Worthless.

Jamie Egan

A report from expert witness Dr Dewi Evans in an unrelated civil case was described as "worthless" by a senior judge, jurors in the trial of Lucy Letby have heard.

Manchester Crown Court heard that Dr Evans was criticised over his involvement in an application for permission to appeal against a care order involving two children—a case unconnected to Letby.

The court heard that Dr Evans supported the parents' desire to have increased access to the children being cared for by their grandparents.

Refusing permission last December, Court of Appeal judge Lord Justice Jackson said Dr Evans' report was "worthless" and "makes no effort to provide a balanced opinion". He either knows what his professional colleagues have concluded and disregards it or has not taken steps to inform himself of their views. Either approach amounts to a breach of proper professional conduct. No attempt has been made to engage with the full range of medical information or the powerful contradictory indicators. Instead, the report has the hallmarks of an exercise in 'working out an explanation' that exculpates the applicants. It ends with tendentious and partisan expressions of opinion outside Dr Evans' professional competence and has no place in a reputable expert report. For all those reasons, no court would have accepted a report of this quality even if it had been produced at the time of the trial."

Of course, in court, Evans, an egomaniac with no capacity for self-reflection, said he was "more than happy" to stand by his report" and did not accept either Myers's or Lord Justice Jackson's opinion that his conduct was unprofessional. Evans then lies that he had sent a letter to a firm of solicitors on the subject, which he said was not intended to be used in an appeal. But the kicker was the following remark: "I had no idea it had been sent to the court. I had no idea about this judgment until about two weeks ago."

Most people would take the money and run because money was Evan's game. But no, Doughy went on the warpath after the trial, lashing out against everyone except the consultants.

When referring to management, he said: "They were grossly negligent. I shall write to the Cheshire police and ask them, from what I have heard following the trial, if we should now investigate a number of managerial people concerning corporate manslaughter. The police should also investigate the hospital in relation to criminal negligence.

"Failing to act was grossly irresponsible – let's make it as clear as that. We are talking about a serious emergency. It's grossly irresponsible and, quite frankly, unbelievable that they failed to act sooner."

Evans called for the police investigation after being told about the two-page review in May 2016 ( the RCPCH review of the CoGH Neonatal Unit). By this point, senior doctors had been asking for "urgent" meetings with executives for months to discuss their concerns after five murders and the attempted murder of another five babies.

But nothing appears to have happened until the two-page document was produced in May 2016, effectively clearing Letby of any wrongdoing and blaming other NHS services for the deaths. Letby went on to murder two newborn triplet brothers and attempt to kill a sixth child the following month.

The review, made public for the first time, states: "LL works full time and has a qualification in the speciality. She is, therefore, more likely to be looking after the sickest infant on the unit. LL also works overtime when the acuity or unit is over capacity.

"There are no performance management issues, and there are no members of staff that have complained to me or others regarding her performance. I have found LL to be diligent and have excellent standards within the clinical area."

It goes on to state that there had been a higher death rate in the unit in the year to May 2016 but blamed other NHS services for a number of the mortalities: "The Cheshire and Mersey transport service have been involved in a few of these mortalities, and they may have survived if the service was running adequately.

"Alder Hey children's hospital's failure in facilitating a cot also added to the complexities of these mortalities. If there had been a bed sooner the infant may not have died."

Evans continued: "They were grossly negligent. I shall write to Cheshire police and ask them, from what I have heard following the trial, that I believe that we should now investigate a number of managerial people in relation to corporate manslaughter. The police should also investigate the [hospital] in relation to criminal negligence.

"Failing to act was grossly irresponsible – let's make it as clear as that. We are talking about a serious emergency. It's grossly irresponsible and, quite frankly, unbelievable [that they failed to act sooner]." According to Evans, by this point, senior doctors had been asking for "urgent" meetings with executives for months to discuss their concerns after five murders and the attempted murder of another five babies.

Again, according to Evans, "nothing" happened until the two-page document was produced in May 2016, effectively clearing Letby of any wrongdoing and blaming other NHS services for the deaths.

The review stated: "LL works full time and is qualified in the speciality. She is, therefore, more likely to be looking after the sickest infant on the unit. LL also avails herself to work overtime when the acuity or unit is over capacity.

"There are no performance management issues, and there are no members of staff that have complained to me or others regarding her performance. I have found LL to be diligent and have excellent standards within the clinical area."

It goes on to state that there had been a higher death rate in the unit in the year to May 2016 but blamed other NHS services for a number of the mortalities: "The Cheshire and Mersey transport service have been involved in a few of these mortalities, and they may have survived if the service was running adequately.

"Alder Hey children's hospital's failure in facilitating a cot also added to the complexities of these mortalities. If there had been a bed sooner the infant may not have died."

How true is it that the consultants in the CoGH were beating down management's door to get to the root cause of the rising mortality in their unit?

The gang of four at the CoGH wants the world to believe that a sinister dark force is at work among them. Malevolent and unseen, Letby insinuated her way into a seamless operation. In due course, she became a person of interest as the body count remorselessly rose. Frantic and insistent attempts by the consultants to alert management fell on deaf and cynical ears.

Nothing, of course, could be further from the truth.

There were opportunities and mechanisms galore to stop a murder, but no one except Dr Brearey ever believed there was a "murderer on the ward. The notion is, even now, too ridiculous for words.

From the RCPCH report:

Incident reporting:

4.4.3 If an incident meets the criteria, a serious incident panel is established within two days and chaired by the Medical Director and Director of Nursing. An SBAR report is prepared, and the panel's recommendations are reviewed at the Governance Board and Divisional meetings.

There is a formal Level 2 Root Cause Analysis system for internal Trust reviews

run by the Risk Manager, but this is relatively new and was used in only one of the index cases.

Which one of the "index cases" had this kind of review, and why was not every case followed this way?

4.44: The deaths are reviewed, using case notes, initially by the neonatal lead, senior nurses and the quality facilitator and a report regarding any learning and actions required is completed. Deaths and near misses which are not Serious Incidents are reviewed at the perinatal Mortality and Morbidity (M&M) panel, which is chaired by the Fetal Medicine Consultant and meets around five times a year. The meeting does not include the risk midwife or any external adviser. The M&M death review report template has been updated and improved since February 2016 following the neonatal death review and includes brief findings and actions/learning arising from the incident, together with the names of those present. Minutes from the M&M are circulated to all the paediatric consultants and senior nurses on the neonatal unit for dissemination, but responsibility for follow-up of findings and implementation of lessons learned is not clearly documented. Largely lying with the neonatal lead.

The "neonatal lead" was Dr Brearey. The RCPCH places responsibility for the follow-up of "unexpected" deaths "largely" in his lap. As far as the RCPCH is concerned, deaths are a medical matter, not a managerial matter.

4.4.5 Two of the clusters of deaths were not reported; the current policy indicates that not all deaths need to be submitted as DATIX. If they are expected deaths, and in 2015-6, only 10 of the 13 deaths were reported as incidents on the neonatal incidents summary. The definition of 'expected" was not available but presumed to be used in safeguarding /child death panels, and it was not clear who was responsible for DATIX entry. Other areas in the hospital report well, but the neonatal unit has, for some time, apparently been less systematic in reporting.

This is a severe criticism of Brearey. I certainly cannot read it any other way. Dr Brearey had, for some time, failed to take the deaths of babies seriously enough to report them systematically. Does Dr Brearey have a conflict of interest then in Letby's guilt? If yes, why was he the doctor who initially helped Operation Hummingbird, the Cheshire police investigation into Letby? The first time any copper heard the words "air embolism" had to be from Dr Brearey because he suggested the same to the RCPCH.

4.46 Until early 2016, there was a Risk and Patient Safety Lead, but the role was redesigned when she left the Trust (around the time of the CQC visit), and the post of Risk Midwife was established and filled in May. A Risk Facilitator from Urgent Care covered children's risk, but the Risk Midwife subsequently covered neonatal risk.

4.7. Some of the deaths were reported on the Risk Register and the Review team noted that some were recorded with 'green - low risk of harm status.

4.48 the review of deaths carried out by the (neonatal lead) consultants, which, together with two additional deaths, triggered the unit's reconfiguration in July 2016, did not use a recognised Root Cause Analysis process, nor did it involve the governance lead/risk manager, The staffing grid in particular was not validated. The Risk Manager has conducted a more systematic review of staffing on duty at the time of the deaths and the shift before, but this only includes clinical staff, not cleaners and others with access.

It is clear to anyone who can read that contrary to what the consultants said at the trial, there was at least a half-hearted effort to maintain patient safety at the CoGH. Brearey tried on many occasions to hawk his scientific junk to all takers, but none of them bought it. Eventually, his bizarre "air embolism" theory ends up in court by the hand of the maker of facts, Dewi Evans.

The three initial deaths in June of 2015 were clearly the result of incompetent care. The only doctors in the world who wouldn't see it that way were "expert" witnesses for the prosecution, which had nothing other than this bizarre coterie.

The mainstream media will get to the Letby case; I know this for a fact. They will not show the same fawning reverence for the gang of four nor allow the jury to convict a person without asking themselves the basic question: "How did she do it?" Justice Goss instructed the jury that they did not have to worry about that when reaching their conclusions. How utterly absurd.

In most continental Europe, the long-standing problem of biased experts is partly neutered by the nature of their systems. Only a court service can appoint an expert. Thus, the prosecution avoids any temptation to create the type of fiction we see here.