Will the Thirlwall report change the debate about Lucy Letby?

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Will the Thirlwall report change the debate about Lucy Letby?
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Mention Lucy Letby and you're likely to get a strong reaction.
The nurse was sentenced to spend the rest of her life in prison for murdering seven babies and attempting to murder seven more.
But though two juries have convicted her, and she has twice been denied permission to appeal, it seems everyone has an opinion on whether she really did it.
There's loud scepticism about her convictions from some, and vocal certainty about her guilt from others. She has become the centre of an information war.
The name Lady Justice Thirlwall, however, attracts less recognition.
She's the judge who's been tasked with examining how Letby was able to commit her crimes at the Countess of Chester Hospital in 2015-2016, and whether her managers should have responded differently when suspicions about her were raised.
After months of hearings, the findings of her inquiry will be published on Tuesday, almost a year later than originally anticipated.
So will the Thirlwall Report change the conversation about Lucy Letby? Will people who have entrenched views about her change their mind as a result?
The quick take is this. The report won't change the narrative about Letby's guilt or innocence because it didn't examine that subject at all. That wasn't its remit.
Lady Justice Thirlwall said she had "approached the inquiry on the basis that Lucy Letby is guilty of the crimes of which she has been convicted".
She emphasised that it was not her role "to set about reviewing the convictions", telling the inquiry: "The Court of Appeal has done that, with a very clear result."
But there is also a longer, more complex answer.
Whatever the report's conclusions, Letby's convictions will stand. However, the inquiry hasn't operated in a vacuum. There are other parts of the legal system which will have an eye on its findings.
And the chairwoman of the Criminal Cases Review Commission (CCRC) - the only organisation with the power to send Letby's case back to the Court of Appeal - has told the BBC the CCRC will be paying close attention to Thirlwall.
Dame Vera Baird said: "We will be looking at the report with interest to assess whether it has any bearing on our review of the case."
The CCRC has given no indication of when it will make its decision.
But while questions over Letby's convictions weren't within the scope of the Thirlwall Inquiry, it didn't stop the subject making itself felt within the hearing room.
Just as the inquiry was wrapping up, the hospital's former executives applied for it to be delayed until the CCRC has made its decision.
Letters pushing for a delay were also written to the inquiry by Letby's lawyers and Sir David Davis, an MP who has campaigned on her behalf.
Sir David argued that an inquiry "predicated on the presumption that Lucy Letby's conviction is safe, when there is now a wealth of authoritative voices questioning that conviction, will only undermine the conclusions arrived at by your inquiry and potentially lead to more babies dying unnecessarily".
Lady Justice Thirlwall refused the requests to pause the inquiry. She said that she was not scrutinising Letby's actions, but those of the officials and managers who were responsible for responding to the crisis.
The families of babies whom Letby has been convicted of murdering and attempting to murder did not want the inquiry to be paused.
Richard Scorer from Slater & Gordon Solicitors, who represents three of the families, told the BBC that the fact that Letby's convictions still stand is crucial.
"That's the legal reality," he said. "And the noise about her convictions doesn't change that."
But he added that, irrespective of Letby's convictions, "serious failures" at the hospital – and the way in which managers handled concerns as they emerged – must not be repeated elsewhere.
So, what is the Thirlwall report likely to tell us?
The questions the report may answer
The most stark question it may answer is whether any babies might have lived, or avoided injury, if action had been taken earlier.
The inquiry released thousands of documents which shed new light on what was going on inside the hospital. When the hearings finished, we put together this timeline which illustrates how events unfolded.
Should alarm bells have started ringing as early as June 2015 when three babies died in quick succession – the same number of deaths within two weeks that the unit would normally expect in a year? What about in August 2015, when a baby was poisoned with insulin?
The results of his blood test didn't raise an alert. At the inquiry, hospital consultants accepted this had been a "collective failure".
Lawyers for the baby's family said the test results "provided the clearest opportunity to detect and stop Letby" and were "a bright line within the chronology after which no babies should have been harmed".
By early 2016, senior managers including medical director Ian Harvey and director of nursing Alison Kelly knew there was an unusually high death rate on the neonatal unit and that there were escalating concerns about a nurse. But it didn't lead to safeguarding action.
It was only after two triplet brothers died in June 2016 that Letby was taken off nursing duty.
After widespread concessions from managers and other witnesses, it's expected the Thirlwall Inquiry will find there was a total failure of processes to ensure patient safety at every level at the Countess of Chester Hospital.
In her report, Lady Justice Thirlwall will give her assessment of revelations including Lucy Letby's parents threatening executives, Letby failing her training assessment for lacking empathy, and the extent of her relationship with doctor Mark Deakin, who arranged for her to make visits to another hospital, despite her being under suspicion of murder.
The doctor, whom prosecutors at Letby's trial referred to as her "boyfriend", was identified for the first time this month following his death.
Thirlwall will also make recommendations for change. These could include new controls on the storage of insulin; compulsory procedures to be followed when deliberate harm is suspected; detail on the regulation of NHS managers and executives; and greater use of CCTV within neonatal units.
She will also expose the number of recommendations made by public inquiries into more than 30 previous NHS scandals, which have not been followed.
Analysis by the inquiry's legal team showed that, of more than 1,400 recommendations made by previous healthcare-related inquiries, the majority have not been clearly implemented.
Solicitor Richard Scorer refers to the failure to implement recommendations from public inquiries as "the British disease".
"It is a betrayal not just of the people who have suffered in these cases, families like those I represent, it's actually betrayal of the public," he said.
Dr Rosie Benneyworth, who gave evidence to the inquiry, also believes the report has the potential to make a difference across the NHS.
"We can't keep going on diagnosing the problem, and not making the change," said Benneyworth, who is chief executive of the Health Services Safety Investigations Body.
She said the inquiry had "a huge amount" to report on and that it needed to lead to cultural change to help keep patients safe.
Carla Duprey of Bond Turner solicitors, who represents two families at the inquiry, sees the length of time taken to produce the report as a positive sign that Lady Justice Thirlwall has left no stone unturned.
"I am optimistic that the report is going to be thorough, will raise criticisms, and will hopefully result in some real change," she said.
Lucy Letby: The Public Inquiry
The BBC's Special Correspondent Judith Moritz explains what we have learned from the Thirlwall Inquiry this week. Produced by Rob Wood, Michaela Howard and Anna Jones.
Available for over a year.
By making recommendations for the whole NHS, the Thirlwall report will undoubtedly aim its fire further than Chester. But what about the question we started with - will it make any difference to the conversation about Lucy Letby?
Though the former nurse is the reason behind the inquiry, she was not allowed to be part of it. Her lawyers applied for her to be represented at the hearings but were denied permission.
Her bid to overturn her convictions has been running at the same time as the inquiry but it's wholly separate to it. Her supporters have run a media campaign which included two well-publicised press conferences.
They backed her application to the CCRC which was made after a panel of experts assembled by Letby's legal team concluded "there was no medical evidence" to support the convictions.
Journalist David James Smith, who is a former CCRC Commissioner, says the commission will be paying attention to the Thirlwall report "for any evidence that supports or undermines the convictions and supports or undermines the submissions it has received on Letby's behalf".
Cheshire Police will also have a close eye on the Thirlwall report. A criminal investigation into three hospital executives is still underway. They were previously arrested on suspicion of gross negligence manslaughter, and one of them has since been rearrested on suspicion of perverting the course of justice.
It's likely that detectives will look closely at the inquiry's findings about those managers, which could be factored into their investigation.
And then there is the public debate.
As the legal wheels have been turning in the background, those campaigning to free Letby have redoubled their efforts, with protests and websites dedicated to her cause. But there are also strong feelings from those who believe she belongs in jail. Both sides have found energy online, within highly active forums on Facebook, Reddit, Tattle Life, and elsewhere.
How will Lady Justice Thirlwall's report go down with those communities?
David Wilson, emeritus professor of criminology at Birmingham City University, believes it's unlikely that the report will reverse hard-baked opinions.
"The 'noisier' Letby commentators are almost universally on the side that she is innocent," he says. "I have no doubt there will be aspects of the governance of the hospital where she killed within the report that will be harnessed to support that view."
Prof Wilson believes it will become "another component of the information war that's constantly being waged about her guilt or innocence" and he feels much of the conversation about Letby "seems to generate more heat than light".
One thing is certain. No matter what their point of view, everyone with a strong opinion about Letby will pay close attention to the report. Even those who wanted it to be delayed, or who didn't support it in the first place, will scour its findings.
But it's much less likely to take the heat out of the public debate or draw a line under the case. Those who say they're already sure about Lucy Letby may scrutinise the report, but take from it whatever supports those ready-formed views.
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