Judith Moritz
Special correspondent, reporting from the inquiry

Image source, Getty Images

The inquiry is shown a letter which Lucy Letby’s parents sent to Nichol and hospital chief executive Tony Chambers in 2017.

They wrote: “It is now one year since our nightmare began. There is a saying ‘innocent until proven guilty’ but it doesn’t seem to apply to Lucy."

In the letter, Letby's parents also requested a meeting with both of them.

Nichol says he didn't respond, and it was agreed that Chambers would meet the parents.

Asked about what level of support he thinks was being given to Letby at the time, Nichol says: "I have no insight into that".

Judith Moritz
Special correspondent, reporting from the inquiry

The questioning now moves on to the next extraordinary board meeting, in April 2017., external

At this meeting, a criminal barrister - Simon Medland KC - was invited to attend, after been asked to advise the hospital on its approach to involving the police.

Nichol says the barrister “reported back to us that he didn’t find any evidence of criminality but he used an expression that stayed in my memory".

"Along the lines that 'if events are still unexplained, the police should be called'... I wish we had had that advice in July 2016.”

Sir Duncan Nichol - the former chairman of the Countess of Chester Hospital, where serial killer Lucy Letby worked - is still giving evidence to the Thirlwall Inquiry

If you're just joining us, here's a quick recap of what he's said so far:

• Shipman situation: At a meeting in June 2016 - when Letby was still working on the ward - a doctor told hospital executives "this is a Beverley Allitt / [Harold] Shipman situation", something Nichol says he doesn't recall
• Doctors' suspicions: He recalls one doctor - at a later meeting in July 2016 - describing suspicions about Letby as the "elephant in the room", but the hospital's then-medical director had "drawn our attention to the possibility that multiple factors" lay behind the deaths

• 'Not good enough: The former chairman says risks were not logged and escalated by the proper system - and that written notes on the ward regarding baby deaths weren’t good enough
• A matter of reputation?: The rise in baby deaths at the hospital had been logged as reputational, rather than a risk to public safety, something Nichol tells the inquiry was "inappropriate"

Image source, The Thirlwall Inquiry

Sir Duncan is now being asked about a board meeting on 10 January 2017, at which the then-medical director, Ian Harvey, recommended that the board should be “invited to consider assisting the staff member’s return to work on the neonatal unit”.

Unlike at the previous board meeting, the consultants were not present.

Rachel Langdale KC, counsel to the inquiry, asks: "Do you think as a board it might have been helpful for you to have the consultants’ views of the adequacy of the RCPCH report?"

Nichol replies: "Yes, I do, absolutely. I regard it as personally a big failure on my part, that the consultants were present at the first extraordinary board meeting and they were not present at this one, and they should have been."

He says the decision over who attends was ultimately his.

He agrees with Langdale that the tone of this meeting was "very different from the last one" and discussed the risk to babies.

Nichol says he does not recall whether there was any discussion over what parents would be told about the impact of the report on their children.

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry has previously heard there was a public version of the Royal College of Paediatrics and Child Health report, and a redacted version, with references to Lucy Letby removed. The consultants were not shown the full version.

“I thought it was essential that they see it,” Nichol tells the inquiry.

Inquiry counsel Rachel Langdale KC asks if he checked whether they had, to which Nichol says no.

He adds that he doesn’t know if the full hospital board ever saw the full RCPCH report.

Judith Moritz
Special correspondent, reporting from the inquiry

To give you some idea of where this all fits into the timeline, the last murder which Lucy Letby has been convicted of is that of Baby P - on 24 June 2016.

She worked on the neonatal unit until 30 June, and then went on annual leave for two weeks.

On her return, she was moved to a clerical role in the risk and patient safety office.

This board meeting was on 14 July 2016, and a subsequent external review by the Royal College of Paediatrics and Child Health (RCPCH) was conducted in September 2016.

Image source, EPA

Judith Moritz
Special correspondent, reporting from the inquiry

The counsel to the inquiry now asks Nichol about an extraordinary meeting of the hospital trust board, which was called on 14 July 2016 - two of the unit's paediatricians, Dr Stephen Brearey and Dr Ravi Jayaram were there.

Nichol says he remembers Jayaram using the phrase "elephant in the room" at this meeting, to refer to their suspicions about Lucy Letby’s association with the timing of the deaths of babies.

He adds that at the same meeting, then-medical director Ian Harvey had “drawn our attention to the possibility that multiple factors” lay behind the deaths, and had said “we cannot see a single hypothesis”.

And, he says, he was influenced by Jayaram noting police would need "hard evidence" to begin an investigation.

Judith Moritz
Special correspondent, reporting from the inquiry

The hearing restarts and Sir Duncan Nichol is asked about a press release the hospital put out in July 2016, external to communicate the decision to downgrade the unit.

Rachel Langdale KC, counsel to the inquiry, asks whether it was "transparent or accurate" to not mention that some paediatricians were concerned about the actions of a nurse on the ward.

“I think that at the point we were it was the right communication, it was transparent," Nichol says.

At the time enquiries were ongoing, he explains, and they believed that the increase in mortality on the neonatal unit could be down to “multi-factorial” reasons.

“I am content that was a fair press release at that time”, he says.

Image source, The Thirlwall Inquiry

Judith Moritz
Special correspondent, reporting from the inquiry

Nichol is asked about the creation of a "silver command" unit within the hospital in July 2016, which included him, some executives and other managers.

He says it was established in the wake of the decision to downgrade the unit to care for less premature babies.

“I think it was in anticipation of the actions that would be taken in that July and August."

"A great many of them would have a great effect on the hospital, the community, the mothers, and we just needed to prepare for what would be a very demanding communications exercise.”

The inquiry is now heading on a short 15 minute break.

Judith Moritz
Special correspondent, reporting from the inquiry

Moving on now to a different meeting later that same day, which Nichol attended along with hospital executives and some doctors.

One doctor, Dr Jim McCormack, is recorded as saying: "This is a Beverley Allitt / Shipman situation” - referencing Allitt, a nurse convicted of murdering babies in her care, and Dr Harold Shipman, who was responsible for the deaths of up to 215 patients.

Rachel Langdale KC asks Nichol: “Did that make you sit up when you heard that?”

He says he doesn’t recall the doctor making the comment.

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry is now shown handwritten notes from a meeting between hospital executives and Sir Duncan Nichol on 30 June 2016.

In this meeting, then-medical director Ian Harvey is seen to have said that it couldn’t be accepted that the neonatal unit was safe.

Nichol says this is the first time that he had heard discussion of the unit being downgraded - meaning it would care for babies who were less premature.

Image source, The Thirlwall Inquiry

Judith Moritz
Special correspondent, reporting from the inquiry

The inquiry now moves on to a meeting of the hospital's Quality, Safety and Patient Experience Committee, which was addressed by then-medical director Ian Harvey on 19 September 2016.

This was shortly after an external organisation - the Royal College of Paediatrics and Child Health (RCPCH) - had been invited into the hospital to review the neonatal unit.

Harvey told this meeting that the external review “had not raised any immediate concerns”, but in fact the RCPCH had recommended that there should be an immediate HR process to investigate the allegations against Lucy Letby.

Nichol is asked if, in the light of this, he believes that the statement Harvey made to the committee was accurate. "No," he says.

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, The Thrilwall Inquiry

The quality of note-taking and documentation relating to reviews that were conducted into the rise in neonatal deaths at the hospital wasn’t good enough, Nichol tells the inquiry.

“They were difficult to understand, not all of them made it easy to connect the point to who was taking action - I found them difficult to follow.”

He agrees that they notes should have been typed up with a clear chronology and an action plan with clear responsibilities.

“From the written notes it wasn’t entirely clear to me who was following up, and I had no sense of whether that was happening or not.”

Judith Moritz
Special correspondent, reporting from the inquiry

Inquiry counsel Rachel Langdale KC asks Nichol for his opinion on the relationship between doctors and nurses at the hospital while he was chair.

"Generally, I thought we had a happy team that worked together," he says.

"You’ll always find a hot spot or two somewhere, but in general I thought we had a cohesive team that was working as a team across professions."

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, Cheshire Constabulary

Nichol tells the inquiry that he had never discussed safeguarding - in particular in relation to the neonatal unit - with Alison Kelly, the executive lead for safeguarding at the hospital,

Rachel Langdale KC asks if he doubted any time that consultants "had genuine misgivings" about Lucy Letby.

"No", Nichol says, "I genuinely felt that they had those misgivings".

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, The Thrilwall Inquiry

The inquiry is shown an entry which was made on the hospital’s Urgent Care Risk Register in July 2016, where the risk of an "apparent" rise in baby deaths is logged as reputational., external

Rather than, for example, a risk to patient safety.

Nichol is asked what he makes of the way the risk was recorded.

"I think it’s inappropriate," he says, "I don’t think a matter of patient safety and the explanation of that should present any reputational risk to the hospital."

"I think it raises important questions of how we communicated with the community, and in the case of neonates, with the parents."

Judith Moritz
Special correspondent, reporting from the inquiry

Nichol is asked about the way risk management worked within the hospital’s management structure.

"The risk management system works on risk issues being logged at ward level and escalated to the Quality and Safety Committee," he says.

And with Lucy Letby, "that did not happen”.

Image source, PA Media

Judith Moritz
Special correspondent, reporting from the inquiry

At the time that Lucy Letby was on the neonatal unit, the Countess of Chester Hospital was fundraising for a new unit.

"I remember a very busy and crowded unit and a sense that we were looking forward to the new unit we were seeking to fund," Nichol says, somewhere "with more space".

Judith Moritz
Special correspondent, reporting from the inquiry

Image source, The Thrilwall Inquiry

Nichol became chairman of the board at the Countess of Chester Hospital in 2012.

He is asked about his relationship with the former chief executive, Tony Chambers, which he says was "professional and warm".

“We met very frequently", Nichol tells the inquiry. "I was in the hospital two or three times a week and I would meet Mr Chambers on some if not most of those days".

"We had informal discussions, we would do walkabouts together in the hospital.”

Asked if these would ever occur within the neonatal unit - where Lucy Letby worked - Nichol says "yes", including "two or three times over a two or three year period" during the events being examined by the inquiry.

Judith Moritz
Special correspondent, reporting from the inquiry

One of the recommendations in the Allitt report - put together by Sir Cecil Clothier - reads as follows:

He was asked to circulate this point of learning by the then-Health Secretary, Virginia Bottomley.