It was, as one doctor put it, the safest place in the world. A place where babies smaller than an adult’s hand take their first fragile breaths, where every pounding heartbeat is cause to celebrate, and where – almost always – those born on the edge of life eventually go home with their parents.
To imagine a killer stalking the quiet, hopeful corridors of a hospital neonatal unit is to push back the frontiers of what many think of as evil. That a young, smiling woman in blue NHS scrubs could carry out these crimes is somehow even worse.
The name Lucy Letby will now be seared into the national conscience in the same way as Myra Hindley, Rose West and Beverley Allitt. The 33-year-old nurse has been convicted of murdering seven newborns and attempting to kill another six, making her the worst baby killer in modern British history.
She was cleared of two counts of attempted murder and the jury was unable to reach verdicts on six further attempted murder counts relating to five babies.
What turned this young, university-educated children’s nurse into a “cold, calculated, cruel and relentless” baby killer? How did she carry out such unthinkable murders within the confines of an institution designed to save the most vulnerable of lives? And, perhaps the most difficult and pressing question: why?
Unlike with West and Hindley, there were no signs of a traumatic or abusive childhood. Letby grew up in Hereford city centre, a picture of middle-class England. She was an only child to John, 76, and Susan, 62, who were described by neighbours as well-liked and respected. The pair attended every day of their daughter’s trial and remain fiercely loyal to her.
Many will suspect Letby has some form of psychopathy. Those who observed her in court saw a defendant coldly detached from the allegations she faced, often staring impassively from the glass-panelled dock as jurors heard the most harrowing testimony – including from parents who witnessed their babies’ “horrendous” screams and others who saw tiny limbs contorted in seizure.
One father, whose statement was read to the court, described the haunting image of his triplet son’s final moments: “You could see his veins bright, bright blue, going different colours. He looked like he had prickly heat. You could see something oozing through his veins.” Letby stared ahead, later dismissing the father’s testimony from the witness box: “I can’t comment on their truth. I didn’t see anything like that myself.”
Some parents recalled watching the oddly cheerful nurse bathe and dress their dead baby, learning only years later their child had not died of natural causes – and that the woman who performed this postmortem ritual was in fact their baby’s killer.
Those who survived were not always the lucky ones: two of Letby’s victims, a girl, now eight, and a boy, now seven, sustained brain damage as a result of her attacks. The girl, who was born 15 weeks early and given just a 5% chance of survival, has since been diagnosed with quadriplegic cerebral palsy. She is nil by mouth and requires 24-hour care.
It was not until the 16th week of the trial that Letby showed any emotion, but it had nothing to do with her victims. A married doctor with whom she was said to be infatuated – she denied that they were in a romantic relationship – arrived in courtroom seven at Manchester crown court to give evidence one afternoon in February.
As he confirmed his name from behind the screen that shields witnesses from the view of the defendant, Letby started crying and left her seat to try to open the door to the court cells. Four months into one of the most distressing criminal trials in recent memory, this was the first time she had shed a tear.
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Before 2015, the Countess of Chester’s neonatal unit was like any other in England. A team of about 30 nurses and seven paediatric consultants provided 24-hour care for hundreds of premature babies each year, some born as many as 12 weeks early, and weighing as little as 450g (1lb). The prospects for such extremely premature babies are good with the right level of care, despite being born in what doctors call “the margins of viability”. Studies show that for every 1,000 premature babies born in the UK each year, fewer than two die.
Of the hundreds of babies that passed through the Countess of Chester hospital’s neonatal unit in an average year, only between one and three would die. Until 2015.
In just 14 days in June that year, three infants died suddenly and a fourth deteriorated rapidly without warning. All had been otherwise stable, still only days old, but expected eventually to go home with their parents. Letby had other ideas.
Minutes after clocking on for her night shift on 8 June 2015, she injected air into an intravenous long line connected to a boy who was born the previous day, six weeks early, along with his twin sister. He collapsed immediately. Doctors rushed to resuscitate him as his mother, in a wheelchair recovering from the labour, sobbed: “Please don’t let my baby die, please don’t let my baby die.” Attempts to save the boy failed and he was pronounced dead at 8.58pm, within 90 minutes of Letby coming on duty.
That night, the boy’s father stood guard over his sleeping daughter’s cot metres from where her twin brother had died. Relatives took it in turns to watch over her for almost 24 hours, staying with her until 8pm the following day. But this was, cruelly, the time Letby came back on shift.
The little girl’s alarm sounded shortly after midnight. She suddenly looked desperately ill, the trial heard, despite having had no problems in her first 48 hours of life. One of the nurses shouted: “Oh no, not again,” as doctors tried to resuscitate her. Hospital staff noticed her skin changing colour in odd purple and white patches that they had seen for the first time the night before on her brother. “Not my baby, not again,” wept her mother. The doctors managed to save the girl’s life, but she would remain in hospital for another month before she was allowed home.
Records from Letby’s phone showed she had searched Facebook for the twins’ mother several times – the first shortly after finishing the shift on which she murdered the one-day-old boy, and then again the night after attempting to kill his sister. She searched for the mother again two months later.
The nurse had searched online for many parents of the babies she treated, she admitted later. Police found the records of 2,381 Facebook searches on her phone in the year to June 2016 – about 200 a month. Only a minority of these were for the parents of the 17 babies in this trial, but they had a disturbing pattern. Letby often searched for several of her victims’ parents within a matter of minutes, seemingly going one-by-one, hunting for grief. She even searched for them on Christmas Day.
Letby murdered two more babies in the days after she attacked the twins. There was no rational explanation for the sudden collapse of the four-day-old boy and two-day-old girl. And again, doctors were struck by the strange discoloration of their skin. It would later become clear that three of the four had been deliberately injected with air through an intravenous line into their bloodstream – Letby’s “favourite” method of attack, the jury was told. The changing skin colour, a phenomenon many consultants had never seen before, was a hallmark of her crimes, although nobody knew it at the time.
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Dr Stephen Brearey, the head paediatric consultant on the neonatal unit, has the calm, measured, rational temperament you would expect of a children’s doctor. But he was disturbed by the three deaths in 14 days. He reviewed the babies’ care and, besides a few minor learning points, there was nothing to explain why they had died so unexpectedly.
Then he looked at who was working at the time. Only one nurse was on duty for each death: Letby. Brearey took the findings to Alison Kelly, the director of nursing, and explained that the mortalities were still unexplained but added, almost as a postscript, that there was one common link. “It can’t be Lucy. Not nice Lucy,” Brearey told her. It was unthinkable to imagine a nurse harming babies in a neonatal unit, so the suspicion was all but dismissed the instant it had been raised.
It was the first time Letby had been identified as a potential suspect, but at the time most colleagues felt she had just been unlucky. “My initial feeling towards Lucy Letby was that I felt sorry for her,” one of her colleagues, the paediatric consultant Dr John Gibbs, told the Guardian. “She happened to be around when some of these babies were collapsing and dying and perhaps it was purely coincidental. When it kept on happening, it began to look like this cannot be just pure coincidence.”
Over the following year, the young nurse poisoned two newborns with insulin, pumped others full of air, overfed a baby with milk, and caused trauma to one baby’s throat by tampering with his feeding tube.
Almost all the newborns were attacked at night, often moments after their parents had left. A number were targeted when their nurse had briefly popped out of the room. On other occasions, Letby injected newborns with air and deliberately overfed one at the end of her shift, so the babies deteriorated on someone else’s watch.
It was no secret that Letby was present when the infants suddenly collapsed, yet her crimes were so subtle they were imperceptible. Trainees started referring to her as “the angel of death”, the Guardian has been told, although it was “tongue in cheek” rather than because they suspected her of foul play.
It has been more than 30 years since Allitt, another children’s nurse, was given that same nickname after murdering three infants and another child in eerily similar circumstances in 1991. No one thought it could happen again.
One of the reasons Letby was able to get away with it for so long was because no one saw her harm babies, and she was adept at covering her tracks. But one night she was almost caught in the act.
At about 9pm on 3 August 2015 a mother arrived on the neonatal unit with expressed breast milk for her five-day-old twin boys, known in court as Child E and Child F. The boys were born 11 weeks premature but had made such good progress they were due to leave Chester for a hospital closer to their home. As their mother arrived, a “horrendous” scream pierced the dimly lit corridor outside nursery one. She rushed in and saw Letby standing near Child E’s incubator. Her son had fresh blood around his mouth and was in extreme distress.
The mother asked Letby what was happening and the nurse, who wore a yellow butterfly sticker on her name badge, reassured her that he was OK and the blood was just from a feeding tube rubbing his throat. She should go back to the postnatal ward and rest, the nurse said. Two hours later the doctors were racing to save Child E’s life. He had lost more than a quarter of his blood and the skin on his tummy had turned purple and white – similar to the discoloration described for three of the nurse’s previous victims.
He was pronounced dead at 1.40am. His mother, “just broken” by her loss, allowed Letby to bathe her dead son before wrapping his 1.4kg (3lb) frame in the smallest white gown the nurse could find. His brother was her next target. This time Letby tried a crude new tactic – she poisoned Child F with insulin.
He had been prescribed a tiny dose of insulin to help regulate his blood sugar levels two days after his birth, and was being fed fluid nutrients from a bag connected via an intravenous long line to his leg. In the early hours of 5 August, just 24 hours after his twin had died, Letby injected insulin into the bag connected to Child F’s veins and added more to a replacement bag that would be used when the first ran out. If the first did not kill him, the second almost certainly would.
The five-day-old boy’s heart rate surged and his blood sugar levels plummeted; one of his legs swelled. The doctors, perplexed, changed the fluid bag but saw no improvement. Little did they know the insulin was still dripping into Child F’s body. Only when doctors decided to withdraw the second fluid bag did he begin to recover. Results later showed that Child F had “extremely high” insulin levels along with very low C-peptide levels in his blood. It was conclusive proof that someone had given him a large unprescribed dose of insulin and that a poisoner was at work.
It would be weeks before these results came back, however, and when they were read by doctors on the unit the significance was not immediately clear.
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One senior doctor who analysed Letby’s victims said they were selected carefully, not chosen at random. Almost all had other vulnerabilities, such as extreme prematurity or inherited conditions, that gave her plausible deniability when they died.
Deaths on the unit, although rare, were described by doctors as “expected and explainable”. Babies’ very presence on a neonatal unit meant they were incredibly fragile and Letby’s victims were often the most vulnerable of these: the majority required round-the-clock intensive care treatment, rather than just needing feeding and monitoring.
She tried to kill one boy less than 12 hours after he was born by ramming a nasogastric tube down his throat, using his haemophilia as cover to explain the severe bleeding. She appeared to target siblings, too: three sets of twins and one set of triplets were among her victims in the year to June 2016.
The timeline of her attacks show bursts of brutality in June 2015 – three murders and one attempted murder – and again exactly a year later. In between, the assaults were spaced out. In just 10 days in June 2016, she murdered two triplet brothers and attempted to kill another boy, either side of a two-night trip to Ibiza with a fellow nurse. By this time, the prosecution said, she was “out of control” and enjoying “playing God” with her defenceless victims.
Letby heard the identical triplets had been born the day she returned from Ibiza. She was due to return to work the following morning. The nurse texted friends that she would be “back in with a bang lol” – a reference, she insisted, to the unit being busy rather than anything sinister.
The three brothers were all in good condition. Letby was given responsibility for two of them: Child O and Child P.
At lunchtime on 23 June 2016, when the boys were almost 48 hours old, Child O’s heart rate rose and his tummy ballooned “like ET’s stomach”, his father recalled.
The parents were called from the labour ward as Child O suffered two further serious collapses. There was a “state of panic” on the unit as doctors tried to save the newborn. Their mother, recovering from labour, sat outside the intensive care room in a wheelchair, unable to bring herself to go closer.
Child O was pronounced dead at about 6pm. Doctors told the grief-stricken parents they didn’t know why he died but reassured them that his brothers were fine.
Little did they know that Letby, just 13 minutes after murdering Child O, had set about killing one of his brothers. The nurse pumped air into Child P’s stomach as she fed him milk, shortly before the end of her shift.
The little boy recovered overnight, when Letby was at home, and then, within 90 minutes of her starting work the next day, he collapsed again.
The parents recalled vividly the horror of the following hours. The unit was “pandemonium”, the father said, as doctors tried frantically to save the second triplet in a grim echo of events 24 hours earlier.
“He’s not leaving here alive, is he?” Letby said to a doctor as the little boy struggled to breathe. She had made a similar remark after attacking Child C a year earlier.
A transport ambulance team arrived to transfer Child P to a specialist hospital, but it was too late to prevent his next – and final – collapse. He was pronounced dead at 4pm. The boys’ parents “begged” the ambulance team to take their surviving triplet to Arrowe Park hospital, where Child P had been due to go. They agreed.
Letby was in “floods of tears” as she brought the two dead triplets into a private family room in a cooling Moses basket before their bodies were taken to the mortuary. “She was in pieces – almost as upset as we were,” their mother told the police.
They were the final murders for a nurse who was, by then, “completely out of control”, the prosecution told jurors. She searched Facebook for the boys’ parents on the first anniversary of their death. When asked about the searches, she claimed the “harrowing” experience had stayed on her mind, adding: “You don’t forget something like that.”
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Much of the evidence in the 10-month trial was so medically complex and contested it was impossible to know what the jury were making of it. They heard about a week of evidence for each of the 17 children. The medical notes of one baby alone ran to more than 8,000 pages. There were more than 5,500 pages of witness statements and 32,000 pages of exhibits, including text messages and photographs. Jurors were given a 25-page glossary of medical terms – such as “absent end-diastolic flow” and “biphasic positive airway pressure” – to help them understand the case.
After listening to 30 weeks of evidence, from nearly 300 witnesses, the seven women and four men on the jury were left with the biggest unanswered question: why?
Prosecutors gave them the germ of a motive, suggesting Letby enjoyed “playing God” – a phrase used for the first time on the 132nd day of the trial – and got a kick out of the “excitement” of resuscitating babies. It was a notion the nurse did not wholly disabuse when she gave evidence.
Letby told jurors she wanted to look after the most seriously ill babies – she was a band five nurse, which meant she was qualified to care for those in intensive care – and complained to colleagues when she was not assigned to those most in need. Jurors were even told Letby may have attacked babies to get attention from a married male doctor, whom she “loved as a friend” but consistently denied was her boyfriend.
The parallels with Allitt’s crimes in 1991 are striking. Her trial and a public inquiry concluded that Allitt, who like Letby was a nurse in her 20s at the time of her offences, had Munchausen syndrome by proxy, suggesting she harmed her victims in order to win the sympathy of others. Like Allitt, Letby seemed to enjoy the attention she received when the babies in her care collapsed.
After the third baby’s death in two weeks in 2015, Letby received a text from her mentor: “I can’t believe you were on again. You’re having such a tough time.” It was “part of the job”, Letby replied, saying she would “keep ploughing on”. She added, chillingly: “I think there is an element of fate involved. There is a reason for everything.”
Nicholas Johnson KC, prosecuting, suggested Letby was often simply bored when she attacked her victims. She would scroll Facebook endlessly and send WhatsApp messages to her two best friends, both of whom worked on the unit. They would spend hours sniping about colleagues, chatting about patients and arranging salsa, Zumba or hula-hoop fitness classes.
On one Saturday shift she attempted to murder a twin boy by injecting him with air shortly after arranging a bet on the Grand National. Two hours after the boy underwent a life-threatening collapse, Letby messaged a friend: “Work has been shite but … I’ve just won £135 on the grand national!!” along with a horse emoji.
The truth was that police cannot say how this “confident and competent” nurse became one of the most malevolent murderers of modern times. One detective said the lack of clues in Letby’s background made her a “completely unprecedented” serial killer.
“There isn’t really anything we have found in her background that’s anything other than normal,” said DCI Nicola Evans, of Cheshire constabulary. “She’s operated in a really average way, but being average has allowed her to go under the radar. And it’s allowed her to operate in plain sight.”
In the witness box, Letby tearfully described how she had always wanted to work with children and that it was “sickening” to hear the allegations against her.
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For months, senior doctors on the unit had raised mounting concerns about Letby’s link to the growing number of unexplained deaths. But it wasn’t until early July 2016 that her appalling crimes were finally ended. She was removed from the Chester neonatal unit after the sudden death of two otherwise healthy boys from a set of triplets .
It was the tipping point that prompted consultants to demand that she be removed. “It was devastating,” she told jurors. “I don’t think you can be accused of anything worse than that.”
The nurse was initially moved to a clerical role in – of all places – the hospital’s risk and patient safety office. It would be almost a year before the Countess of Chester hospital NHS foundation trust contacted the police in May 2017.
It was another 14 months before Letby was arrested at 6am on 4 July 2018. She had returned home to Chester the previous night from a holiday with her parents in Torquay. Her father had stayed the night, and watched as his daughter was led out of her three-bedroom house, where she lived alone with her cats, Tigger and Smudge, in her nightie and a blue Lee Cooper tracksuit.
When questioned by police, Letby blamed the deaths of her victims on a combination of poor staffing, the incompetence of others and the fact that some of the babies had other medical issues. It was a defence that largely crumbled under cross-examination, yet Letby continued to protest her innocence.
If there was a time, during the trial, when Letby’s fate looked sealed, it came on her fifth day in the witness box. Under forensic cross-examination by the prosecutor, she accepted for the first time that someone had deliberately poisoned two babies with insulin. There was no other medical explanation for their blood results, she admitted, though she maintained that she was not responsible.
Only two members of staff were working both shifts when the insulin poisonings occurred, eight months apart, the prosecutor told her. One was Letby, the other was a colleague against whom there was no evidence to suggest she was the guilty party, the trial heard.
The fellow nurse was quickly ruled out as a suspect when police analysed who had been present during a series of suspicious incidents. Of the 24 incidents at the centre of the trial, Letby was present for them all. The next was Dr John Gibbs, a consultant paediatrician who was often called to deal with emergencies, the court heard. He was present at 10 incidents.
During the criminal investigation, the insulin poisonings were, initially, the closest detectives had to a smoking gun. But then, after her arrest, they searched Letby’s bedroom – and what they found there left them stunned.
Tucked inside a teddy bear diary and a pink leather handbag were a jumble of notes filled with hundreds of scrawled words in black ink. On green and yellow Post-it notes, she had written: “I killed them on purpose because I’m not good enough to care for them” and “I AM EVIL I DID THIS”.
In court, Letby claimed they were the ramblings of a person in crisis, and pointed out she had also scribbled: “I am innocent.” Detectives saw them as the confessions of a serial killer.
Det Supt Paul Hughes, who led the investigation, believes she may have left them in her bedroom for police to discover. “You do think: well, if you knew we were potentially going to knock on your door at some point, you knew the investigation was ongoing, and you knew the police were involved, then why was all this stuff lying around? Is it so it could be seen? I don’t know, but yes, it surprised me that it was there,” he said.
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As soon as Letby was removed from the neonatal unit in July 2016, the deaths stopped. Since then, the Guardian has been told, nurses have cared for more than 2,500 babies and recorded only one death. The unit was downgraded after Letby’s attacks, so it now only cares for infants born up to five weeks premature. Still, the contrast is striking. Between 2015 and 2016 it recorded 15 fatalities – two years of more than double its annual average.
Today, visitors to the neonatal unit are welcomed by photos of smiling staff, pinned to a board in the entrance. It is based in a new building thanks to a fundraising campaign started years ago by workers. Letby herself was part of the money-raising team, telling a local newspaper in 2013 that a bigger ward would “provide a greater degree of privacy and space for parents and siblings”.
The building is nothing like the old 1960s unit, which had ageing wooden doors and faded cream walls. It has a playroom with colouring books, building blocks and scooters. There is a small garden and a living room, watched over by a Paddington Bear cartoon.
Families can now sleep over on beds next to the tiny incubators where their babies grow steadily, second by second, minute by minute, hour by hour. Once more, it feels like the safest place in the world.
• This article was amended on 19 August 2023. An earlier version incorrectly said Baby F had initially been prescribed a tiny dose of insulin to help “raise his low blood sugar levels”; insulin acts to lower blood sugar.
