Junior doctors were referring to Lucy Letby as “Nurse Death” as early as 2016, two years before she was arrested, a public inquiry has heard. Letby, 34, was sentenced to 15 whole-life orders after she was convicted across two trials of murdering seven babies and attempting to murder seven others. The inquiry led by Lady Justice Thirlwall at Liverpool town hall will examine events at the Countess of Chester hospital’s neonatal unit, where Letby was a nurse between 2015 and 2016. Letby was first arrested in 2018 and convicted in 2023 and 2024. On Wednesday, the inquiry heard opening statements on behalf of the counsel to the inquiry delivered by Nicholas de la Poer KC. In September 2016, the Royal College of Paediatrics and Child Health was invited to conduct a review of the neonatal unit, during which it interviewed hospital staff including Ian Harvey, the then medical director, and Alison Kelly, the then director of nursing and quality. De la Poer said Harvey was noted as saying in his interview: “… had to intervene with the neonatal lead as junior doctors had been referring to her as ‘Nurse Death’.” Harvey also said the “correlation of one nurse” was seen as an “elephant in the room” by paediatricians. Earlier, De la Poer told the inquiry that Letby attempted to murder one child, referred to as Child K, while Care Quality Commission inspectors were conducting an inspection in the hospital. He said the CQC regulator “did not detect prior to or during the inspection the concerns on the neonatal unit”. The CQC inspected the trust in February 2016, and during unannounced visits on 26 February and 4 March 2016. The inquiry heard that at least one doctor told an inspector “we have some serious patient safety concerns and don’t feel like we are being listened to” – but this was ignored and the inspectors left before there was time to expand upon concerns. De la Poer said: “It is notable that Letby attempted to murder Child K in the early hours of 17 February 2016, the second day of the inspection.” Letby was convicted of attempted murder of Child K after a retrial, as at the previous trial jurors could not reach a verdict. On Wednesday morning the inquiry heard that the hospital trust first characterised concerns over a high mortality rate on the neonatal unit where Letby worked as a risk to “reputational harm” rather than a threat to the safety of the infants. Turning to issues of governance at the hospital, De la Poer said the inquiry had identified that concerns about the mortality rate in neonatal unit were referred to in a July 2016 “urgent care risk register”. “However, the risk was characterised as ‘potential damage to reputation of the neonatal service and wider trust due to apparent increased mortality within the neonatal unit’,” De la Poer said. “The risk was characterised in terms of reputational harm, rather than in terms of a risk to the safety of babies.” De la Poer said it was noteworthy that the risk was “only added in July 2016”, six months after a review had identified a higher-than-expected mortality rate in the neonatal unit in 2015. De la Poer explained that the increase in neonatal mortality at the hospital and the concerns about Letby were matters that fell squarely within the remit of the quality, safety and patient experience committee (QSPEC). “A seemingly striking feature of QSPEC’s monthly meetings during the period [between] June 2015 and June 2016 is that the increase in the mortality rate on the neonatal unit was discussed just once,” he said. The inquiry also heard that in May 2016 a “risk midwife” named Annemarie Lawrence requested a copy of the review of neonatal mortality review and – going through the table using a highlighter – identified that Letby was a common factor in the case of most of the deaths. Lawrence took her findings to her boss, Ruth Millward, the head of risk and safety, but found Millward to be “dismissive of her findings”, De la Poer said. Discussing the hospital board, the KC said that “in the period June 2015 to March 2017, no board committee ever escalated to the board issues relating to neonatal mortality or Letby”. On the opening day of the inquiry on Tuesday, Thirlwall said comments on the validity of Letby’s convictions had created a “noise that caused an enormous amount of stress” for the parents of the victims and had come from people who were not at her trials. The inquiry heard that Letby launched a grievance procedure in September 2017 over her removal from duties amid concerns about high infant mortality, which was resolved in her favour several months later. The counsel to the inquiry, Rachel Langdale KC, said a planned return to the neonatal unit was then only stopped by the “tenacious lobbying of the consultants”. “But for their determined approach, it appears likely that she would have been permitted to return to dealing with babies,” Langdale said. The inquiry continues.