Royal College guidance evolution — 2015–2026
Prosecution claim
The Crown's expert evidence at trial was based on appropriate contemporary clinical standards. The methodology the Crown's experts applied was professionally appropriate.
Counter-evidence
UK neonatology clinical standards have evolved since 2015–2016. Specific changes are load-bearing for the Letby case: Level 2 / Level 3 designation clarification (current guidance is explicit that extremely preterm infants belong in Level 3 tertiary units, not Level 2); differential-diagnosis expectations in mortality review (post-2018 RCPCH guidance requires blinded multidisciplinary review on every unexpected death); expert-instruction standards in forensic paediatric cases (expert must be currently in routine relevant practice; blinded methodology required); cluster-response guidance (post-Letby guidance specifically addresses the institutional failure modes the Countess of Chester displayed). Applied under modern guidance, the Crown's expert methodology would not be commissioned. The Shoo Lee Panel's methodology is explicitly aligned with modern standards.
The methodology the Crown's expert applied is not the methodology modern RCPCH guidance would commission. Applied under 2026 standards, a case of this kind would be handled very differently at every institutional layer.
What the jury heard
The jury heard the Crown's experts applying 2015–2016 clinical standards interpretively in 2023. The subsequent evolution of guidance was not before the jury.
What the Panel says
The Panel explicitly applies modern differential-diagnosis methodology. Its conclusions reflect what a modern-standards expert review of the Letby casebook produces.
What independent experts add
- Level 2 units should not, on current guidance, routinely admit below-27-week infants.
- Post-2018 RCPCH guidance requires blinded multidisciplinary mortality review.
- Current expert-instruction standards require currently-practising relevant specialism.
- Post-Letby cluster-response guidance addresses the Countess of Chester failure modes specifically.
- The evolution of guidance is partly in response to the Letby case itself.
- The Shoo Lee Panel methodology is the modern-standards version of what the trial should have had.
- Under current standards, the Crown's forensic-from-hypothesis expert approach would not be commissioned.