LL Part 10: Numbers

Numbers everywhere...

Following on from our previous post about the Lucy Letby case here.

One of the key issues that keeps being relitigated is the number of neonates that died that were either at Countess of Chester Hospital (CoCH), or were cared for in CoCH’s neonatal unit for some period of time prior to their demise.

There are at least three different positions on the number of neonates that died after being cared for in the CoCH neonatal unit during 2015-2016.

1. Around 30-33

2. Fewer, perhaps as few as 17 (and note that Lucy was only ever considered a suspect in 8 of these, of which 1 was removed during pretrial submissions)

3. That the true total may also include babies that were transferred out and died elsewhere and is therefore currently unknown

However, below I will explain why each position is potentially wrong and why we truly do not know exactly how many of these vulnerable neonates’ lives may have been impacted as a result of their interaction with CoCH.

CoCH FOI Release

In an FOI release the CoCH hospital acknowledged that:

(a) in 2015 they reported: 8 early neonates, 1 late neonate and 0 post neonatal deaths

(b) in 2016 they reported: 7 early neonates, 1 late neonate and 0 post neonates.

The more astute of you will no doubt see that this makes for a total of only 17 neonates.

However, we have to remember that these are only the neonates that died on the CoCH neonatal unit. This number does not include neonates that died in other parts of the hospital, or those that were transferred out because they needed more specialist or surgical care and subsequently died elsewhere - for example, at Arrowe Park, Alder Hay or Liverpool Womens Hospital (LWH).

Dewi Evans’ Evidence

During cross examination by Ben Myers KC on the 25th of October, 2022, Dewi Evans testified that he was asked “to investigate 33 cases in total”, with the “two insulin cases [added] later.” We do not know whether he means deaths or crashes here. While the back and forth between himself and Myers in the minutes leading up to this statement suggests that they may have been talking about deaths¹, it is not clear whether it includes 33 neonates who had adverse events on the unit OR 33 deaths. Similarly, it could also mean 33 events, given that a few of the neonates had more than one ‘crash’. The testimony is unclear.

What DO we know?

We know that more than 600 babies are born each year at the CoCH (ONS) and that CoCH was already at the highest end of statistics for the number of stillbirth and neonatal deaths. We know that during the year before (2014) CoCH was branded ‘poor’ because clinicians and hospital management were “failing to report patient safety incidents in an open and honest manner” including “incidents leading to death or severe harm.” This drew even more attention to the hospital, and that attention identified a ‘blip’ in increased mortalities at the hospital that was reported in the media in early February 2015 - just before the deaths attributed to Lucy Letby were said to have started occuring. We can suggest that the issues at CoCH did not involve midwives, because they were winning national awards at the time for the higher-than-average standard of care they were providing. Therefore, we may be open to infer that any issues with the standard of care these neonates experienced is more likely to have been occuring downstream of the delivery unit - i.e., in the paediatric and neonatal care they were recieving. We also know from testimony that the neonatal unit was drastically understaffed most of the time, that nurses who were meant to be caring for neonates on a 1-to1 basis often had to care for 2 or 3 such poorly babies, and yet the hospital management were were talking up their newly acquired Trust rating of “Good” even as they knew they were required to “ensure staffing levels are maintained in accordance with national professional standards on the neonatal unit and children's ward.” To what degree does making a nurse responsible for two (or three) babies requiring 1-to-1 care affect the quality of care they can provide? Let’s not forget that at least one nurse under oath admitted that the care she was providing when Baby D died “fell outside the guidelines.”²

Recently, someone pointed me to this 2015 article which speaks of a mother who raised money for a live webcam from the neonatal unit. It would be interesting to find out where this camera was positioned and to view any footage it may have gathered (if retained). How likely is it that when the babies Lucy is meant to have harmed occupied different positions all over the ward, that the camera was incredibly never positioned on any one of the 17, 33 or whatever number turns out to be the final count?

My Position

I, for one, and after discussing the matter with nurses and midwives from various hospitals including those from LWH (a hospital that often recieves mothers and babies from CoCH), subscribe to the third position. I believe that the true number lies somewhere beyond the 17 ‘deaths’ exposed in the FOI. While Dewi Evans’ meaning is unclear, I cannot hang my hat on his numbers as being the correct number of ‘deaths’ because of the ambiguity in his testimony.

The numbers I have been seeing as I review various sources (MBRRACE³, ONS⁴, and FOIs) and those which different hospitals are now also looking at (which includes the fact that LWH have internally emailed around to their staff that they are investigating two neonates that died on their unit that may have some link) seem to coalesce at 30 or 31 deceased neonates in total. The number of allegedly ‘harmed’ neonates when using Evans’ descriptions for harm would therefore be much higher - perhaps in the early 50’s.

Because of the known problems of accurate reporting of statistics in these cases it is unlikely that we will ever know the true figure for certain. These problems are not limited to: (i) the privacy and GDPR issues that limit access and release of this data; (ii) the high number of neonates potentially involved and which the police now estimate at being close to 4,000; (iii) the potential to miss some neonates where patient records systems have changed in the interim (for example, LWH upgraded their maternity EHR systems in 2016 and have another complete replacement project running at the moment); and (iv) the potential to make some of the same mistakes we have seen in court during the trial when reinterpreting and refreshing practitioners’ memories using the information recorded in these old records.

The next article on the Lucy Letby case can be found here.

1. In the 3-4 minutes leading up to this comment they discussed the death of Baby A, and the death of another baby in Swansea, and Evans’ position that he was not tasked to investigate crimes of murder - also suggesting deaths, but rather “a clinical condition”.

2. Nurse Oakley under cross examination related to the death of Child D to whom she was the designated nurse.

3. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) reports describe perinatal mortality rates and maternity outcomes during a prescribed period in the United Kingdom. https://www.npeu.ox.ac.uk/mbrrace-uk

4. The Office for National Statistics (ONS) release an annual Maternity Statistics dataset: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2021-22