The sequence in outline
- September 2016. Seven consultants write to Trust executives demanding Cheshire Police be contacted about the cluster of unexplained neonatal deaths (see the letter).
- Autumn 2016. Rather than refer to police, executives commission the RCPCH Invited Service Review (see our analysis of the RCPCH review). They simultaneously encourage Letby to raise a grievance against the named consultants under the Trust’s HR procedures.
- Winter 2016–2017. Letby’s grievance is processed as a formal HR matter. HR Director Sue Hodkinson, HR Business Partner Karen Townsend, and Director of Corporate Affairs Stephen Cross (a former police officer) are named in Thirlwall Inquiry evidence as key participants.
- Late 2016 / early 2017. As part of the grievance resolution, consultants who had signed the September letter are required to meet Letby and, in effect, apologise for having raised concerns. The sequence has become known as the “apology letter” sequence.
- Spring 2017. After further deaths and consultants continuing to press executives, the Trust eventually contacts Cheshire Police in May 2017 — eight months after the September 2016 letter.
What the documentary record shows
The Thirlwall Inquiry has placed much of the documentary record from this period into public evidence. The pattern documented across emails, HR records and contemporaneous notes is consistent with HR procedures being used as a tool to suppress patient-safety escalation rather than to manage a genuine interpersonal dispute.
Specifically:
- Executives treated the consultants’ concerns as an HR problem (a grievance about how consultants had treated an individual nurse) rather than as a patient-safety problem (a cluster of unexplained deaths).
- The HR procedures used did not require any objective finding that the consultants’ concerns were wrong before the grievance could be sustained. The process was institutional, not evidential.
- Several of the consultants who attended these meetings have described the experience as professionally intimidating: being required to apologise for a patient-safety escalation in order that they could continue to practise was the institutional cost of persistence.
- Consultants who were, contemporaneously, among those most concerned about the deaths have given Thirlwall Inquiry evidence that the apology process was a material factor in the continued delay of police involvement.
Helene Donnelly’s framing at the Inquiry
Helene Donnelly OBE, one of the UK’s most prominent NHS whistleblowers (she raised the alarm at Mid Staffordshire before that Trust became the subject of the Francis Inquiry), gave Thirlwall Inquiry evidence on 4 December 2024. Her evidence addressed the generic pattern by which NHS trusts respond to staff who raise patient-safety concerns — and the specific applicability of that pattern here.
Her framing of the apology-letter sequence, as reported in the Inquiry record, is that it is a textbook example of a UK NHS trust using HR procedures to neutralise a whistleblower escalation rather than to investigate the underlying patient-safety concern. The pattern, she said, is reproducible across multiple NHS miscarriages of care. See our Helene Donnelly transcript summary.
Why this matters for the conviction
The apology-letter sequence is not itself evidence of innocence or guilt. What it is evidence of is how the institutional record that reached the Crown in 2017, and ultimately the jury in 2023, was shaped.
- Executives who had committed themselves publicly to the position that the consultants were wrong could not easily, months later, tell Cheshire Police that the consultants had been right all along. The eventual police referral in May 2017 was made under pressure but within a frame that executives had created.
- The delay itself — eight months between the September 2016 letter and the May 2017 police referral — meant that evidence of the actual clinical and institutional state of the unit had months to dissipate. Datix records, rota records, outbreak records, infrastructure-incident records all continued to be generated, but the specific evidence relevant to the cluster period was no longer contemporaneous.
- The three ex-executives arrested by Cheshire Police in July 2025 on suspicion of gross-negligence manslaughter are the same three executives whose names appear most often in the apology-letter documentary record. This is not a coincidence.