KB-2025-001016 - [2025] EWHC 2023 (KB)

At trial, oral evidence was given by Dr MN, as well as by Ms Y and Mr W (the current Chief Executive Officer of the Trust). The witness statements of Mr Wilkinson (the Adviser from the PPA), Mr A (the Case Investigator) and Mr Z (the Chief Medical Officer) were provided to the Court but not challenged by Dr MN.

Mr Wilkinson’s witness statement, made on behalf of PPA, noted that PPA was advising on 538 cases involving Consultants. Of those, in 489 cases a Case Manager had been identified, and in 210 of those cases (43%) the Medical Director/Chief Medical Officer acted as Case Manager. In 278 cases where a Case Manager had been identified, the Medical Director/Chief Medical Officer was not acting as Case Manager. Mr Wilkinson stated that:

“PPA is unable to establish, without undertaking a much more detailed analysis, what Trust’s policies incorporating MHPS state in those cases, including whether or not they specifically provide for the Case Manager to be someone other than the Medical Director/CMO in cases involving consultants”.

Mr Wilkinson also pointed out that PPA was aware that:

“especially at larger NHS trusts, the wording of local policies sometimes specifically permits individuals other than the Medical Director to act as Case Manager for cases involving consultants”.

Mr Wilkinson also expressed the view that:

“If there were to be a blanket requirement for all NHS organisations to appoint the overall Medical Director (often now called the CMO) as Case Manager in cases involving consultants, that could place a very significant burden on some Medical Directors/CMOs, particularly at larger NHS organisations”.

In his witness statement, Mr A set out his reasons for wishing to interview Mr Z (the Chief Medical Officer): they relate to a meeting held by Mr Z (and the Chief Nursing Officer) with Dr MN on 25 August 2023 which Mr A considered makes them “witnesses of fact”. Further, Mr A had seen a letter that Mr Z had drafted but did not send to Dr MN following that meeting. Mr A said that he wished:

“to ask questions related to that content; I will want to understand what Dr MN told Mr Z and [the Chief Nursing Officer] at that meeting in relation to his organisation of the Letby visits as this will contribute to the overall factual picture of what Dr MN knew, at what point in time and what he subsequently told the Trust that he knew, both in 2018 and from 2023 onwards”.

In his witness statement, Mr W explained that he was Deputy Chief Executive until November 2024. He stated that he was involved in the discussions surrounding the selection of Ms Y as the Case Manager; and that he agreed with the then Chief Executive that Ms Y be appointed to the role, a decision with which the Chair of the Trust agreed:

“It was a difficult and unusual situation. First and foremost, we were very concerned about preserving the anonymity of Dr MN, which Dr MN had raised with us in clear terms and informed us was the subject of a court order. The case manager therefore needed to be selected from the small group of Executive Directors who were already aware of the case as there were (and remain) Executives who are not aware of the nature of the case. There were no issues relating to the exercise of clinical skill, so we believed the case manager did not need to be a clinician. There were, however, a range of governance issues related to the concerns and this was Ms [Y’s] area of expertise. In addition, there was to be a Public Inquiry, so there were substantial legal aspects surrounding the issues under investigation, which is also within Ms [Y’s] executive remit.

Ms [Y] was also very experienced in handling complex confidential matters relating to medical staff, having dealt with numerous cases over many years”.

In Mr Z’s witness statement, he described his recollection of the meeting with Dr MN on 25 August 2023: that Dr MN “had no knowledge of any potential crime that Letby may have been suspected of committing when he supported her to undertake observational visits at the Hospital in early 2017”. Mr Z also referred to subsequent discussions among the small Executive group which had been set up to decide how to proceed. Mr Z referred to the need to keep the matter confidential. Mr Z also referred to “the gradual emergence of information that pointed towards a potentially different relationship between Dr MN and Letby”.

Mr Z said that he had oversight of all MHPS cases at the Trust as part of his role as Chief Medical Officer. He explained that “The breadth of my wider responsibilities within the Trust (having responsibility for over 500 consultants and Trust doctors) make it all but impossible for me to function as the day-to-day case manager for all cases”. Mr Z also exhibited statements from Medical Directors at other Trusts within the area. They all state that they regularly delegate the Case Management function to others, and only act in that role occasionally. They say that to do otherwise would be very difficult if not impossible, given the other responsibilities that they have.

I found that each of the witnesses who gave oral evidence to the Court did their best to answer the questions posed helpfully and truthfully. It does not seem to me that there are any issues of fact that the Court needs to determine at this trial that turn on the credibility or reliability of any of the witnesses, or that it is necessary to prefer the evidence of one witness over another where they were inconsistent.

Of relevance to the issues that I will need to consider, I note that in cross-examination Mr W accepted that both the concern that Dr MN may have been aware of suspicions about Lucy Letby at the time when he sought to arrange the observership for her, and the complaint about Baby N, had potential patient impact. In her evidence, Ms Y accepted that those matters might transgress the behavioural standards expected of staff; that issues around management decisions in the workplace and matters to be arranged in the workplace may say something about Dr MN’s clinical competence. Further, Ms Y accepted that failures to comply with doctor-patient confidentiality could have patient safety implications.