I sat through the entire ten-month Lucy Letby trial. For all the armchair warriors defending her, here's proof from the Thirlwall Inquiry that she's guilty as hell

A few weeks have passed since Lady Justice Thirlwall delivered her devastating report into the failures made by Countess of Chester Hospital while Lucy Letby was murdering babies.

The senior Appeal Court judge was unequivocal that 'dysfunctional management' and a 'complete failure' to understand safeguarding meant vulnerable infants were not protected from harm. 

Up to three children murdered by the 36-year-old former neonatal nurse should not and would not have died had hospital managers acted sooner to remove her from the ward, she said.

Lady Justice Thirlwall insisted it was not her job to re-examine the evidence called at Letby's lengthy trial or to pre-empt the work of the Criminal Cases Review Commission (CCRC) – the body charged with examining miscarriages of justice. 

The CCRC is currently considering Letby's case and is her final hope of freedom after two failed appeals.

But, despite this, the contents of the judge's 822-page public inquiry report did not make good reading for those who continue to insist on Letby's innocence.

Although it was not in her remit, the judge dismissed many of the arguments of Letby's supporters, who claim that no murders took place at the hospital and insist Letby was a scapegoat for a failing, understaffed and dirty ward.

As we release a special podcast episode of The Trial on the subject, the time has come to explain precisely why Letby's supporters are not only wrong but continue to cling to indefensible misconceptions about the case – only harming the parents of Letby's victims further. In light of Lady Justice Thirlwall's review, here, in forensic detail, is a reminder of the sheer weight of the claims against Letby...

On a special episode of the Trial podcast, Caroline Cheetham and Liz Hull are joined by reporter Kim Pilling to 'draw a line' under the speculation still surrounding Lucy Letby's convictions

Many of Letby's supporters point to staffing shortfalls on the ward but, as Lady Justice Thirlwall said, 'none of the deaths could be attributed to staff shortages... [because] the nursing staffing levels at the Countess were slightly better than in all other comparable hospital neonatal units in the region'.

On sewage and the deadly pseudomonas bacteria in the neonatal unit's taps, which Letby fans repeatedly trot out to explain why several infants died, the judge was similarly forthright: 'There had been two periods of concern about infections on the unit.

'In 2012 and 2015, pseudomonas was found on the taps, and was dealt with and had no consequences for babies... There was no evidence that pseudomonas played any part in any of the deaths.'

And on Letby's 'I AM EVIL I DID THIS' 'confession' note, which supporters claim she wrote under extreme stress on the advice of her occupational health mentor Kathryn De Berger, Lady Justice Thirlwall had this to say: 'Contrary to some reporting, Ms De Berger was not a counsellor and there is no evidence that counselling or any form of therapy was provided to Letby.'

And finally, on whether the downgrading of the neonatal unit to no longer take babies of less than 32 weeks' gestation explained the drop in deaths to zero – rather than that being due to Letby's removal from the ward – the judge concluded: '[This] was not an explanation for the absence of deaths and unexpected collapses.'

Lady Justice's Thirlwall's report made news around the world last month, but it took just a few days for the PR machine now powering Letby's 'innocence' campaign to fire up again. Westminster-based Maltin PR has confirmed they are working pro-bono for her bid.

Timed to push the unfavourable inquiry coverage off the front pages, the latest in a series of documentaries questioning the guilty verdicts was aired on Channel 5, accompanied by more newspaper stories highlighting failings at the 'filthy' hospital or calling for a retrial of the serial killer.

Both the film and articles revisited theories debated at length in the mainstream media and online.

Lady Justice's Thirlwall's report made news around the world last month, but it took just a few days for the PR machine now powering Letby's 'innocence' campaign to fire up again 

Documentaries examining the guilty verdicts have been aired, including shows on Netflix and Channel 5

They also featured the usual contributors, including a statistician whose services Cheshire Police declined to use, a nurse made redundant from the unit eight years before Letby was operating and a disgraced coroner's officer forced out of her job for alleged misconduct. All have long been cheerleaders for the convicted murderer.

But retired vascular surgeon Colin Ferguson was a new voice to enter the fray. He told the Channel 5 documentary that none of the murdered babies could have been killed by air embolism – in which air is injected into the bloodstream – because all the medical literature suggested gas would have been found in the hearts of the infants if they had died this way.

'We've done a review of the cases in literature and there are only eight,' he says. 'And in every single case, there is air in the right side of the heart, or the proximal large veins, or the pulmonary arteries. The real-world data says that in order to die from air embolus, you have to have those features.'

But, if Dr Ferguson had done his research, he might have realised that this is exactly what happened with several of Letby's victims.

Although no air was detected in their hearts, Professor Owen Arthurs, a leading paediatric radiologist based at Great Ormond Street Hospital in London, told the jury at Letby's trial that air could indeed be seen in the major blood vessels of three of the infants, Babies A, D and O, when he studied X-rays taken shortly just after they died.

The court was shown a particularly striking X-ray which revealed a 'line of gas' in a blood vessel along Baby D's spine that, in the absence of a fracture or infection, Professor Arthurs said, must have been injected into her circulation.

Professor Andreas Marnerides, the expert pathologist who also testified at Letby's trial, said he too found gas in a blood vessel in Baby D's belly which could not be explained by infection or decomposition.

He also described seeing bubbles of air within veins in tissue samples from Baby A's lungs and brain, and said haemorrhaging was 'highly suggestive' that the air had entered the brain while they were still alive.

In evidence to the public inquiry, pathologist Jo McPartland, who carried out some of the post-mortems on Letby's victims, also made it clear that air is very difficult to see in the hearts of neonates, even in scans after death.

Other new claims attempt to cast fresh doubt on Letby's convictions for poisoning two baby boys with insulin – evidenced by the 'extremely high' levels of the hormone in their systems.

The former nurse accepted during cross-examination that someone – just not her – must have poisoned Babies F and L, two boys from different sets of twins that were attacked eight months apart, in August 2015 and April 2016.

But critics say the prosecution failed to explain to the jury that newborn babies can produce high levels of insulin naturally after birth. They also contend that control tests used to detect insulin in the infants' blood were flawed, which meant they could have produced falsely high results.

The problem with that argument is it was discussed at the trial at length in front of the jury, who heard from Dr Anna Milan, a biochemist based at the laboratory at the Royal Liverpool Hospital.

'None of those doubting Letby's guilt were present during her lengthy ten-month trial – but they still claim to know better and confidently claim the jury got it wrong'

She told them she was 'very confident' in the veracity of the tests they carried out, while endocrinologist Professor Peter Hindmarsh also told the court that the blood readings could only be explained by someone having given insulin to the baby, not produced by the child themselves.

Question marks have also been raised over a supposedly 'normal' blood test result from Baby F, five hours after Letby tampered with his drip, which was 'not consistent with insulin poisoning'.

However, the trial heard that Letby herself entered that test result into Baby F's medical notes and she was caught deliberately doctoring timings and entries in other infants' records to cover her tracks.

The truth is that none of those doubting Letby's guilt were present during her lengthy ten-month trial – but they still claim to know better and confidently claim the jury got it wrong.

They cherry-pick flaws in the medical evidence, while paying scant regard to important testimony about Letby's odd behaviour after babies died, her bizarre searches on Facebook for parents of murdered infants she'd barely met and her hoarding of hundreds of confidential nursing handover sheets for patients at her home.

In all the newspaper articles and documentaries that have been written and produced since Letby was found guilty, few pay any attention to key moments in the trial which, I believe, helped convince the jury she was responsible for the most heinous crimes.

Two examples in particular stick in my mind.

The first involved the powerful testimony of nurse Ashleigh Hudson, who gave evidence about an attack on a premature baby girl, known as Baby I, in October 2015. Letby tried to kill the infant three times in three weeks, before succeeding in murdering her on the fourth attempt by pumping air into her feeding tube.

Labelled the 'seeing in the dark' attack by the prosecution, Ms Hudson tearfully explained how she stepped away from the infant to help a colleague and returned 15 minutes later to be told by Letby, who was standing in the doorway to the unlit nursery several feet away, that Baby I 'looked pale'. 

The alarm on her breathing monitor had not triggered (Letby was accused of turning it off) and when Ms Hudson pulled back the blankets Baby I was so close to death she needed more than 20 minutes of CPR to save her.

'My first thought, and worry, was that she had deteriorated so rapidly that it was too late,' Ms Hudson told the court. 'The change in her had been remarkable.'

Prosecutor Nick Johnson KC asked Letby how she was able to tell Baby I was struggling – the infant's face was concealed with a cot canopy – from so far away.

She replied that she knew 'what I was looking for', before quickly correcting herself and saying 'at'.

Letby immediately realised she'd slipped up, adding: 'I don't mean it like that – I'm finding it quite hard to concentrate on all these dates,' before asking for a break.

It was one of just a handful of times she looked uncomfortable and agitated during the trial.

Up to three children murdered by the 36-year-old neonatal nurse should not, and would not, have died had hospital managers acted sooner to remove her, said Lady Justice Thirlwall

Liz Hull, pictured, says the contents of the judge's 822-page public inquiry report did not make good reading for those who continue to insist on Letby's innocence 

The jury was later also told about strange, insensitive comments Letby made after Baby I had died, about being there for her first bath. The mother explained: 'She was smiling and kept going on about how she was present at the first bath and how [Baby I] had loved it.

'I wished she would just stop talking.'

There was also a sympathy card she wrote to Baby I's parents, which she claimed she sent along with colleagues attending her funeral but which was never received.

Letby denied getting a thrill out of taking a photograph of the card – a time stamp revealed she took the picture on the unit during a night shift – or keeping it as a souvenir. It was still on her device more than two-and-a-half years later when she was arrested.

Testimony from Baby E's mother is also rarely mentioned by Letby's supporters but that too was pivotal, I believe, in helping convince the jury she was guilty.

You could hear a pin drop in court seven, at Manchester Crown Court, when the twin boy's mother described entering the neonatal unit just before 9pm, on August 3, 2015, to 'horrendous' screaming coming from her son.

'It was a sound that should not have come from a tiny baby,' she told the jury. 'It was more of a scream than a cry.'

Letby reassured the mother that blood she could see around his mouth was from his breathing tube irritating his throat.

She also claimed she had bleeped the registrar, who was on his way, and urged Baby E's mother to return to her bed on the maternity ward.

The child's mother did what she was told because she 'trusted' Letby but told the court she was so worried she immediately telephoned her husband.

Significantly, phone records later confirmed the timing of this call as being around 9pm but when police examined Baby E's medical notes they discovered Letby had falsified the timings to make it seem like the event happened an hour later, when she eventually called the doctor to the infant's aid, at 10pm.

By then it was too late. Letby was convicted of murdering Baby E by ramming a hard piece of medical equipment down his throat and injecting air into his bloodstream.

In their closing remarks to the public inquiry, the parents of all the babies murdered and harmed by Letby made it clear, through barrister Richard Baker KC, that they are in no doubt she was rightfully convicted.

'Everybody who recklessly promotes conspiracy theories or who parrots, without questioning, the same tired misconceptions about the case against Letby should be ashamed of themselves,' Mr Baker said.

'The families, along with a jury, collectively sat through ten months of evidence... They have no doubt that she was guilty.'

Summing up her findings, Lady Justice Thirlwall also paid tribute to the parents and urged everyone, 'whatever their views', to respect their dignity and courage, adding: 'They must not be collateral damage in the public argument about whether or not Letby is guilty.'

Sadly, until the CCRC or Court of Appeal put to bed the issue once and for all, I fear they will continue to be the ones to suffer most in this ongoing war of words.