Why her inquiry matters
The Thirlwall Inquiry is the statutory public inquiry examining how the Countess of Chester Hospital and its regulators responded to the cluster of unexplained neonatal deaths in 2015–2016. It is the single most detailed institutional-record exercise ever conducted on the case. Its evidence bundles have made visible the documentary record the criminal trial did not systematically explore: the Datix record, the apology-letter sequence, the scope limits of the RCPCH review, and the three-body-external-review package Trust executives used as rhetorical cover against police involvement.
The Inquiry’s final report is expected after Easter 2026. When published, it will be the most authoritative account of the institutional failings surrounding the case.
Professional background
- Called to the Bar; practised in criminal and public law; appointed King’s Counsel.
- Appointed to the High Court bench and subsequently to the Court of Appeal (Criminal Division).
- Appointed to chair the statutory public inquiry into the Countess of Chester institutional response in 2023. The Inquiry opened its hearings on 10 September 2024.
The Inquiry’s terms of reference
Lady Justice Thirlwall set out the Inquiry’s terms of reference at its opening on 10 September 2024 (see our opening-statement summary). Critically, she was explicit that the Inquiry would not itself re-examine the medical evidence on which the criminal convictions rest. The convictions are a matter for the appellate courts and the CCRC; the Inquiry proceeds on the basis of the verdicts as they stand.
This boundary is legally correct — a statutory public inquiry does not have criminal-appellate jurisdiction — but it sets up an important structural feature of the post-conviction record: institutional findings will co-exist with, rather than displace, whatever the CCRC ultimately concludes.
What the Inquiry has done
From autumn 2024 through 2025 the Inquiry heard evidence from:
- Consultant paediatricians (Brearey, Jayaram, Gibbs, Newby, Lambie, Saladi).
- Trust executives (Chambers, Harvey, Hodkinson, Kelly, Cross, Nichol).
- HR (Townsend).
- Nursing staff (Powell, Bissell, Farmer, Hudson, Rees, Mancini).
- External reviewers (RCPCH review authors, Hawdon, Subhedar, Eardley).
- Cheshire Police (former DCS Wenham).
- Counsel to the Inquiry (Slingo, Medland KC, Browne KC).
- NHS whistleblowing experts (Helene Donnelly OBE).
The resulting evidence record is the material against which the conviction-safety questions are now being considered. The documentary record the CCRC application draws on comes substantially from the Inquiry’s disclosure exercise.