A public inquiry into infant deaths at the Countess of Chester Hospital has found that a senior hospital official altered a report to obscure evidence of murders committed by nurse Lucy Letby. The inquiry, led by Lady Justice Thirlwall, determined that Ian Harvey, the hospital’s former medical director, doctored a review to portray the deaths of two babies as natural causes, despite evidence to the contrary. Harvey, 68, made these changes without consulting the report’s author, neonatologist Dr Jane Hawdon, and used the revised document to persuade hospital leadership to allow Letby to return to the neonatal unit.

Lucy Letby, 36, was convicted of murdering seven infants and attempting to kill seven others at the hospital between 2015 and 2016. The inquiry report criticised the hospital’s leadership as “dysfunctional” and accused managers of failing to act decisively to protect vulnerable newborns. Lady Justice Thirlwall highlighted that earlier intervention by hospital officials—such as suspending Letby and involving the police—could have saved at least three lives. Instead, the hospital commissioned two separate reviews, including one by the Royal College of Paediatrics and Child Health and another conducted by Dr Hawdon, which failed to identify the deliberate harm inflicted on the infants.

Harvey, who retired to France where he lives with his wife, had engaged Dr Hawdon to review the medical records of 17 babies—13 deaths and four near-fatal incidents—that occurred within a one-year period. Dr Hawdon initially classified five of these deaths as unexpected and unexplained, warranting further forensic investigation. However, after receiving a post-mortem report on one infant, “Baby D,” from Harvey, she was led to conclude that the death resulted from pneumonia. Harvey then altered her report to confirm the death was due to natural causes without informing her, an action she only discovered during the inquiry.

Subsequent evidence presented to Dr Hawdon indicated that Baby D had died with pneumonia, not from it—a critical distinction that ultimately cast doubt on the original natural causes ruling. Letby had been convicted of murdering Baby D in June 2015 by injecting air into the infant’s bloodstream.

The inquiry also revealed discrepancies regarding “Baby E,” who Letby was convicted of killing in August 2015 by forcibly injuring him and injecting air. Dr Hawdon acknowledged that Baby E should have been included among the unexplained deaths, as the cause of a gastric bleed attributed to the infant was unclear. She also found that the report contained a medical term, necrotising enterocolitis (NEC), next to Baby E’s name—an addition she did not make and which did not align with the child’s health history.

In his testimony, Harvey admitted to making amendments to Dr Hawdon’s report. The inquiry’s comprehensive findings, set out in an 822-page document and conducted at a cost of £18.5 million, sharply criticised the hospital’s failure to protect infants from Letby’s lethal actions. Letby is currently serving 15 whole life sentences for the murders and attempted murders at the Countess of Chester Hospital.