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Police were called into the hospital in 2017.
Thirlwall added that “no-one seems to have understood that safeguarding action is required when a member of staff is suspected of causing deliberate harm – and does not require colleagues to be sure of guilt”.
“All the safeguarding guidance in the world makes no difference to the safety of babies if those to whom concerns are expressed do nothing.”
She highlighted that there was “still no NHS-wide protocol on deliberate harm”.
The report found Letby had ignored management instructions when she disliked them and shouted at her manager.
She had falsified records and one infant in her care had been found covered in their own faeces.
She was also found to have been repeatedly untruthful in her dealings with friends and colleagues, and was noted by patients to have been “inappropriate” and “callous” in her manner.
After an investigation lasting about 14 months, detectives arrested the then-28-year-old neonatal unit nurse.
She was arrested three times over the course of the investigation, and charged with multiple baby murders and attempted murders in November 2020.
Her trial, at Manchester Crown Court, began in October 2022 and lasted about 10 months. The jury returned guilty verdicts on seven counts of murder and six counts of attempted murder – finding she had tried to kill one baby twice.
She was found not guilty on two counts of attempted murder, and the jury failed to reach verdicts on six other counts.
Letby was sentenced to 14 whole life orders, and received a 15th after she was convicted in a 2024 retrial for one of the attempted murders.
Thirlwall made 17 recommendations in her report, which ran to over 1,100 pages over three volumes.
She said that cots and incubators in neonatal units should be fitted with baby monitors, and access to insulin – which Letby was convicted of administering to two of the babies she killed – should be controlled by either biometric data or CCTV monitoring.
She also said a “suspicion of deliberate harm” policy, which outlines the steps to be taken by managers when suspicions are raised, needed to be created, and that NHS staff should be contractually obligated to follow the policy and other safeguarding guidance.
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