died on consecutive days at the end of June 2016.
She points out that whilst these emails are being sent back and forth about the subject, Lucy Letby is still being allowed to keep working in the unit.
It starts with an email from a consultant, Dr Saladi, to his colleagues. He says they are "all under suspicion and the only agency who can investigate all of us I believe is the police”.
Another consultant, Dr Ravi Jayaram replies to say that he and Dr Steve Brearey were “trying to meet with the execs ASAP to discuss exactly this” but “they do not seem to see the same degree of urgency as we do”.
Ian Harvey then replies to all the doctors on the email chain to say: "This is absolutely being treated with the same degree of urgency… all emails cease forthwith."
Judith Moritz
Special correspondent, reporting from the inquiry
Counsel for the inquiry Rachel Langdale KC now moves forward in time, and asks Ian Harvey about the period at the end of June 2016 after two triplet brothers, babies O and P, died on consecutive days.
Letby has since been convicted of their murders.
Dr Brearey asked Harvey to join a meeting with the paediatricians after the two deaths.
He did not go. Langdale asks why not. “Why didn’t you attend that meeting? Two babies have just died on consecutive days. It’s hard to imagine anything more serious in the hospital."
Harvey says he can’t say, and doesn’t know what other commitments he had at the time. He was aware that there was a separate prearranged meeting for a hospital fundraising drive, and took that opportunity to meet instead.
Judith Moritz
Special correspondent, reporting from the inquiry
Image source, Thirlwall InquiryDr Brearey previously told the inquiry that - at this same meeting on 11 May 2016 - the neonatal unit manager Eirian Powell countered his concerns “quite forcefully and with great emotion, saying there were no issues with Lucy Letby".
Ian Harvey is asked about his recollection of this.
He says: “I think Dr Brearey is overstating it by saying ‘with great emotion’.
"I believe that Eirian was factual. She was obviously passionate about her unit, but I don’t think that she was excessively - as is implied - passionate with regard to defence of Lucy Letby.
"I think that has been overstated."
Judith Moritz
Special correspondent, reporting from the inquiry
Rachel Langdale KC shows the inquiry an email to the director of nursing, Alison Kelly, which Dr Brearey sent in May 2016.
The email says, external that there's a nurse on the unit who has "been present for quite a few of the deaths and other arrests".
Ian Harvey replies to Kelly, who has forwarded him the Brearey email, and suggests Brearey may have raised this point in his email because he was "concerned" for the nurse involved.
The inquiry has previously heard evidence from Brearey about a meeting on 11 May 2016 in which he went through the detail of the ‘thematic review’, highlighting things like the unusual number and pattern of deaths which happened in the early hours of the morning.
Harvey now says he does not agree with Brearey’s recollection of that meeting.
"I don’t recall Dr Brearey being that detailed or that assertive”.
Judith Moritz
Special correspondent, reporting from the inquiry
Rachel Langdale KC puts it to Harvey that in August 2016, when the coroner was preparing for the inquest of Baby A, hospital staff had "been talking in various meetings about whether Letby is killing babies”.
She asks him: “Do you think the coroner was adequately informed about the suspicions and concerns you had about Lucy Letby killing babies, and whether or not she was looking after this baby?”
Ian Harvey says he doesn’t know.
He is asked about one of the “themes” a thematic review carried out in February 2016 identified, which was that 6 out of 9 babies whose deaths were reviewed had had cardiac arrests in the early hours of the morning.
It’s pointed out to him that in the case of serial killer Harold Shipman, a local GP spotted a pattern in the deaths of his patients (many of whom Shipman had killed in the afternoon during home visits).
He’s asked whether the fact that Dr Brearey identified a pattern of the timing of the baby deaths in Chester should have stood out to him as unusual.
Harvey says no - because he was made aware that there were still further investigations being carried out.