Karen Townsend, the divisional director of urgent care at Countess of Chester Hospital, expressed her feelings of being “out of her depth” during the public inquiry addressing the actions surrounding serial killer nurse Lucy Letby and the grave concerns raised by medical staff.
During her testimony at the inquiry held at Liverpool Town Hall, she faced scrutiny regarding her response to serious allegations from senior physicians who linked Letby to a disturbing rise in unexpected infant deaths and emergencies in the neonatal unit.
Ms. Townsend admitted that she lacked the necessary “clinical insight” to grasp the full gravity of the situation, stating that her decisions were heavily influenced by the directives of the executive team regarding how to address the concerns being voiced.
According to the Thirlwall Inquiry, a critical meeting took place on June 24, 2016, in a coffee shop within the hospital, where Ms. Townsend first became aware of the worrying concerns raised by consultant Dr. Ravi Jayaram. This discussion was particularly notable due to its proximity to the tragic death of a triplet known as Baby O, a case for which Letby was later convicted of murder, and bearing in mind that this meeting occurred shortly before Baby P, Letby’s second victim, would die.
At that juncture, the prospect of involving law enforcement in the disturbing developments was considered during a follow-up meeting with senior management on June 30, 2016, but the inquiry revealed that no such action was taken until 2017, despite numerous concerns about Letby’s actions being escalated to senior executives over a year earlier.
When questioned if the police intervention should have occurred by the end of June, Ms. Townsend admitted, “I probably felt out of my depth because I didn’t have the clinical insight, I didn’t have the clinical knowledge, and I felt I was very much being led by how the executive team wanted to manage it at that time because of how awful a scenario it was.”
The inquiry further explored why Ms. Townsend did not document Dr. Jayaram’s concerns in the hospital risk register post-meeting. She suggested that the discussion lacked concrete details, referring to it as “very vague” and indicating that no substantial evidence was provided to back the concerns raised.
She indicated that she had consulted with Karen Rees, who was the head of nursing in urgent care, for guidance on the matter. However, when prompted about her delay in relaying doctors’ concerns to the hospital executive team, Ms. Townsend acknowledged it was a combination of her naivety in her role and the fact that the doctors, who possessed more detailed information, had not escalated their concerns themselves.
‘I did not know’
In a moment of introspection, she pondered why Dr. Jayaram and his colleagues hadn’t approached the executive team directly with their worries. During the cross-examination by barrister Richard Baker KC, who represents families of Letby’s victims, it was underscored that the meeting with Dr. Jayaram transpired while Baby P was still under Letby’s care.
Baker pressed Ms. Townsend, asking if in hindsight, she believed urgent measures should have been taken to remove Letby from the neonatal unit. In her response, she stated: “So all of what you’ve articulated I did not know.” She emphasized that her discussions with Dr. Jayaram were brief and lacked detailed content, indicating that there were “no specifics” regarding any alleged harm caused by the nurse.
When further questioned about what level of detail would have triggered action, she noted that terms like “attacking” or “harming” were never part of the conversation, underscoring the ambiguity of the communications surrounding Letby’s behavior.
Later in the inquiry, Ruth Millward, a patient safety manager, shed light on a detrimental culture within the NHS that leads individuals to copy colleagues on emails as a way of claiming that information has been shared, rather than ensuring effective communication on serious matters. She recounted receiving a March 2016 email from a consultant detailing unexpected deaths in the neonatal unit, but criticized its lack of specific instructions and concluded that it unfairly shifted the onus of responsibility onto her without ensuring she read it properly.
Millward further clarified that at no point did any consultants express concerns that Lucy Letby was intentionally causing harm to infants. She offered her reflection, stating that the lack of formal reporting of concerns through established hospital governance processes significantly impaired the seriousness with which those concerns were ultimately addressed.
She asserted, “Absolutely,” in response to whether the consultants’ informal approach explained why their grave concerns were not taken seriously enough, highlighting the vital need for traceability and transparent communication in matters affecting patient safety.
Lucy Letby, originally from Hereford, was ultimately convicted of murdering seven babies and attempting to murder an additional seven between June 2015 and June 2016. She is currently serving a full life term and has faced multiple rejected appeals against her convictions in the Court of Appeal.
The inquiry continues to unfold as it seeks to unearth systemic failures that allowed such shocking breaches of care to occur.
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**Interview with Karen Townsend on the Thirlwall Inquiry: Reflections and Accountability**
*Host:* Welcome, Karen Townsend, the Divisional Director of Urgent Care at Countess of Chester Hospital. Thank you for joining us today to discuss the findings of the Thirlwall Inquiry and your recent testimony.
*Karen Townsend:* Thank you for having me.
*Host:* In your testimony, you expressed that you felt “out of your depth” regarding the concerns raised about Lucy Letby. Can you elaborate on what made you feel that way at the time?
*Karen Townsend:* Yes, during the inquiry, it became clear to me that I didn’t possess the necessary clinical insight or knowledge to fully understand the gravity of the doctors’ concerns. I was primarily influenced by the directives from the executive team on how to manage the situation. It was an incredibly severe and distressing scenario, and I was relying heavily on the guidance I received.
*Host:* You mentioned a significant meeting took place on June 24, 2016, in which Dr. Jayaram shared serious concerns with you. How did this meeting impact your subsequent actions?
*Karen Townsend:* That meeting was indeed crucial as it was my first real awareness of the troubling situation relating to unexpected infant deaths. However, the discussion itself felt vague, and at that moment, I did not feel there was enough concrete evidence to warrant urgent action.
*Host:* In hindsight, do you believe police involvement should have been considered earlier in the process?
*Karen Townsend:* Upon reflection, I think there are definitely areas where we could have acted sooner. Given the alarming context, I do question if more direct and explicit concerns should have triggered immediate action. However, I did not have the broader context — it was not communicated clearly to me at that stage.
*Host:* You also mentioned that communication among the medical staff may not have been as effective as it should have been. Can you discuss that further?
*Karen Townsend:* Absolutely. There seemed to be a culture where staff would copy each other on emails to adequately demonstrate that information was shared, but that created confusion rather than clarity. I believe the lack of structured reporting through established governance meant that concerns were not taken as seriously as they needed to be.
*Host:* Reflecting on this experience, what are your main takeaways regarding hospital governance and safety protocols?
*Karen Townsend:* This inquiry has highlighted the critical need for robust communication channels and formal reporting mechanisms within the hospital. The urgency of patient safety must be at the forefront, and we need to ensure that concerns are escalated without fear of dismissal. My experience has underscored the importance of empowering all staff members to feel confident in voicing their concerns.
*Host:* Thank you, Karen, for sharing your insights. The Thirlwall Inquiry continues to raise important questions about accountability within healthcare systems. We appreciate your honesty and dedication to addressing these critical issues.
*Karen Townsend:* Thank you for having me. It’s essential we learn from these events to prevent similar tragedies in the future.
