Amanda Knox (3:13)

before we begin, please be aware this episode contains discussions around infant deaths and other difficult topics. Please take care while listening.

Beth (3:28)

What should I say? A very traumatized woman, young woman somebody destroyed. My heart just went out to her. We sat in from day one and it was an eye opener. There was people there that thought she was guilty that had come and the people there that believed her, she was, you know, felt that she was innocent and wanted to see for themselves.

Amanda Knox (3:57)

This is a woman we are calling Beth. She has a special connection to Lucy Letby. You see, Beth spent her career in the neonatal unit at Chester, retiring only a couple of years before Lucy was

Beth (4:11)

arrested, seeing a nurse destroyed and sitting in the dark there, being accused when you can see yourself that there's a lot more to this than is coming out here.

Amanda Knox (4:28)

Beth attended every day of Lucy Letby's second trial, the retrial for baby K.

Beth (4:35)

I really, really am so angry that these parents have been put through so much. I lost a baby and I know what it's like. If I'd have had to go through what they went through and then have a policeman knock on my door and say, we think your baby was murdered.

Amanda Knox (4:56)

In the cacophony of voices swirling around the story of Lucy Lepe, in every screaming headline, every panel of experts, in all the police conferences, there was one group of people who never seemed to rise above the fray. A group of people who would have known more than anyone what Lucy's life was like and would have possibly been able to tell a different story or fill in some blanks. Lucy's fellow nurses, they've been silenced and

Beth (5:30)

they live in fear now that next time it might be them. They'll be investigated. They'll be found guilty Because Lucy isn't the first, she won't be the last.

Amanda Knox (5:44)

I'm Amanda Knox and from Vespucci and I Heart podcasts, this is Doubt the Case of Lucy Letby. Chapter eight, the nurses.

Beth (6:09)

I've never met a nurse that's come in to work to harm a patient. I've met a nurse that made a mistake and been absolutely, been devastated. I mean, absolutely devastated.

Amanda Knox (6:20)

Beth took care of the sickest babies for around 40 years.

Beth (6:25)

The job in the hospital is very, very stressful. It changes throughout the day. You may be quiet at one point and then sit. Suddenly an emergency happens and, you know, it's all hands to the deck, you know, people rushing around everywhere. Patient care is paramount. Good patient care is paramount. And I don't know a nurse, never met a nurse that hasn't wanted to give her best to those patients, but they still try and put that smile on their face. And, you know, I don't see anyone going into the profession of nursing unless they really want to do that job. It's not a job that you would do to earn a wage. It's a job you do because you enjoy what you're doing.

Amanda Knox (7:14)

Those that knew Lucy say that she loved being a nurse, that she dreamed of being one since she was a kid, and that she was a good one, too. Which of course meant that the arrests and the two trials that ended in guilty convictions were even harder to understand.

Beth (7:32)

When Lucy was first arrested, I was in the hospital that day visiting, and the TV cameras were everywhere and nobody was saying what was going on. So I had to wait until the news. When the news came on, I found that a nurse, a neonatal nurse, had been arrested. Allegations of harming babies. Now something just didn't sit right with me. It sat very, very uncomfortably.

Amanda Knox (8:09)

Beth took that feeling and did something with it.

Beth (8:13)

I'm reading everything I can get of the journalists reports because I don't want to miss anything. It became obvious to me that it was multifaceted, the problems. There were not just one problem, there were lots of problems surrounding it which were causing these increase in deaths. And you have to get to the bottom of why this is happening so that you can put it right, learn from it and put it right.

Amanda Knox (8:41)

It was because of this unease that Beth and a fellow nurse friend felt compelled to sit through Lucy's retrial.

Beth (8:50)

It was Manchester, so it was fairly close, and we decided that we wanted to go and follow this case. So we went and there was quite a lot of nurses there. And we sat in from day one and it was an eye opener before the trial.

Amanda Knox (9:13)

Lucy was guilty. The second trial offered an opportunity to hear the evidence for herself. Maybe she'd hear something that made sense of the verdicts, but it wasn't clear cut.

Beth (9:25)

There was no factual evidence there at all. Where is the evidence that puts her at fault here that she's harmed this baby? There's lots of things happened before she even came on duty that you can't put that blame on her. So those of us that were, with interest, watching, listening to what was happening, could see that there was a lot of red flags appearing. To me, the evidence was there to prove her innocence. I could see it. Most of us with the medical knowledge could see it.

Michelle Worden (10:04)

I just think it's just absolute rubbish. People who go into nursing, going to nursing because they want to help people, they want, they want to, they're caring individuals. I mean, it's always caring people who get locked up in prison. It's really, really scary. It's very scary. It's a bit like the old 16th century witch hunts, isn't it? I think people get ideas in their heads and once you've got an idea in your head, you can't, you can't get rid of it.

Amanda Knox (10:38)

Like Beth, Michelle Worden spent her career in the neonatal field.

Michelle Worden (10:43)

I was the advanced neonatal nurse practitioner at the Countess of Chester Hospital.

Amanda Knox (10:49)

In the years leading up to Lucy's arrest, Michelle had a front row seat to the changes in funding and ultimately the care at the Countess of Chester.

Michelle Worden (10:59)

I went to work on the unit in 1988 and Wear and tear was beginning to show even back then. By the time you get to the time of the indictment in 2015, this is a very tired unit with problems with the plumbing, problems with the ceiling tiles, problems with the sinks and the taps sometimes not working properly, not being able to, to get hot water. And it wasn't just true in the neonatal unit, it was throughout. The Women and Children's Hospital labour ward had as many problems as did the gyne wards and the paediatric wards. But it was a very old, tired building.

Amanda Knox (11:46)

Along with the physical problems. Michelle says that a lack of funding affected the working environment at the Countess, including the number of experienced nurses on staff. In 2011, Michelle and five other senior nurses were laid off.

Michelle Worden (12:02)

Nurses were dispensed with under the terminology of restructuring, but in actual fact it was cost cutting and then they employed eight nursery nurses.

Amanda Knox (12:14)

A nursery nurse simply means that they solely worked in the nursery and only had childcare qualifications. They would have needed to be supervised to perform any clinical tasks and usually by a registered nurse.

Michelle Worden (12:28)

Now, we'd always had nursery nurses on the unit and they have a valid role to play, but they should be there to enhance the role of a registered nurse, not to replace the registered nurse. So by the time you got to the indictment period, I think it was the perfect storm. You had very few really senior nurses, you had very few registered nurses on duty. You had nursery nurses who were being asked to care for babies beyond their level of competency. You had consultants who were never there. If you take Lucy, Lucy was employed in Chester in 2012. There was two newly qualified straight out of university, registered nurses employed, Lucy being one of them. By the time we get to the indictment period in 2015, which is only three years, they're saying she's really senior. You cannot compare three years experience with somebody like me who had 30 years experience. I cannot think of any profession where you would be deemed to be senior after three years post grad.

Amanda Knox (13:41)

And there was evidence that those inexperienced nurses were buckling under the pressure.

Michelle Worden (13:48)

Well, we know from emails that have now been released that by the time you got to 2015, December, one of the consultants was writing to management saying the staff are in tears, the workload is overwhelming. We know in December 2015 this unit was only funded for 16 COTs, so it had three intensive care, four high dependency and the rest were special care cots. But there was at least two occasions in December 2015 where they had 20 and 21 babies. So they were running out of incubators, they were running out of basic equipment, they were taking more babies than they really had cots for. And she actually writes in the email, this is going to result in children's lives or the physical and mental well being of the staff.

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Amanda Knox (17:49)

These problems were also noted by the Royal College of Pediatrics and Child Health. A 2016 report found that staffing levels were inadequate. And perhaps most revealing, they noted that it wasn't just the neonatal ward that had an increased mortality rate in 2015. The maternity ward where Lucy Letby did not work also had elevated rates of stillbirths. That makes me wonder if the problem was bigger than just one bad nurse. Was this a problem across the entire maternity unit? Well, according to the Royal College of Pediatrics, the cause of increased deaths in the neonatal ward were systemic issues like crumbling infrastructure and staffing shortages. To date, the Countess of Chester Hospital has been very guarded about this data

Beth (18:42)

and the austerity is hitting all public services and that had a major impact on the NHS as a whole. So Chester was no different.

Amanda Knox (18:52)

Beth was working through this belt tightening time as well. She also witnessed the crumbling infrastructure and the lack of updated equipment and the staffing shortages.

Beth (19:03)

You've got to work within your financial constraints, which means that some things have to go. So training is cut to the quick staff. We tend to work on low levels of staff and then the stress levels start rising. Staff go sick, so they become more dependent on bank and agency to fill those shifts. You don't have that same continuity. So over time, standards start to fall. It's gradual, but they fall. And you'll find staff going home at the end of the day in tears, absolutely in tears, because they've not been able to, in their eyes, deliver the standard of care that they've been trained and want to give.

Amanda Knox (19:52)

This question around staffing was something that statistician Professor Jane Hutton looked at when she had originally been approached by the police to help them create that all important chart. However, Jane was quickly dropped from the investigation when she disagreed with the police's approach. She has since gone on to be one of the many voices questioning the validity of the statistical evidence against Lucy.

Professor Jane Hutton (20:17)

Lucy Letby was one of the most experienced nurses because the management had got rid of the advanced nurse practitioners whom you're supposed to have, if you try to run a unit like this and they weren't there, so you'd be getting the most experienced person and obviously the sicker patients tend to be given, if you've got a choice, to the most experienced doctors and nurses. The other thing the chart doesn't show is who wasn't there, which is important because of course, you might like to know about the doctors as well as the nurses. But the doctors were only doing two ward rounds a week. They should have been doing two ward rounds a day. That information clearly is Very important were the baby's dying because the consultants weren't getting around to caring for them.

Amanda Knox (21:03)

For Jane, the issues brought up in the report by the Royal College of Pediatrics and Child Health pointed to a much bigger problem at Chester Hospital.

Professor Jane Hutton (21:14)

When the Royal College of Pediatrics and Child Health was asked in to carry out a review, they found 23 major failings with the unit. They were also told by the doctors of the. The doctor said they were suspicious of Letby and they said, there is no evidence to support that suspicion. But that's where you got the comment on the lack of consultant ward rounds and the lack of communications, a lot of other problems. That report recommended a more detailed investigation, which Jane Horden did, a neonatal consultant, and in the 17 cases she looked at, I don't know how those cases were selected, she found major or substantial clinical, that is medical failings in 14 out of the 17. So to my mind, that gives you a set of possible explanations for the events that you should consider

Amanda Knox (22:07)

within this swirl of problems and stress. Humans make mistakes, and that includes nurses. But when you have an institution that is fighting tooth and nail for every penny they can get, people start to protect themselves, their jobs and their positions leading to a culture of fear and a lack of willingness to be open about mistakes.

Professor Jane Hutton (22:32)

If we're honest, how many of us likes admitting we've got something wrong? How many of us consultants, management, would much rather find somebody to blame? You know, let's be honest, this is not a matter of, aren't they terrible and we're perfect. None of us is perfect.

Amanda Knox (22:48)

And for Beth, if you've got a

Beth (22:50)

really sick patient and that patient dies, they're terrified that somebody's going to come along and point a finger and try and blame you for somebody's death. You know, you see nurses dealing with emergency situations and they're calm and they're cool. That is because they're trained to stand back, let the emotion, let motion get in the way. And you deal with that case in front of you, that emergency in front of you. You just get on and you calmly do the work. Then afterwards, you can go and cry. It is a difficult job, it's a very rewarding job, but it does come with its traumas as well. Nobody wants to lose a patient. And sometimes, you know, many times the nurses will sit there after an emergency situation where they've lost a patient and question themselves and say, is there something I missed? Did I miss anything? Could I have done something differently? Because nobody, nobody wants to lose a patient. It's a massive impact on care because they will be too frightened, they're too frightened to speak out.

Amanda Knox (24:16)

That is exactly what drove Jenny Harris away from her work as a neonatal nurse with the NHS after 18 years.

Jenny Harris (24:25)

It's like a roller coaster of emotions on the neonatal unit. It really is. I think you could experience every emotion in one shift, to be honest. Like, we're humans at the end of the day, aren't we? We've got hearts. That's why we want to be neonatal nurses, because we care for these babies

Amanda Knox (24:43)

and these families that drive that love for the job. Jenny says that it can only take you so far. Years of funding cuts, staff shortages and a culture of blame and can make even the most loving and professional nurse rethink her role.

Jenny Harris (25:02)

The management support is not. Is not really there. You're not appreciated, you're not thanked, you're just blamed for things. The bullying is horrendous. I had to see the psychologist once a week just to get through the week because of bullying that was happening. It can be really toxic. It's just not worth it.

Amanda Knox (25:25)

But it was the Lucy Letby case that really pushed Jenny to walk away from the nhs, because I was just

Jenny Harris (25:33)

like, this could have. I know people say all the time, but this could have easily have been me because I'm an INATA nurse. I look after babies that have died. Babies have died on my shift. Babies have died whilst I've been caring for them.

Amanda Knox (25:46)

Jenny felt especially knocked off guard when she heard about some of the evidence used to convict Lucy. One of those were the handover notes found under Lucy's bed. Handover notes are written by nurses at the end of their shift, recording what care a baby has received and flagging anything the next nurse needs to know.

Jenny Harris (26:07)

I've taken handover notes home. I've done it for many reasons, especially when I was in the first few years of being an neonatal nurse, I would take them on by accident. I see a lot of similarities with me and Lucy in the way, from what I've heard, like, I don't know Lucy, but, like, I used to keep a lot of the handover notes and even, like, other bits and pieces, she

Amanda Knox (26:32)

says that taking those papers home was never malicious. Neither was looking up patient families on Facebook, just like Lucy did.

Jenny Harris (26:41)

Because you want to see that the family, family are okay, because you're not allowed to. You're not allowed to contact them, you're not allowed to have their phone number. Imagine caring for a baby for a few weeks. You've really got to know the parents well. You've built up a relationship with them. The baby dies. Nurses need closure too. We need closure as much as. Well, not as much as the parents do, but do you know what I mean? We need closure too. And if that's her way of getting closure, then I don't understand what the problem is.

Amanda Knox (27:13)

And those suspicious post it notes. Jenny was also encouraged by her therapist to write things down as a way of coping with the stress of the job.

Jenny Harris (27:22)

For example, I had a core belief that I was worthless and I was a bad person. There was no evidence that I was a bad person. That's what I've learned through my therapy. But I was to write that down and I would write down, I'm worthless, I'm a bad person, but I'm not a bad person. But just, just because I wrote it down doesn't mean it's true. But as soon as I heard that she'd written these post it notes, I was like, well, I've done that because my therapist told me to do it.

Amanda Knox (27:55)

Jenny says it was the death of one particular baby that scared her the most.

Jenny Harris (28:00)

And I was distraught. Like it was, it was natural causes. It wasn't anything like that. But straight away my management were like, well, why didn't you do this? Why didn't you do that? You should have done this, you should have done that. No support that. I've just gone through this massive ordeal that was very traumatic. It was just, why didn't you do that? You should have done that. You should have done this. And I sat there and I thought if there was anything about the. Luckily we did a post mortem and everything was natural causes. But imagine if it hadn't been and there'd have been something else that they thought was suspicious. It's just, it's not even worth thinking about. That was like, literally like my final. I was like, that's it. I can't do this anymore. It's just too much. Now,

Amanda Knox (28:50)

Beth, the former neonatal nurse who retired from the Countess, knows that Jenny isn't the only nurse who felt that way. She sees that the Lucy Letby case

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Amanda Knox (32:04)

Waves through the entire UK health care

Beth (32:07)

system, the tremors we feel today reveal deeper fractures that have been building for years. We are seeing a profession in fear. Nurses, doctors and healthcare workers, all who have lost their voice, lost their confidence in speaking truth to power, and lost faith in the very systems designed to protect both patients and practitioners.

Amanda Knox (32:34)

And the tremors, they go even further than those who work within the system. Jenny says parents, they felt it too.

Jenny Harris (32:43)

It's like they stopped trusting us. A lot of them, we've even had parents and family members saying to us, like, oh, you know, we have to be careful now because of Lucy Letby. They've even used her name to us. And like, things that we used to do without the parents around now we've had complaints. You can't do that to my baby without me there. I need to be watching what you're doing and what you're giving. It makes your job harder and it makes you feel horrible because it's like, how can people not trust me with their babies? And actually, some of the the time it's putting their babies actually at more risk. Like, I had a mum that refused to let any nurse near her baby. She would only let the doctors. And I'm not saying the doctors can't do anything, but the things that this baby needed are things that the nurses do day in, day out and the doctors don't do very often because the nurses do it. So then all of a sudden she's like, I want the doctor to do it. And I tried to explain, I was like, this is something I do every day. The doctor will do it maybe once every few months, but it didn't matter. She didn't want a nurse near her baby.

Amanda Knox (33:58)

Nursing shortages are not unique to the uk. Low pay, long hours, stressful shifts. It's a common refrain around the world. But you add the idea of a serial killer nurse into the mix, and for some, especially those that work at the Countess, the toll is personal.

Michelle Worden (34:21)

One of them said to me, michelle, if Lucy's innocent, we really want her to be acquitted. But are they gonna come after us? So who's gonna speak out? Another one of them said to me, michelle, you don't understand. We've had eight years of hell. You know, they've been told they can't converse with each other, they can't meet Lucy, they were friends with Lucy, some of them went on holiday with Lucy, some of them subsequently, from the guilty verdict coming in, have completely broken contact with Lucy.

Amanda Knox (34:50)

Beth and Jenny and Michelle are just three nurses out of thousands in the UK who have concerns about this case.

Beth (34:59)

So social media became very, very active and it ended up with three groups. There was the guilty group, sitting on the fence group and the innocent group. And it started to get quite vocal. So I distanced myself from it, along with my friend Bertie, and we set up a group for people to discuss the cases. And through that we've come to meet an awful lot of people from the medical professions, not just nurses, you know, a lot of people, professors and specialists in their fields. So we've been able to talk a lot amongst the ourselves, we set a group up, it was a closed group and we found as well, when we started looking at, in depth into this, that there were so many nurses that were too frightened to speak out. It turns out the doctors as well, there are quite a few that we've been told are still frightened to speak out.

Amanda Knox (36:18)

This group, it's called 19 nurses, it's a place where medical professionals can ask questions about the Lucy Letby case anonymously. They are also working with Lucy's new lawyer on a judicial review of her case and they support whistleblowers and nurses who worry their rights may have been violated.

Beth (36:39)

There's a lot of anger out there. I think one of the things that this case has really unearthed is how medical cases, how complex they are, and that we really should not be investigated by police and that the judicial system itself needs a complete overhaul. We must confront uncomfortable truths. Our health care system has developed a toxic tendency to seek individual blame rather than address systemic failure. When something goes wrong, and healthcare things inevitably do go wrong, there is often a rush to find someone to hold accountable, someone to punish, someone to sacrifice on the altar of public accountability.

Amanda Knox (37:34)

Michelle Worden agrees.

Michelle Worden (37:36)

Things happen in garages when you're repairing a car. Why on earth would people think that it's not going to happen in a hospital? But the important thing is, is to recognize it, not to call the person out for making that mistake, because then they just go, I'm not going to say anything when it happens again. I'm going to push it underground, but to address how you can improve the system. I don't know why these consultants got the idea that it was a nurse as opposed to a system failure or suboptimal care. There is very much an ethos in the United Kingdom of doctors are God. You don't question a doctor, you believe them. I loved nursing. Would I do it again? No. Knowing what I know now.

Amanda Knox (38:31)

Next time on Doubt the Case of Lucy Letby.

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We did not find any murders.

Amanda Knox (38:36)

In all cases, death or injury were

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due to natural causes or just bad medical care.

Beth (38:43)

In our opinion, the medical opinion, the

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medical evidence doesn't support murder.

Amanda Knox (38:52)

Doubt the Case of Lucy Letch is brought to you by Vespucci iheart Podcasts and Knox Robinson Productions. I've been your host, Amanda Knox. This episode was written by Kathleen Goldhar. The co producer was Lucy Ditchmont. The senior producer was Natalia Rodriguez. The assistant producer was Ami Gill. The sound designer is Tom Biddle. The theme music was written by Tom Biddle. Story editing by Kathleen Goldhar. Fact checking by Ami Gill. Legal advice was provided by Jack Browning. The executive producers were Joe Meek, Amanda Knox, Christopher Robinson, Daniel Turkin and Johnny Galvin. Thank you for listening.

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Sponsor Announcer (41:21)

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Amanda Knox (42:01)

This is an iHeart podcast.

Jenny Harris (42:03)

Guaranteed Human.