How a 25-year-old nurse became one of the UK's worst serial killers.

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"I have always wanted to work with children."

It's a phrase you might expect from a nurse who chose to spend their working days caring for babies and children. But these simple words took a sinister turn when spoken by Lucy Letby, as she stood trial for the murder of seven babies, and the attempted murder of six others.

At the time of her arrest, Letby was a Neonatal Nurse, a profession according to clinical and forensic psychologist Dr Ahona Guha, "where people are deified and implicitly trusted".

This was certainly the case for Letby, who was entrusted to care for the most vulnerable babies at the Countess of Chester Hospital's infant intensive care unit. Instead, she did the unthinkable, abusing her position of unquestioned power to take away their tiny lives before they'd even begun.

"Why she was attracted to working with babies and what they symbolise and represent for her is an interesting question," says Dr Guha. "It's so unusual to see babies as victims."

Letby was the first person in her family to attend university, studying nursing at the University of Chester. Almost all of her work placements were at the Countess of Chester Hospital, either on the children's ward or the neonatal unit.

In January 2012, Letby began working full time at the hospital, before qualifying to work with the intensive care babies in 2015. The court heard from Letby herself that she spent most of her time looking after the "sickest babies" on the unit. She estimated she cared for hundreds of newborns during 2015 and 2016.

"She appears to present as much younger and more unformed than she should be – based on chronological age," says Dr Guha of Letby, who is now 33. "What does this mean in terms of her capacity to connect, find attention and care, and make her way in the world as an adult would?

"From a personality structure, it's probably likely she had at least some narcissistic or psychopathic traits. It would be hard to kill infants and watch distress if you didn't have the capacity to not feel emotion."

From aspiring graduate to the UK's most prolific child serial killer.

In July 2018, aged just 28, Lucy Letby was arrested in her home, led away in handcuffs, and questioned following an extensive investigation by Cheshire Police, dubbed Operation Hummingbird.

An unexplained rise in deaths and deadly collapses of premature babies in the Countess of Chester Hospital's neonatal unit prompted the investigation. Throughout the investigation, police interviewed doctors, nurses and hospital administrators, while combing through hospital records. One such document showed Letby was on shift every time one of the babies collapsed or died.

Watch: The actual footage of Lucy Letby arrested in her home. Post continues after video.

"What is really fascinating about Letby is how studiously normal she looked. She didn't have the usual risk factors we expect – no poverty, abuse, trauma, deprivation, parental substance addiction, or justice involvement," says Dr Guha.

Letby was released on bail, and following two more arrests, was charged in November 2020. Throughout the trial, which commenced at Manchester Crown Court in October, Letby denied the 22 charges against her, which including the murder of seven babies and the attempted murder of 10 others.

After 110 hours of deliberation, the jury found Letby guilty of seven counts of murder and seven of attempted murder. She was acquitted on two counts of attempted murder, and jurors were unable to reach verdicts on six further attempted murder charges.

What was revealed in court?

Letby continues to steadfastly deny any wrongdoing, despite police finding a post-it note in her bedroom, scrawled with the words: I AM EVIL. I DID THIS!

Letby's defence barrister denied the note was an admission of guilt, but rather "the anguished outpouring of a young woman in fear and despair". The prosecution told a different story, however – one of a cold-blooded killer trying to 'play God' and hide it by falsifying medical records, gaslighting colleagues, and connecting with grieving parents.

The court heard Letby once sent a condolence card to the parents of a baby she was accused of trying to kill three times, finally succeeding the fourth time. She spent time with another set of parents, photographing their deceased children.

Policing Academic Associate Professor Dr Michael Kennedy drew comparisons to the Kathleen Folbigg case, where diary entries were used to convict Ms Folbigg of the murder of her four children.

"Experts advised that 'coincidence' was unlikely. This also occurred in the Letby matter."

DNA later proved the possibility of natural causal factors in the children's death, and Folbigg was subsequently released. 

During the Letby trial, jurors were shown pictures of her home, prompting tears from the accused. The photos showed a child-like bedroom, adorned with fairy lights, stuffed toys, and affirmation posters.

Why did she do it?

Determining a motive for such a heinous crime has proven difficult, particularly as Letby has continued to plead innocence. Detective Superintendent Paul Hughes of Cheshire Police said Letby clearly "loved the attention".

"But if we are looking for why she's done this, then to re-use her own words, 'she is evil, and she did this'."

Dr Guha says it's most likely more complex than this. 

"It's really unusual to have a female serial killer, and the small number that do exist often offend with partners or for financial motives. All we are left with then, is her personality formation. This is the crux on which everything hinges and where motives might be found in the absence of any other obvious motives, like money or passion."

Assoc Prof Kennedy agrees that while there are many possible explanations for the murders, the least likely is that Letby is evil.

"Mental Health plays a huge role in these matters. It is not to say that the accused people do not understand their actions are wrong or they should not be incarcerated," he explains.  

"For me the behaviour of Letby is best explained by Munchausen's syndrome. It's a cry for attention and help and a need to be valued and useful."

How did she get away with it for so long?

As well as Letby's clever manipulation of her trusted role and relationships with colleagues, both Dr Guha and Assoc Prof Kennedy believe system failure played an integral role in her ability to continue to murder babies without ramification.

The court heard several doctors had reported concerns about Letby to hospital management as early as 2015. "This takes toxic workplace to a whole new level, and really points to the harm which can arise when concerns are not acted upon appropriately," Dr Guha says.

"It's unlikely that this would have been noticed at the outset. But it sounds like once it was noticed, there was protection for her by hospital management."

Assoc Prof Kennedy described the events as a "fascinating case of workplace dynamics".

"It seems 'red flags' appeared ages ago, but she knew how to navigate her way through," he says. "The other factor is senior management engaging in brand name protection for their institution, their executive colleagues, and of course themselves. This factor is very evident in the Letby matter where despite years of concern regarding her behaviour, they failed to notify authorities.

"In the end this failure has likely resulted in deaths that could have been avoided."

Is rehabilitation possible?

"I for one wouldn't want to be letting Letby around anyone with any medical or physical or psychological vulnerabilities," says Dr Guha. 

"And a specific note on mental health... it doesn't cause offending of this nature – unless for instance, she was psychotic before each murder. Many people have mental health difficulties and the majority of them don't go to kill babies. In the forensic world, we look for a causal link, not just a correlation."

Assoc Prof Kennedy says rehabilitation is possible, but doesn't always work. 

"Sadly, there are also some who need to remain in jail."

Yesterday, Judge James Goss handed Letby a 'full life order', meaning she will spend the rest of her life in prison. 

If you find yourself needing to talk to someone after reading this story, please call Lifeline on 13 11 14.

Feature Image: Facebook/Reuters: Cheshire Constabulary/Handout.