The long-awaited Thirlwall Inquiry report into the Countess of Chester Hospital has delivered a devastating indictment of NHS leadership, finding that a cascade of failures allowed nurse Lucy Letby to murder seven babies and attempt to kill others. But the report, which cost between £18m and £19m, has also drawn sharp criticism for what it did not do: engage with growing concerns that Letby's convictions may be unsafe.

A hospital's failure to protect babies

Lady Justice Kathryn Thirlwall's inquiry, which opened in September 2024, examined how Letby was able to carry out her crimes between 2015 and 2016 and why hospital managers failed to act on repeated warnings from clinicians. The report, described by UK news outlets as damning, blasts the hospital's failure to protect babies. It found that senior managers dismissed concerns, ignored whistleblowers and prioritised the hospital's reputation over patient safety. Consultants who raised alarms about Letby were told to apologise; police were not called until much later. The inquiry heard from parents, doctors, nurses and managers. Its recommendations are expected to include a statutory duty for NHS staff to report concerns, tougher regulation of NHS managers, and a review of neonatal staffing levels.

The biggest question left unanswered

Yet the inquiry's decision not to pause proceedings pending a review of Letby's convictions means the £18m report does not address the central controversy now surrounding the case. Letby, who maintains her innocence, was convicted in 2023 of seven counts of murder and several attempted murders. She is serving a whole-life sentence. Her case is now before the Criminal Cases Review Commission (CCRC), which is examining whether new evidence could undermine the convictions. A panel of experts has raised questions about the medical evidence used at trial, and some scientists have argued that the deaths could have been due to natural causes or poor care.

The Guardian noted that just two months before Lady Justice Thirlwall opened her inquiry, a report by Chris Henley KC into the wrongful conviction of Andrew Malkinson was published. Henley's report pleaded with the legal establishment to recognise that miscarriages of justice happen. Right up to top judges in the Court of Appeal, Henley wrote, the system has 'a deep-seated … cultural reluctance' to accept it 'will on occasion make mistakes' and that 'entirely innocent defendants will sometimes be convicted'.

Henley warned of a 'deep-seated … cultural reluctance' to accept that 'entirely innocent defendants will sometimes be convicted'. The Thirlwall Inquiry's refusal to engage with that possibility has been criticised as a missed opportunity.

Critics argue that by declining to examine whether Letby's convictions are safe, the inquiry leaves the most consequential question unanswered. Sources at MSN and Yahoo said the inquiry 'burned through £19m' but did not answer the 'one big question'. The decision not to pause was made by Lady Justice Thirlwall, who said the safety of convictions was a matter for the courts. But campaigners say the inquiry could have considered whether hospital failures contributed to misdiagnoses or whether the deaths were properly investigated.

Cost and controversy

The cost of the inquiry has become a political flashpoint. Estimates range from £18m to £19m, a significant sum for a public inquiry. For the families of Letby's victims, the report validates their long fight for answers about hospital failings. For those who believe Letby is innocent, it represents an expensive whitewash that avoided the elephant in the room. The inquiry heard evidence from dozens of witnesses and reviewed thousands of documents, but its terms of reference focused on the hospital's response, not the criminal convictions.

What happens next

Letby remains in prison while the CCRC reviews her case. If the commission refers the case to the Court of Appeal, a fresh appeal could be heard. If not, her convictions stand. Meanwhile, the government must respond to the inquiry's recommendations, likely within a few months. NHS England has said it will study the report closely. The families of victims may pursue civil claims against the hospital trust. The report could also lead to a new duty of candour for NHS managers and a stronger whistleblowing framework.

Different outlets have framed the story in distinct ways. The Guardian and Yahoo emphasised the unanswered conviction questions, with headlines saying the inquiry 'left biggest questions around the Letby case unanswered' and 'ignored the biggest Letby question of all'. MSN focused on the £19m cost and what happens next to Letby. Another Yahoo report led with the inquiry's blast at the hospital's failure to protect babies. Together, they paint a complex picture: a report that is both damning and incomplete.

A miscarriage of justice in waiting?

The juxtaposition with the Malkinson case is stark. Andrew Malkinson spent 17 years in prison for a rape he did not commit before being cleared in 2023. Henley's report found that police and prosecutors had resisted evidence of his innocence. The same institutional reluctance, critics say, may be at play in the Letby case. The Thirlwall Inquiry had a chance to confront that possibility. By choosing not to, it has left the biggest question of all hanging over a case that continues to divide public opinion and torment the families involved.

As the CCRC review continues, the Thirlwall report will stand as a landmark examination of hospital failure. But it will also stand as a reminder of what it did not examine. For now, the question of whether Lucy Letby is guilty remains unanswered by the very inquiry that bore her name.