Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry is now moving on to a hospital board meeting on 10 January 2017.

The RCPCH report was handed out there. It contained six points under the heading "immediate recommendations".

In the minutes for that board meeting, Chambers is recorded as saying the report made "a number of recommendations although nothing immediate".

Asked by Nicholas de la Poer KC whether this was a false statement, Chambers disagrees.

"It’s important to understand that an immediate recommendation is one that you take action on that day, where there is an immediate patient safety risk. There was nothing in the RCPCH review that I felt into that category," he says.

De la Poer challenges this: "So although there was a heading ‘immediate recommendations’ you didn’t think there were immediate recommendations?"

Chambers restates his previous answer, adding that "its almost one where, for example, the Care Quality Commission come in and they see something and they almost press the stop button. … I didn’t read those recommendations in that way."

Judith Moritz
Special correspondent, reporting from the inquiry

Chambers is asked whether the hospital trust's executive directors should have gone back to Dr Jane Hawdon - who led the RCPCH review - to ask what the significance of her findings were after the review said that four of the baby deaths were unexplained.

In response, Chambers says that nothing at all within the review pointed to anything suspicious.

Judith Moritz
Special correspondent, reporting from the inquiry

Nicholas de la Poer KC presses Chambers to answer a question about what the document says about the department's leadership.

Chambers accepts that it’s not unreasonable to say that the thrust of the Royal College of Paediatrics and Child Health (RCPCH) report was that the neonatal unit was well led.

He also accepts that the review did not say that staffing levels were an explanation for the rise in mortality levels - the number of deaths - on the neonatal unit.

Judith Moritz
Special correspondent, reporting from the inquiry

The RCPCH produced two reports as a result of its review - one public, and the other confidential and kept by executives.

Chambers is asked about what the public, or "dissemination", copy said about leadership on the neonatal unit where Letby worked.

"We had some brilliant doctors working there who worked really hard. We also had some wonderful nurses working there who too worked hard," he says.

"The relationships between the two could change by a shift. This was a unit that was under significant pressure. This was a unit that had gaps in the nursing rotas and these were things that we were seeking to resolve."

Judith Moritz
Special correspondent, reporting from the inquiry

Chambers is currently being taken through the detail of a string of reviews which happened in late 2016.

The Royal College of Paediatrics and Child Health (RCPCH) review recommended a further detailed case note review of the baby deaths.

This was carried out by an external paediatrician - Dr Jane Hawdon - who found that four of the deaths remained unexplained, and recommended them for further investigation.

Key dates to help you navigate the details of today's hearingpublished at 12:16 Greenwich Mean Time

12:16 GMT

Judith Moritz
Special correspondent, reporting from the inquiry

It may be helpful for me to remind readers of some basic dates, to be able to keep track of the evidence as it jumps around.

Lucy Letby has been convicted of murdering seven babies and attempting to murder another seven between 8 June 2015 and 24 June 2016.

Tony Chambers says that he was first aware of the fact consultants suspected her of causing deliberate harm on 29 June 2016. Letby worked on the unit 30 June. A series of reviews - internal and external - were carried out after this point.

One which is often referred to was an invited review by the Royal College of Paediatrics and Child Health - the inspection visit for which took place in Sept 2016.

• Also in Sept 2016, Letby raised a grievance complaint at having been taken off duty and moved to a clerical role. This was upheld in her favour in December 2016
• In January 2017, the consultants were ordered by Tony Chambers to apologise to Letby
• Letby was posed to return to work on the unit at the end of March 2017, though this did not happen
• In April 2017, the Trust instructed a criminal barrister to advise them on what to do
• On 2 May 2017, Tony Chambers wrote to the Chief Constable of Cheshire to invite a police investigation. On 5 May 2017, the police investigation began
• On 3 July 2018, Letby is arrested
• On 11 November 2020, Letby is charged

Judith Moritz
Special correspondent, reporting from the inquiry

We are jumping around the timeline quite a bit, in terms of the order of questioning.

That’s because the questions being put to Tony Chambers are being broken down into topics, for example "contact with the police" - rather than him being taken through details chronologically.

Hearing from Tony Chambers is a big moment for this inquirypublished at 11:53 Greenwich Mean Time

11:53 GMT

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, Crown Copyright

Tony Chambers hasn’t spoken publicly about Letby before, and this is a big moment at the inquiry.

He has multiple questions to answer about how he handled things. Several times he’s given very long answers which depart from the question he’s been asked.

On one occasion, when the questions moved on, he asked to be allowed to continue to talk about the previous topic.

Nicholas de la Poer KC has reminded him on a few occasions to answer the specific question that he is being asked. At one point, Lady Justice Thirlwall intervened to tell Chambers that the barrister was asking fair questions and she would intervene again if she felt that Chambers wasn’t being given due opportunity to answer fully.

Judith Moritz
Special correspondent, reporting from the inquiry

Tony Chambers is taken to a press release which was put out by the hospital in 2018 after he had done an newspaper interview about police involvement.

Chambers is quoted explaining why police were brought in. In the release, he said: "We have had various enquiries including the Royal College of Paediatrics review and there were just a few things that our clinicians said, 'look we think we have got 90% of the answers but there are still bits that we need to do to ensure we’ve not missed anything'".

De la Poer puts to him that this was not an accurate characterisation of the consultants' position before he went to the police.

Chambers is asked about the likely effect of this statement on the families of the babies, who would have read it in the papers.

He says: “It was clumsy, it was disrespectful, and I’m terribly sorry."

Image source, Crown Copyright

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry sees minutes of a meeting between hospital executives and police from 12 May 2017. In the minutes, it’s recorded that "there is nothing that could potentially be evidence of a criminal investigation".

De la Poer presses Chambers on this. "This wasn’t an investigation you were encouraging, it was an investigation that you were discouraging?" he says.

"Absolutely not," Chambers replies.

De la Poer continues, saying that executives at the trust didn't think there should be a police investigation because they didn't believe a crime had been committed.

"No, that’s not right," Chambers says, "we were saying we couldn’t find any evidence of criminality" and asking for help.

Judith Moritz
Special correspondent, reporting from the inquiry

Nicholas de la Poer KC puts it to Chambers that when the trust contacted the police, the consultants’ concerns weren’t presented fully to them.

Chambers says he takes issue with that.

He says that the various reviews which had previously been carried out, including by the Royal College of Paediatrics and Child Health, contained these concerns.

De la Poer asks Chambers if he agrees that he "did not state the case for a police investigation at its highest".

Chambers says that is an "unfair proposition".

"We shared with police very openly and candidly what we genuinely believed to be the position as we understood it at the time," he says.

We've been hearing this morning from Tony Chambers, the former chief executive officer of the Countess of Chester Hospital. He was in charge of the hospital when Lucy Letby murdered seven babies there.

Here's what we've heard from his evidence so far.

• Chambers began by saying he was "truly sorry" for the "pain that may have been prolonged by any decisions or actions that I took in good faith"
• Asked whether he had personally failed, he said "it's difficult to say otherwise"
• He said he first learned of doctors' concerns on 29 June 2016, five days after the death of the last baby Letby murdered
• He said the concerns about Letby were "very shocking" to hear, but that "we wouldn't jump to criminality as the causal factor"
• On 27 March 2017, a consultant told Chambers that police should be involved, and Chambers agreed - but after consulting a criminal lawyer, Chambers only informed police (via a letter to the chief constable) on 2 May

Judith Moritz
Special correspondent, reporting from the inquiry

The day after this meeting - 28 March 2017 - Letby was due to return to work, but executives and the board chairman agreed the police would be called on 31 March.

Rather than calling the police as agreed on 31 March, they instead instructed a criminal barrister to advise them on what to do.

Chambers says "there was never any intention not to go to the police. We sought some independent advice around that."

Chambers eventually wrote to Cheshire Police's chief constable on 2 May - over a month later - with the first meeting with the police after that was on 5 May.

This was the beginning of Cheshire Police's Operation Hummingbird criminal investigation.

Judith Moritz
Special correspondent, reporting from the inquiry

Counsel to the Inquiry Nicholas de la Poer KC is asking Tony Chambers specifics about when people within the trust were talking about getting the police involved.

De la Poer jumps forward in the timeline to a meeting in March 2017, where the lead neonatal consultant Dr Steve Brearey said that the matter needed to be escalated to the police.

Chambers says "it’s important that the inquiry understands the matters which led up to this meeting … It was the first meeting where there was a decision that we would formally go to the police."

He accepts that his position by the end of this meeting was that the police needed to be called.

Judith Moritz
Special correspondent, reporting from the inquiry

Nicholas de la Poer KC now moves on to ask Tony Chambers about a meeting held on 30 June 2016 - a meeting attended by execs and the chairman of the board.

Letby was about to go on annual leave for a fortnight, and this was said to have given the execs "an opportunity to test the hypothesis" of Letby being removed from the unit.

Chambers is asked what’s meant by "testing the hypothesis".

He says: "I was very clear that we would test all thoughts around how to manage these matters, but in my mind Letby was going to be removed."

Judith Moritz
Special correspondent, reporting from the inquiry

Counsel to the Inquiry Nicholas de la Poer KC asks former Countess of Chester Hospital chief executive Tony Chambers if steps should have been taken to remove Letby from the staffing rota after hearing the concerns of consultants on 29 June 2016.

"What I was hearing was that there were concerns being raised, there was some hypothesis of what those causes of harm might be and there was a suggestion that there was a member of staff who was on duty more times than another member of staff," Chambers says.

De la Poer asks if the allegations about Letby were a safeguarding concern.

"It's a significant safety concern," Chambers says.

He adds that what de la Poer is "presenting is a very emphatic, descriptive description of harm and a very subjective link to one individual.

"(But) there was strong rebuttal to the proposition that this one nurse was deliberately causing harm … There was a very strong level of support for this individual."

Judith Moritz
Special correspondent, reporting from the inquiry

Chambers says that typically "we wouldn't jump to criminality as a causal factor" in the deaths and would "want to explore a broader set of answers" to questions about the deaths.

De la Poer says that in his testimony, Dr Ravi Jayaram gave evidence saying he raised concerns of deliberate harm being caused to the babies.

"You said: 'I can see how that would be a convenient explanation for you, but there must be something else.'"

Chambers says he doesn't recall making that comment.

A note from the meeting between Chambers and the consultants is recorded as reading: "Nurse cannot be excluded". Chambers accepts that this must have been said by one of the executives at the meeting.

Judith Moritz
Special correspondent, reporting from the inquiry

Tony Chambers met with paediatric consultants on 29 June 2016.

At that time, they explained to Chambers why they believed Lucy Letby was causing deliberate harm to babies.

Chambers is asked if he accepts that this was borne out of expert knowledge and experience. He says: "This was the first time that I’d been made aware of these matters. These were very shocking things to hear. I listened and heard their concerns."

Chambers agrees with de la Poer's suggestion that the consultants were experts. "I was a layperson in context of this so these were concerns that were being relayed to us by the doctors on our unit," he says.

De la Poer puts it to Chambers that the paediatric consultants were looking for leadership.

"I think that's absolutely right," Chambers says.

Judith Moritz
Special correspondent, reporting from the inquiry

Chambers says that the first time he became aware of concerns with Letby was on 29 June 2016.

That was five days after the death of Baby P, the last of the babies Letby has been convicted of murdering and attempting to murder.

On 24 June 2016, the day that Baby P died, two senior consultants told Director of Nursing Alison Kelly that they believed Letby was causing deliberate harm.

Letby was able to carry on working for another four days.

De la Poer asks Chambers if Letby's ability to keep working at the hospital mean that the issue wasn't being taken seriously enough.

"All I can say for certain is that I knew on the 29th - I was not aware of Letby’s name at that time. I was not aware specifically of the nature of the concerns," Chambers says.

Judith Moritz
Special correspondent, reporting from the inquiry

Inquiry counsel Nicholas de la Poer KC begins by saying he wants to give Chambers "the opportunity ….to identify" his most significant failure.

Chambers says that "it was not a personal failing. I’ve reflected long and hard as to why the board wasn’t aware of the unexplained increase in mortality in 2015 and 2016".

He says as CEO, it was his responsibility to deliver "safe care within the hospital" but adds that "the processes that we had in place weren’t being used properly, and I think I must take some responsibility for that".

De la Poer asks if Chambers believes he had any personal failing.

"It’s difficult to say otherwise. My witness statement has acknowledged that," Chambers says.