Concerns raised by consultants to hospital bosses about Lucy Letby before her baby killing spree ended should have “triggered” a call to the police, a public inquiry has heard.

Dr Elizabeth Newby told the Thirlwall Inquiry into the events at the Countess of Chester Hospital’s neonatal unit that fellow senior colleagues approached her about Letby after the sudden and unexpected death of a baby girl, Child I, in October 2015.

Letby murdered Child I at the fourth attempt by injecting her with air.

Consultant Dr Newby was called out to one of the earlier collapses of Child I and said she was asked if Letby had been present.

The only thing that we could say at the time was that she happened to be on all the shifts. No-one had ever seen anything, heard anything. There was lots of counter arguments that she was a very competent nurse, observed good practice etc

She said: “The conversation was then around the fact that she was always on duty when these events had happened and there were also some counter-arguments that we were a very small unit with a very small pool of nursing staff and so it was not inconceivable that the same poor person might be on duty for a number of events.”

Dr Newby said she “found it hard to comprehend that a healthcare professional could be deliberately harming babies” but added: “As 2015 went on, and into 2016, the thought that something awful could be happening solidified in people’s minds.

“It was completely out of normality that we should have so many deaths on the unit.

“It was very difficult. There was an air of disbelief about it. The only thing that we could say at the time was that she happened to be on all the shifts.

“No-one had ever seen anything, heard anything. There was lots of counter arguments that she was a very competent nurse, observed good practice etc.”

Dr Newby told the inquiry though that “everything needed to be considered” and she backed neonatal clinical lead, Dr Stephen Brearey, and children’s services clinical lead, Dr Ravi Jayaram in raising the concerns with hospital executives.

Counsel to the inquiry, Nicholas de la Poer KC, asked: “Was there any discussion between yourselves about whether the police should be contacted if there were discussions about the need to raise it with the senior management?”

Dr Newby said: “No, I suppose we felt that we needed to discuss the concerns and then they would help and guide us with what to do next.”

She said she did not know the exact date the meeting took place, although the inquiry has heard Dr Brearey met with medical director Ian Harvey and director of nursing Alison Kelly on May 11 2016.

In a statement to the inquiry, she said: “That should have triggered a request for a police investigation by the hospital as this should have been taken very seriously”.

Mr de la Poer said: “Was it your expectation that one thing would lead to another?”

“Yes,” said Dr Newby.

In June 2016, Letby attempted to murder a baby boy and went on to murder two triplet boys before she was moved out of the unit the following month to clerical duties.

Cheshire Police were not called in by the hospital until May 2017 and Letby continued working at the hospital until her arrest in July 2018.

After the triplet deaths, Dr Murthy Saladi told consultant colleagues and Mr Harvey in an email that police should be called in, the inquiry heard.

He wrote: “I believe we need help from outside agencies who can deal with suspicion. At the moment we are all under suspicion and the only agency who can investigate all of us I believe is the police.

“That is the only agency who can know our past history and our life outside the hospital, which might shed more light. I think we should proactively seek their help before we are forced because of further deaths.”

Giving evidence, Dr Saladi said senior managers thought this appeared to be an issue of “doctors versus nurses” and they decided instead to order an external independent review.

He said: “I was thinking they were looking for information sharing, or at least exploring our concerns. That did not happen and that’s when I thought they had made up their minds.”

He also recalled there was “concern” that the hospital would be in the media spotlight if police were brought in and no-one would want to come to the labour ward.

The inquiry has heard that chief executive Tony Chambers told the consultants in January 2017 to “draw a line” under the Letby issue after external reviews found no evidence of criminality and ordered them to apologise.

Paediatrician Dr Suzy Holt told the hearing she was “devastated” that a letter of apology was subsequently sent to Letby from herself and six other consultants.

She said: “I didn’t feel I had a choice and I’m quite embarrassed that we ever wrote that letter and sent it.

“It was an apology for how she felt rather than any suggestion she was innocent.”

Dr Holt said she became “anxious” and “stressed” that hospital executives were taking steps for Letby to return to clinical work.

She said she thought neonatal ward nursing manager Eirian Powell and director of nursing Alison Kelly were both “very” supportive of Letby.

She said: “I didn’t really speak to any of the nurses on the neonatal unit about it but I know that many of them were good friends with Lucy and were really traumatised, and themselves torn about what to think and how to think.”

Counsel to the inquiry Rachel Langdale KC asked: “Was the fact that there were other people expressing very positive views about her at that time, did that impact in how clearly sighted you were on the essential concerns?”

Dr Holt replied: “Yes. The facts we knew with certainty were around the death rate and the facts we knew without certainty were how that had come about.

“And people you worked with and respected were advocating very strongly for her. So much so that Lucy turned up on a Christmas night out that December (2016) that I had gone to.

“The two things just seemed so hard to balance. That the nurses were so supportive of her that they would be still be inviting her to come on a social evening, I think it was Eirian’s joint retirement do.

“You are desperately trying to continue to work with these colleagues to provide safe and excellent care… I couldn’t believe it when she turned up. I didn’t think she would come.”

Letby, 34, from Hereford, is serving 15 whole-life orders after she was convicted at Manchester Crown Court of murdering seven infants and attempting to murder seven others, with two attempts on one of her victims, between June 2015 and June 2016.

The inquiry is expected to sit at Liverpool Town Hall until early next year, with findings published by late autumn 2025.