The Liverpool Women's Hospital / twin-pregnancy referral network
Prosecution claim
The Crown's trial narrative treated the high proportion of twin and higher-order multiple births in the Letby indictment (eleven of seventeen indicted babies are twins or multiples) as a feature of the cluster rather than as a referral-pattern anomaly requiring institutional explanation.
Counter-evidence
Independent researchers — Sarah Hawkins and Prof. Richard Gill in particular — have documented that the Countess of Chester neonatal unit was receiving a disproportionate number of high-risk twin and multiple births during the indictment period. Best-practice pathways for complicated twin pregnancies (twin-to-twin transfusion syndrome monitoring, MCMA surveillance, selective feto-reduction decisions) run through tertiary fetal-medicine centres — for the North West, principally Liverpool Women's Hospital. The research documents an apparent pattern of high-risk multiples being managed at the Countess of Chester (a Level 2 unit) when clinical best practice would suggest management at LWH (a tertiary centre). The professional network of Asma Khalil, Surabhi Nanda, Andrew Sharp and Mark Kilby intersects with NHS Quality Strategy targets on multiples, the Harris Research Grant, and the TTTS registry. The structural question this line of evidence raises is: why were high-risk multiples being delivered or managed at a Level 2 unit when the tertiary pathway existed?
Eleven of seventeen indicted babies being twins or multiples is not primarily a fact about the accused nurse. It is a fact about referral patterns, tertiary-centre access, and institutional clinical-governance decisions on high-risk pregnancies.
What the jury heard
The jury was not presented with the referral-pattern question. The twin/multiple proportion was treated as a feature of the cluster requiring a cluster explanation (deliberate harm) rather than as a feature of a structural referral anomaly requiring a structural explanation.
What the Panel says
The Panel's case-by-case review of the twin and multiple cases (Babies A and B; E and F; Babies O and P; Babies L and M etc.) identifies natural-cause differentials — including TTTS, prematurity-of-multiple-birth, and cohort-specific NEC and IVH risks — as the most likely explanations for the documented clinical courses, consistent with the high-risk-referral-pattern framing.
What independent experts add
- Asma Khalil is a UK fetal-medicine professor of international standing; her professional network is central to high-risk-multiple management in UK tertiary centres.
- Surabhi Nanda is a fetal-medicine colleague in the same network.
- Andrew Sharp and Mark Kilby have professional-association links to the Harris Research Grant and the TTTS registry.
- NHS Quality Strategy targets for multiples create institutional incentives that intersect with referral decisions.
- The Harris Research Grant (awarded to associated researchers) is publicly documented; its intersection with referral patterns is the load-bearing research question.
- The TTTS registry's access rules are a structural question about how best-practice monitoring is delivered.
- Hawkins and Gill's published audits are the canonical independent treatment of this evidence line.
- Bereaved parents of indicted twins have written publicly (open letter from a twin mother) disputing the prosecution's narrative that their loss was caused by a nurse.