Sir Keir Starmer will open the door to an increase in the size of Britain’s Armed Forces as he announces a review of the nation’s readiness to fight future wars.

The Telegraph understands that a “root-and-branch” strategic defence review, to be announced by the Prime Minister on Wednesday, will “look at everything on the table”.

It is understood that this includes troop numbers, which were cut to their smallest size since the Napoleonic era under the previous government.

The Prime Minister will also restate his commitment to increasing defence spending to 2.5 per cent of GDP but will decline to set a clear date by which this target will be achieved and instead state that the review will determine the “roadmap” to this goal.

Sir Keir will arrive at Nato’s 75th anniversary summit in Washington on Wednesday, his first international trip as Prime Minister

He is joined on the trip by his wife, Lady Starmer, and accompanied by David Lammy, the Foreign Secretary, and Nick Thomas-Symonds, the Europe minister.

The presence of Mr Thomas-Symonds will spark fears among those who believe Sir Keir will use the trip to reset relations with the European Union.

During the trip, Sir Keir will have his first bilateral meeting with Joe Biden, the US president, and he and his wife will attend a dinner at the White House with other Nato leaders.

On Tuesday night, Sir Keir said: “There is no more important duty for me as Prime Minister than keeping the people of our country safe.

“At a time when we face multiple threats at home and abroad, we must make sure we are ready to defend ourselves. That’s why I have immediately ordered a root-and-branch review that will secure Britain’s defences for the future.”

Defence sources suggested the review, which will be officially launched next week and overseen by John Healey, the Defence Secretary, could look at how to increase troop numbers. Cuts to the size of the Armed Forces are understood to be off the table.

In 2021, the Ministry of Defence announced it would cut troop numbers from 82,000 to 73,000 by 2025.

The row over troop numbers has engulfed the military and, according to sources, led to Gen Sir Patrick Sanders, the former chief of the General Staff, being pushed out of his post because he openly criticised the decision.

The Telegraph understands the review will focus on the changing threats of warfare, including a focus on drones, which have played a significant role in the war in Ukraine.

The military’s readiness to fight will also be reviewed, along with how to enhance the UK’s defence partnerships, develop a new defence industrial strategy and deliver procurement reform.

It is understood that the review will set out a “roadmap” for how the UK can reach 2.5 per cent of GDP on defence.

On Wednesday, Sir Keir will say that the UK has committed to increase defence spending and will praise Nato members’ efforts to increase their own budgets while encouraging them to go further.

Nato members have a target to spend 2 per cent of GDP on defence, but last year only 11 of the alliance’s 32 members, including the UK, reached that level.

Sir Keir’s spokesman added: “We obviously want to see other countries continue to take steps to increase defence spending as well in order to ensure that we’re sending a strong signal to [Vladimir] Putin that we will do whatever it takes to support Ukraine in their defence.”

However, writing for The Telegraph, below, James Cartlidge, the newly appointed shadow defence secretary, accused Sir Keir of “rowing back” on the Tories’ commitment to increase defence spending and called on him to produce a “credible timeline” for how Labour will achieve 2.5 per cent.

He said: “In this increasingly dangerous world, the platitudes Sir Keir Starmer has been able to produce so far will not cut it.

“Sir Keir is today attending a Nato summit having rowed back on our plans to increase defence spending, whilst asking our allies to do the exact opposite.”

Mr Cartlidge said under Rishi Sunak, the Government’s pathway to achieving 2.5 per cent by 2030 was “fully funded”.

He writes: “Part of increasing our defence spending is convincing our allies to make sacrifices to increase their own too. How can Starmer stand there at today’s Nato summit and ask others to make sacrifices he is not willing to make himself?”

Former military leaders warned the Prime Minister he is “playing with fire” by waiting for the review before outlining a timeline to increase the defence budget to 2.5 per cent of GDP. 

Philip Ingram, a former colonel in British military intelligence, told The Times the government was “playing with fire” as the “threat is now and it will take years to fix the army, our ammunition stocks, get the RAF and navy ready”.

Meanwhile Admiral Lord West, a former head of the navy who served as a security minister under the last Labour government, urged ministers to outline a timetable at the summit to “set an example to all European countries”, according to the paper.

Speaking before his departure to the US on Tuesday night, the Prime Minister said he was committed to spending 2.5 per cent of GDP on defence “within our fiscal rules” and that he needed to carry out a review before setting a timeline to reach that goal.

He said: “The most important thing is to, at this Nato summit, recommit to our solidarity with and stand with Ukraine and discuss the practical plans for further action we can take together in relation to Russian aggression.”

He added: “In relation to defence more generally, we will carry out our strategic review to look at the challenges, the capabilities, and on the back of that make further plans.

“I am committed to that 2.5 per cent within our fiscal rules. That strategic review needs to come first. But today, tomorrow and the next day is all about standing together with our allies, discussing practically how we provide further support to Ukraine and send a very, very clear message to Putin that we will stand against Russian aggression wherever it is in the world.”

Sir Keir also issued a message directly to Mr Putin.

“This Nato summit is an opportunity for allies to stand together, to strengthen their resolve, particularly in light of that appalling attack, against Russian aggression,” he said, referring to Russian missile attacks on Monday that damaged Ukraine’s largest children’s hospital.

“I’m pleased to have the early opportunity to confirm and reaffirm Labour’s strong support, unshakeable support for Nato.

“We are a founding member, it’s now the 75th anniversary but this is an opportunity to send that message in relation to Russian aggression wherever.

“But that attack … was appalling so that message is even more important than it was before.”

The Prime Minister, who is in Washington for two days, is understood to have no plans to meet Donald Trump, who is running as the Republican candidate for the presidency.

Asked about the presence of Mr Thomas-Symonds on the trip, Mr Healey, who has also joined the Prime Minister in Washington, said: “Nato is a political and military alliance of countries from Europe and North America. It’s not unusual that the minister for Europe would accompany the Prime Minister. I’m sure as you’re aware, the PM has said he wants to reset our relationship with Europe. He’s told a number of his European counterparts exactly that over the weekend, he sees the Nato summit as an important opportunity to continue laying the groundwork.

“Britain’s commitment to Nato is unshakeable. We cannot have prosperity without security and we must never take our ability to live freely for granted.

“The world is increasingly volatile with rapidly changing global threats. In the footsteps of Bevin, our government will help ensure we have a strong Nato in this increasingly insecure world.

“Our Government’s first duty is to keep the country safe. That’s why we will increase defence spending and launch a strategic defence review to ensure we have the capabilities needed to protect the UK now and in the future. The review will also set out defence reforms to secure faster procurement and better value for money.”

PM is showing that defence is not a priority

By James Cartlidge

When it comes to our nation’s defence in a more contested world we need deeds, not words. We must signal to our allies, and our adversaries, that we are serious about defending our nation.

To do this, we need a credible timeline and plan to fund an increase in defence spending to 2.5 per cent. In this increasingly dangerous world, the platitudes Sir Keir Starmer has been able to produce so far will not cut it.

Sir Keir is attending a Nato summit having rowed back on the Conservatives’ plans to increase defence spending, whilst asking our allies to do the exact opposite.

By not joining the Conservatives’ fully funded pledge to increase defence spending to 2.5 per cent of GDP by 2030, Starmer has shown the country and the world that defence is not the top priority for him that it needs to be.

Starmer must produce a timeline and a funding package, as we did, to reach this important target.

This is not party-political point scoring. I’ve been clear that we must work with Labour where it is in the national interest, not least on support for Ukraine.

Nevertheless, it is indisputable that we are living in a more dangerous world: war in Europe; British ships being attacked in the Red Sea Threats growing, not diminishing.

As such, increasing defence spending is a military necessity. How much more unstable will the world have to be for Starmer to give our Armed Forces the funding they need to protect us?

Britain’s future is threatened by a new axis of malign states. But Labour seems blind to it.

The first and most important duty of any prime minister is defence of the realm. That means deterring aggressors. Put simply, potential adversaries must believe you are willing to do whatever is necessary to defend the United Kingdom, at home and abroad.

Having no plan is having the opposite of credibility. It undermines deterrence, rather than strengthening it.

I welcome the fact that Labour now embraces the nuclear deterrent, but we cannot ignore the fact that almost a dozen front benchers – including the Foreign Secretary and Deputy Prime Minister – voted against trident renewal under Jeremy Corbyn.

Sir Keir claims he has changed the Labour party. But by not having a plan for our nation’s defence now, he is doing nothing to regain credibility as a government serious about defence.

The then-Conservative government’s plan to increase defence spending to 2.5 per cent was fully funded, with a clear pathway to delivery by 2030. Whereas Labour’s commitment is weak, and without a timescale. What certainty does that give the brilliant men and women of our Armed Forces?

We are living in a more dangerous world, where national defence comes at a higher price. Either Starmer doesn’t see it, doesn’t understand it, or doesn’t think it’s worth it. To restore the credibility of UK defence policy, he must change course immediately.

Moving to 2.5 per cent will provide significant additional funding to boost our military capability, but also the vital “enablers” that support our personnel – such as service family accommodation.

Moving together slowly but surely are Russia, North Korea, China and Iran. Their bully boy expansionist policies are being tested in the sandboxes of Ukraine and the Middle East. They cannot be appeased. They cannot succeed. We need to stand strong against them, with our allies.

As well as our own defence, the UK’s defence spending increase has global significance.

Part of increasing our defence spending is convincing our allies to make sacrifices to increase their own too. How can Starmer stand there at the Nato summit and ask others to make sacrifices he is not willing to make himself?

The risk is the UK transformed from a global leader to a follower on security, the biggest beneficiaries of which would be our adversaries.

We need to change course before it is too late. The national interest requires no less.

James Cartlidge is the shadow defence secretary

Kemi Badenoch has laid into Rishi Sunak over the Tories’ election disaster.

The shadow housing secretary, who is expected to run in the Tory leadership contest, used the first shadow cabinet meeting to say Mr Sunak’s decision to call an early election without first informing the Cabinet was a mistake.

She said it bordered on being unconstitutional.

Ms Badenoch also branded the Tory leader’s decision to return early from D-Day commemorations “disastrous” and was said to be concerned that colleagues were failing to grasp the enormity of the party’s defeat in a 172-seat majority Labour landslide.

The former trade secretary even took aim at one of her potential leadership rivals as she suggested many colleagues were still traumatised by the size of the defeat.

She said Suella Braverman, who criticised Mr Sunak before the polls closed, appeared to be having a “very public” nervous breakdown.

Ms Badenoch’s intervention came as Conservative MPs were left furious on Tuesday night as the election of the new chairman of the 1922 Committee descended into chaos.

Senior Tories including Jeremy Hunt, the shadow chancellor, and Mark Francois, a former Armed Forces minister, missed the vote after being wrongly told voting closed at 6pm.

Ms Badenoch, who is the bookies’ favourite to succeed Mr Sunak, said it had been wrong of the former prime minister to have opted to tell only an inner circle of colleagues of his plans for a snap summer election.

They included his parliamentary private secretary Craig Williams, whom she described as a “buffoon” after he subsequently placed a bet on the election date.

She said ministerial colleagues such as Penny Mordaunt would still be MPs today if Mr Sunak had stayed in France for the D-Day commemorations rather than departing early for an interview with ITV.

Her attack came after Mr Sunak opened the shadow cabinet with an apology and repeated his previous acknowledgement that the responsibility for the election defeat was his alone.

Shadow ministers paid tribute to Mr Sunak for his work ethic and commitment to public service, saying his efforts had meant the defeat was not as bad as it could have been.

Senior MPs are urging Mr Sunak to stay on as leader until the contest for a successor is completed despite speculation that he might seek to step down at the end of July, when Parliament is expected to go into recess.

Many MPs including Bob Blackman, the new chairman of the 1922 Committee, are opposed to rushing into a quick contest with the expectation that it is unlikely to be concluded before November in an attempt to give time for a proper post-mortem and thorough examination of candidates.

Sir David Davis, the former Cabinet minister, warned the party was on a knife edge. He said: “Make the wrong call and we will be obliterated by Reform. On the other side of the knife edge, we could be back in power because the Labour majority is very fragile. We have everything to play for and everything to lose.”

A distraught mother was left searching a motorway for her eight-month-old baby after a killer driver smashed into her vehicle at 140mph while three times over the drink-drive limit and using his phone.

Darryl Anderson, 38, was playing “Russian roulette” with the lives of others when he killed Zackary Blades and the infant’s aunt, air stewardess Karlene Warner, 30, a court was told.

Anderson took a photograph on his phone of the dashboard of his Audi Q5 three seconds before impact, which showed he was driving at 141mph and the vehicle was flashing a red collision warning alert.

However, Durham Crown Court heard he was so drunk and distracted that he didn’t even see the Peugeot 308 feet ahead of him being driven by Zackary’s mother, Shalorna Warner.

The impact was such that it ripped away the back of Ms Warner’s car and jettisoned Zackary, who was strapped into his baby seat, a distance of 50m across the A1M between Chester-le-Street and Durham.

Anderson showed a shocking disregard for his actions, later caught on bodyworn camera footage telling police: “Everyone makes mistakes.”

Later at the hospital, he flirted with nurses and cracked jokes, and accident investigators found an empty bottle of vodka in the wreckage of his vehicle.

When he later realised the enormity of his actions, Anderson made up a story that he had picked up a mystery hitchhiker who was driving the car at the time of impact.

Both cars had driven away from Newcastle International Airport in the early hours of May 31 this year.

Shalorna had picked up Karlene after a holiday, with Zackary “safely strapped into his car seat in the rear”.

Anderson was returning from Antalya, where he had been on holiday with his wife.

However, his behaviour had been so bad that she had left him and flown home early.

The couple had not been married long, but when he collected the keys for his car from a car park attendant, Anderson told him: “I’m going to go to Bradford to find a new wife.”

He was jailed for 17 years and three months by Judge Joanne Kidd, who told him: “You played Russian roulette with the lives of every man, woman and child you passed on that journey.

“The level of your intoxication, your aggressive and entitled driving, your speed and the use of your phone made it inevitable you would come into collision with another road user.

“At a speed of 140 miles per hour, with your foot fully depressed on the accelerator you were inevitably going to cause serious injury and the probability of a fatality.”

The judge referred to the heartbreaking statement read to the court by Zackary’s mother as she described the horror of being unable to find him.

Wiping tears from her face, Ms Warner said she remembered the impact which sent her car spinning.

She looked to her left to see Karlene clearly badly injured in the passenger airbag, but knew she had to try to help Zackary, calling to Karlene: “I will come back for you.”

Ms Warner said: “I ran to the left rear side of the car where Zackary would have been, but there was no back of the car, it was crushed.

“I could not see my baby, I was standing on wreckage, picking up smashed bits of the car and throwing them, trying to find him but he was not there. I was screaming his name and I called 999.

“I saw the other driver and I ran to him and said: ‘Help, I cannot find my baby.’ I was screaming ‘Zack, Zack’.

“He did not help, he never helped. I began running up to the traffic waving my arms and screaming at cars to help me.”

On the opposite carriageway, a lorry driver pulled over and warned her not to run towards the traffic.

Ms Warner found Zackary’s car seat and turned it over, only to find it empty.

Then the lorry driver shouted, saying that he could see Zackary.

She said: “I heard a painful scream from the lorry driver, he was shouting ‘he’s here, your baby is here’. I ran over and I found Zackary on the grass.

“I picked up my dead baby from the side of the road, he had been propelled 50m and had landed on his head.”

Turning briefly to Anderson, who refused to lift his head to meet her gaze, she said: “You have left a broken shell of a woman and a childless mother.”

When Lucy Letby was convicted of the murders of seven newborns and the attempted murders of six more in August 2023 she was described by the judge as having led a “cruel, calculating and cynical campaign of child murder”.

The detectives who led the case said Letby had operated in plain sight and had abused the trust placed in her in the most unthinkable way.

No one could comprehend what had led a nurse with a previously unblemished career to embark on a campaign of such unimaginable horror, attacking and killing the most vulnerable members of society.

Last week, Letby was convicted of another attempted murder – a charge on which the original jury had been unable to reach a verdict – confirming her status as Britain’s most prolific baby serial killer.

But despite the guilty verdicts and the fact her application to appeal was roundly rejected by judges in May, troubling questions have started to emerge about some of the scientific evidence used to convict Letby.

After the trial, numerous blogs and armchair detectives suggested she could be innocent in interventions which were largely dismissed as conspiracy theories.

The grieving families of the victims have also spoken of their anguish that anyone would question the verdict or show sympathy to Letby.

However, experts from universities including Edinburgh, Harvard and Bristol, and members of the Royal Statistical Society (RSS) are now questioning the way crucial evidence was presented in court. 

One of the scientists whose paper was cited in the original case has suggested that his work was misinterpreted.

Others have gone as far as to suggest that, rather than being a calculating killer, Letby is a victim of NHS failings. 

Here, The Telegraph examines the scientific concerns in the arguments used to convict Letby.

One of the most damning pieces of evidence presented to the jury was a chart revealing that Letby was always on duty at the Countess of Chester Hospital when babies collapsed or died.

The table, which covered a 13-month period between June 2015 and June 2016, showed that each of the 38 other nurses was in attendance on just a handful of occasions when suspicious incidents occurred. 

In contrast, a seemingly conclusive stark black line of dots placed Letby at the scene of all the incidents. Opening the prosecution’s case Nick Johnson KC said that “by a process of simple elimination” only one person could be responsible.

Dr Alexander Coward, a former maths lecturer at the University of Oxford and University of California Berkeley, who reviewed the case, said: “At first glance it’s like ‘Oh my God, at the times all the babies died, Lucy Letby is right there’

“If that was all the data it would be pretty compelling. You’d say something fishy is going on.”

Yet experts say there are major problems in this approach. To begin with, it is unsurprising that Letby is present on all these occasions given that these are the cases for which she is under investigation.

The chart excludes deaths and collapses which occurred at the neonatal unit when she was either not present or where there was little evidence to suggest she was responsible. 

Freedom of Information (FOI) data from the unit shows differing results, but there may have been up to 17 infant deaths during the same period, with Letby only charged with seven. 

Even without the deaths for which she was tried, the mortality rate at the neonatal unit was much higher than it should have been during 2015 and 2016. 

The statistician Peter Elston, who runs the statistics and investment blog Chimp Investor has estimated the probability of so many extra deaths occurring through normal variation to be about 1 in 290. 

It suggests that, above and beyond Letby, there was something else going on in the neonatal unit that was increasing the death risk for babies, Mr Elston says.

David Wilson, emeritus professor of criminology at Birmingham City University, an expert in serial killers, said shift patterns were always a shaky form of evidence.

“The weakness of that sort of statistical analysis was really as plain as a pikestaff,” he said.

“What the defence never did was challenge the fact there were other incidents during that time period when Letby wasn’t on duty, and, in fact, there were [at least] nine other neonatal deaths on the ward during that period.

“So the prosecution present the table and it looks like the common denominator is Lucy Letby, but they don’t present all the collapses or deaths during that period because that doesn’t necessarily suit the argument that they are trying to make.”

He added: “Statistics and the law both speak English but they speak it in a very different dialect.”

There are other reasons to be cautious about the shift patterns. Dr Coward has shown it is possible to take an identical number of nurses and incident rate at a hospital with 170 shifts and place any nurse at the same number of events as Letby, simply through randomness. 

“You could make a chart like that for any nurse in any hospital,” he said.

“All you would have to do is only focus on the times when something went wrong when that nurse was on duty and ignore all the times that nurse was on duty and everything was fine.

“You don’t need a PhD in statistics or maths to know that this is dreadful. This illustrates what you can do with cherry-picked data.”

A similar use of statistics led to the wrongful conviction of Lucia de Berk, a Dutch paediatric nurse convicted of seven murders and three attempted murders in 2004. De Berk was exonerated in 2010 and her case led to reforms of the Dutch legal system.

Partly prompted by this, in 2022, the RSS produced a paper entitled “Healthcare serial killer or coincidence?” to help legal teams present data correctly. 

It recommended that investigators and prosecutors consult professional independent statisticians who could give instructions to the jury on how to interpret the data. This did not happen in the Letby trial. 

It also advised that confounding factors that could distort the figures should be made clear. Again this did not happen. 

Letby was described as a young keen nurse, who would often work over-time. In the spring of 2015, she gained a specialist intensive care qualification, meaning she was allowed to care for the sickest babies on the unit, increasing the likelihood she would be present for deaths or collapses. 

Prof Peter Green, of the School of Mathematics at the University of Bristol, one of the authors of the RSS report, said he was concerned by the way the shift chart was compiled.

Speaking in a personal capacity, he said: “The spreadsheet duty roster is almost a textbook example which I would give to my students of how not to collect and present data.”

In 2022, the RSS report warned that evidence such as shift patterns cannot stand alone but must be backed up by other proof, such as motive or clear method of murder.

In the case of Harold Shipman, who gave his patients lethal amounts of drugs, police discovered that several of the victims’wills had been changed to leave assets to the GP.

Burkhard Schafer, professor of computational legal theory at the University of Edinburgh said: “In the Letby case, the prosecution did also present direct evidence, at least for some of the deaths – a theory of how they think she committed the murders.

“This would have been fine if that evidence had been really strong. In this case though, the direct evidence that I saw was much weaker

“My worry would be now that the inference the jury drew went in the wrong direction, and that the weak statistical evidence ‘shored up’ or compensated for any concerns with the other evidence.”

Throughout the trial, the prosecution insisted that the babies who had died or been harmed at the Countess of Chester were in relatively good health. 

Infants were variously described as “in good condition”, “stable”, “all observations normal” “doing well” and even “excellent”.

Yet it is clear that many of the babies were born desperately early, had extremely low body weight and, from birth, were beset with numerous complications. 

The majority were admitted to the intensive care unit, and most required help breathing with many suffering from medical accidents which had nothing to do with Letby.  

Take Baby C, a little boy who lived just four days. 

He had been born at 30 weeks weighing less than 2lb after problems with the blood flow to the placenta meant he was only half the size he should have been. One nurse described him as “the smallest baby I have ever seen”.

The little boy was also suffering from pneumonia and breathing distress and an X-ray taken the day before his death showed air in his stomach indicating that potentially he had a blockage in his bowel. 

After he collapsed and died, a post-mortem examination at Alder Hey Children’s Hospital, in Liverpool, concluded the death was natural, exacerbated by the lack of blood flow in the womb. A coroner supported this finding.

Despite this, the prosecution claimed his death was caused by Letby pumping air into his stomach.

Michael Hall, a consultant neonatologist at University Hospital Southampton NHS Foundation Trust, was instructed as an expert for the defence but was never called. He said he was troubled by what he considered to be the prosecution’s “exaggeration” of the health of the infants. 

“It’s my opinion, the prosecution medical expert witnesses exaggerated the degree of wellness of those babies to a significant extent,” he said. “I would have thought it would have had a significant influence on the jury.

“One example of this is Baby A. His vital signs were displayed to the court on several occasions and it was clear that he was receiving respiratory support.

“But his breathing rate was clearly abnormal for almost 24 hours, or at least intermittently, certainly for the last 12 hours before he collapsed.”

The experts said Baby A could be considered “stable” because he did not require oxygen ventilation and was doing “so well” that medical staff decided to start giving him some feeds.

But the other babies who died were also vulnerable and initially, nobody considered their deaths to be suspicious, merely a natural outcome of prematurity, illness and even sub-optimal care. 

Baby B, the twin of Baby A was born at just 31 weeks, blue and floppy and needing resuscitation, to a mother suffering from an auto-immune disease that can increase blood clots, and both babies initially needed help breathing.

Likewise, Baby D was delivered by C-section and within 12 minutes of birth had lost colour and become floppy in her father’s arms, later showing signs of respiratory distress and an infection. 

She had been born early when her mother’s waters broke early putting her at risk of health problems with breathing, feeding and infection. Her mother should have been given antibiotics but was not, an error for which the hospital was criticised. 

After death, the coroner ruled Baby D had died from pneumonia with acute lung injury.

Baby E was born at just 29 weeks and needed help breathing. He was also suspected of having necrotizing enterocolitis (NEC), a life-threatening disease with a mortality rate as high as 50 per cent. 

After his death the consultant ruled Baby E had been a “high-risk infant” and certified the cause of death as NEC and prematurity.  

Baby F, the twin of Baby E, also needed resuscitation at birth. Both were suffering from a rare condition where twins share a placenta in the womb (monochorionic pregnancy) that can cause uneven blood flow and uneven blood volume that can threaten the growth and survival of one or both twins.

Baby G was born weighing just 535g (1lb 2oz). According to Imperial College’s neonatal mortality calculator, the chance of survival for a baby of that weight is just 44 per cent.

Baby I was also born at just 27 weeks, while Baby J was born with NEC and a perforated bowel. Baby K also only weighed 692g (1lb 8oz) after being born at just 25 weeks while Baby N suffered from haemophilia.

Imperial College figures show that one in five babies born under 1,000g will die. 

And there were other factors that made them more vulnerable. 

Six of the babies were twins or triplets. Twins are three and a half times more likely to die as newborns and triplets five times compared with single births. Conditions which impact one twin or triplets are likely to affect the other.  

A study in 2005 of deaths in neonatal units in London by King’s College found that birthweight below 1,500g and length of gestation below 32 weeks was found in around half of all preterm deaths. The vast majority of the babies in the Letby case had one or both of those risk factors. 

Several of the babies also experienced medical accidents while on the ward including four incidents where umbilical venous catheters (UVCs) were placed wrongly or fell out, a mistake that can sometimes lead to deadly clots.

In the case of Baby A, staff failed to give fluids for four hours while Baby H had breathing difficulties from birth and the prosecution accepted she had “suboptimal” treatment in the unit. 

As well as delays in intubation, she was left with butterfly needles in her chest which may have punctured lung tissues causing air to collect in the chest. Letby was found not guilty on one count of her attempted murder and the jury failed to reach a verdict on a second count. 

The unit was extremely busy and often did not meet British Association of Perinatal Medicine standards, which stipulated that babies in intensive care should have one-to-one care.

An original investigation into the deaths by The Royal College of Paediatrics and Child Health (RCPCH), found that, as well as staff shortages, there had been “higher activity and lower admission birthweight than average during the period corresponding to an increase in mortality”.

There were also a significant number of stillbirths at the maternity unit in 2015. 

The Royal College’s review found that there was “no definite causal correlation” between any of the cases flagged although it did recommend that new UVC guidance should be issued. 

Likewise, all the deaths examined by pathologists and a coroner were deemed to be natural causes or unascertained. 

The prosecution made much of the fact that the increased deaths stopped after June 2016, when Letby left the unit, but, as the jury also heard, in the same month the neonatal unit was downgraded due to concerns about the standard of care. It was no longer allowed to care for high-risk babies. Two new consultants were also added to the roster to relieve pressures.

The defence did make the case that the babies were very premature, and the jury carefully considered the expert evidence, eventually deciding it was more likely that Letby killed or attempted to murder the infants than that their deaths were from natural causes. 

Commenting on the verdict, criminologist Prof Wilson said: “I did not feel that [Letby] was adequately defended on several of the key prosecution notes; however the jury reached a defensible verdict. 

“If I was asked: was justice done? I’d have to conclude ‘Probably’, I would go no further than that.

“When I was waiting for the verdicts to come in, if they had come back as 22 acquittals I would not have fallen off my chair.”

One of the key planks of the prosecution case was that Letby injected air into the veins or stomachs of babies in her care, causing irrecoverable collapse. The nurse was said to have murdered or attempted to murder 10 babies by this method. 

The suggestion was first made by Dr Ravi Jayaram, a neonatal consultant on the Chester unit, and supported by prosecution defence experts Dr Dewi Evans and Dr Sandie Bohin, a consultant paediatrician at Medical Specialist Group.

The theory relied on a journal paper from 1989, authored by Dr Shoo Lee, an eminent Canadian neonatologist, which detailed 53 cases of air embolism in newborn babies. 

Several of the babies who died or collapsed had “flitting patches of pink” over mottled or blotchy blue tinged skin, which the prosecution experts claimed was a clear sign of air embolism. 

Following Letby’s conviction, Dr Lee gave evidence during the application to appeal, warning that the skin discoloration was not unique to air embolism, and said that none of the babies appeared to have suffered from the condition.

Dr Lee said that air embolism would present as pink blood vessels standing out against a background of blue skin, and appear significantly different to a general discoloration or mottling of the skin.

“There is only one diagnostic of an air embolism – pink vessels against a particular background,” he told the court. 

“When air bubbles go into blood vessels they oxygenate the blood and the vessels appear pink on a blue background. Other [types of] discoloration cannot be used to diagnose air embolism.

“If you do not see pink vessels on blue background you can see that [although] there’s a problem, you can’t say it’s air embolism.”

Commenting on the case of Baby A, Dr Lee said the symptoms described by Dr Bohin at Letby’s trial were not indicative of an air embolism, and said the doctor had been wrong to draw such a conclusion simply because they had excluded other causes. 

He said: “Air embolism should never be diagnosed by exclusion. The rash she [Dr Bohin] described is not diagnostic of air embolism. Air embolism is very specific.”

Moving on to Baby D, Dr Lee said experts were wrong to conclude that skin mottling was indicative of air embolism, warning that such discoloration was generic and could have been caused by a circulatory collapse.

Dr Lee’s paper also described embolism occurring when oxygen was delivered with force through ventilation.

It is a different scenario to that which the prosecution claim happened – air being injected into the babies through tubes. 

Dr Hall, the defence paediatric expert, said: “What was being alleged was that air was being injected into the veins. Now air contains 78 per cent nitrogen, which doesn’t get absorbed across membranes very readily. 

“Relatively recently I did eventually find a description of what happens when a neonate inadvertently receives an injection of air into a peripheral vein and it didn’t report transient skin changes, what it reported was that the baby’s back went blue for several hours.”

He added: “Both the barristers and the medical witnesses talked in terms of ‘we’ve now established that these skin discolorations are clearly due to air embolism’ but there is little evidence for that.

“Babies who are very sick can get variations of skin discoloration.”

Several studies have also shown that the resuscitation process itself can trigger a fatal air embolism even if one has not been present before.

In 2015, Dr Abid Qazi, a former NHS paediatric surgeon now working in Pakistan, published a case report about the death of a baby from air embolism. 

The baby, who was feeding well through a nasal-gastric tube and receiving intravenous fluids, suddenly collapsed with similar blue-purple skin changes to some of the babies in the Letby trial.

Dr Qazi said there had been no obvious cause for the collapse but it was later determined the baby did die from an air embolism. The team concluded that the fatal embolism had occurred during the resuscitation process itself. 

When asked to review the case of Baby A by The Telegraph, Dr Qazi said he was doubtful about the conclusions drawn by the prosecution experts.

“I’m very sceptical about the diagnosis,” he said. 

“Air embolism has been reported in several cases through the natural course of illness and I personally would doubt significantly to diagnose air embolism [on the X-ray evidence].

“I have been closely following the case of Lucy Letby and I believe she has been a victim of the poor NHS system.”

One neonatologist told The Telegraph that it would take a significant amount of air to cause an air embolism and that could not be done simply by using a syringe. 

The consultant, who wished to remain anonymous, said he had only come across one case that was noticed during resuscitation. 

“That was the only case I remember in my career, in which we could definitely say there’s air embolism because, as we were resuscitating the baby, we were getting air out from the umbilical vessels which were connected to the heart, which means it was in the circulation,” he said

“But apart from that, it’s not easy to prove at all. It’s a very difficult diagnosis to make, and I think it’s a diagnosis of exclusion.

“Certainly a small amount of air in a thin syringe will not make the difference.”

Dr Qazi said the misplacement of the umbilical venous catheters – which occurred in several cases – also had the potential to cause problems. 

“Even a well positioned UVC catheter can cause, rarely though, serious life-threatening complications,” he said.

In 2021, Anna Crawford, assistant coroner for Surrey, called for guidelines from the National Institute for Health And Care Excellence (NICE) on the use of the catheters after a newborn baby died when doctors failed to realise the UVC was wrongly positioned. 

As well as air being injected into the veins, the prosecution also alleged that in some cases, air or milk had been injected into the stomach. They pointed out that several of the babies had distended abdomens.

But experts said there were several reasons why newborns might have air in their stomachs. 

“The care of newborn babies, in particular premature babies, often involves the blowing of gas into the lungs at pressure, and so they are constantly getting gas blown into their stomach,” added Dr Hall. 

“They will have a naso-gastric tube going into the stomach to decompress them, but that sometimes works and sometimes doesn’t work terribly efficiently.

“The principle that gas is being blown into these babies in this trial and that it can cause abdominal distention is difficult to dispute.”

Before the death of Baby C, an X-ray was taken that showed an “abnormal build-up of gas in his abdomen”.

“One of the possible causes of that has to be an obstruction of the bowel,” said Dr Hall. 

Premature babies are often treated with a process of Continuous Positive Airway Pressure (CPAP) and many of the babies in the case had this kind of breathing support. 

A paper published in 2020 by doctors from the Neonatal Intensive Care Unit at Westmead Hospital in Sydney suggested that a condition called CPAP belly syndrome can sometimes occur, with similar symptoms to NEC.

Writing in the International Journal of Clinical Paediatrics, the authors described the case of a newborn suddenly developing a massively distended abdomen and feed intolerance, which led to a “crisis point” with extremely low oxygen levels and blue-purplish skin. 

They concluded: “In our experience, the clinical presentation of CPAP belly syndrome in extreme preterm infants can be dramatic, mimicking acute NEC scare, necessitating urgent diagnostic evaluation.”

In the case report, the large amount of gas in the stomach stopped the chest being able to rise, meaning the baby could not breathe and needed immediate intubation. 

A similar breathing issue arose in the case of Baby C, but the prosecution experts claimed it had occurred because Letby had injected air into his stomach, stopping his lungs from functioning. 

However, in the days before his death, Baby C had suffered a “very distended gas-filled stomach” which the prosecution accepted “can be a consequence of CPAP”.

In the application to appeal, Ben Myers KC, one of the defence barristers, argued that the prosecution experts had insufficient clinical expertise of air embolism, and warned their diagnosis had been given “on the hoof” without any scientific basis. 

“None of the experts who gave evidence of air embolisms had the knowledge to do so,” he argued.

The Court of Appeal acknowledged that neither Dr Evans nor Dr Bohin had any significant direct experience of patients with air embolism.

But the judge rejected the suggestion they were not qualified to give evidence on the issue.

They also ruled that if the defence team had wished to call Dr Lee to give evidence during the trial they should have done so at the time.

Letby was accused of attempting to murder two babies by poisoning liquid nutrition bags with insulin.

There was no direct evidence that the bags had been tampered with, as tests were never carried out on the contents, and the prosecution instead relied on blood samples from the babies.

Insulin regulates blood sugar and too much can cause blood sugar levels to crash dangerously, a condition known as hypoglycemia, which can be life threatening. 

In the first case, Baby F had suffered an unexpected drop in blood sugar together with a surge in heart rate in the early hours of Aug 5 2015 when Letby was on shift.

It was the prosecution’s case that Letby had deliberately injected insulin into the bag.

Baby F’s low blood sugar continued even when Letby was not on the ward, and the prosecution claimed that she had also put insulin in a bag in the fridge, which had then been selected by other nurses.

Blood tests from Baby F showed high levels of insulin, yet low levels of another hormone called C-peptide. 

C-peptide is produced alongside insulin in the body, so if there is none present that suggests the insulin present has not been made in the body, and so must have come from outside.

A second baby, Baby L, also suffered an alarming dip in glucose levels on April 8 2016. Tests revealed high levels of insulin but on this occasion C-peptide was within the normal range. 

However Prof Joseph Wolfsdorf, a specialist in child hypoglycemia at Harvard Medical school, said the results “made no sense”.

“When serum insulin is extremely high (caused by injection), the beta cells of the pancreas stop secreting insulin (and C-peptide). One expects, therefore, to have extremely low or unmeasurable serum C-peptide concentration.

“In one of the babies, serum insulin was extremely high and yet C-peptide was within the reference range, i.e. not extremely low or unmeasurable. 

“Therefore, one has to be highly suspicious that the high insulin level was caused by exogenous administration.

“If the sample was obtained at the time plasma glucose was low (hypoglycemia), a C-peptide concentration within the reference range makes no sense.”

Both babies had suffered from blood sugar problems before the catastrophic falls. Just a few hours after birth, Baby F had high blood sugar and was prescribed insulin. Baby L’s blood sugar was found to be low in the hours after his birth and he needed treatment with a sugar infusion. 

When the tests were returned for Baby L, insulin levels were at the top of the scale that the equipment was capable of measuring, around 10 to 70 times higher than in a premature baby.

Both babies survived, and initially there was no suspicion of foul play, so the tests were not checked at a proper forensic lab, but instead carried out at a clinical lab of the Royal Liverpool University Hospital.

An NHS guidance note from the Liverpool lab warns that such testing cannot be used to infer if insulin has been administered artificially.

“If exogenous insulin administration is suspected as the cause of hypoglycaemia, please inform the laboratory so that the sample can be referred externally for analysis,” the guidance reads.

The samples were never checked by forensic experts and the defence were not able to re-test the blood as it has since been disposed of. 

Dr Charline Bottinelli, an insulin expert from the Laboratoire LAT Lumtox, in France, said: “Techniques generally performed at hospital for insulin research are immunoassays. These techniques allow the detection of very low insulin concentration.

“However, it doesn’t allow us to formally identify the type of insulin and to distinguish human insulin from synthetic analogues”

She added: “A high level of insulin in blood could suggest exogeneous (outside) administration but also disease such as insulinoma.”

In the case of Baby L, the prosecution said the insulin readings were “grossly abnormal” yet by the time the tests were returned the infant had recovered. 

Dr Bottinnelli said levels of insulin recorded were so high for Baby L that it was “highly probable” that “severe hypoglycemia and dramatic consequences” would have been expected. 

The Countess of Chester neonatal unit first noticed an alarming spike in the number of newborn deaths in 2015. 

With fingers pointing at Letby, the nurse was removed from her post in 2016 and the Royal College of Paediatrics and Child Health was brought in to investigate the upsurge.

The review team quickly found serious concerns with the unit, uncovering a pattern of “insufficient senior cover and a reluctance to seek advice” from consultants. 

Reviewers warned that senior doctors should have been more available, given the vulnerable nature of the premature babies on the ward, while the number of nurses on the unit was frequently less than the recommended levels.

There was a 21 per cent shortfall in nurses between 2014 and 2015 and agency staff were often drafted in to plug the gaps.

In every board meeting throughout 2015 and 2016, the neonatal unit had the most “red” ratings for staffing levels out of all of the departments in the hospital. 

Nurses were stretched thin, expected to help out on the maternity unit and give antibiotics to infants on another ward alongside their normal neonatal duties, the Royal College found. 

In late 2015, one of the senior paediatricians emailed the hospital’s chief executive, Tony Chambers, to report that staff on the unit were “chronically overworked” and “no one is listening”. 

“Over the past few weeks I have seen several medical and nursing colleagues in tears,” she wrote. 

Doctors were working shifts of more than 20 hours and the unit was so busy that “at several points we ran out of vital equipment such as incubators,” the consultant warned. 

“This is now our normal working pattern and it is not safe. Things are stretched thinner and thinner and are at breaking point. When things snap, the casualties will either be children’s lives or the mental and physical health of our staff.”

An inspection by the Care Quality Commission (CQC) in February 2016, found the neonatal unit was under-staffed and “lacked storage space and resources for the care of patients who required strict infection control measures”.

The hospital knew conditions needed updating, and had launched a £3 million fundraising appeal in 2012 to build a bigger and more modern baby unit, but by 2015, had only managed to raise half of the sum needed. 

Rooms in the unit were small with cots placed too close together “making nursing more of a challenge” and it had poor lighting. 

The Royal College’s report warned: “There is insufficient storage space resulting in many pieces of equipment being stored in corridors. 

“Direct visibility from one area to another is poor, and infants are moved regularly to accommodate acuity – an extra risk in the system.”

When deaths started spiking, the trust carried out post-mortem examinations and reviewed the circumstances in their “mortality and morbidity” meeting.  

But the Royal College said it was concerned that the local safeguarding Child Death Overview Panel did not appear to know about the cluster of deaths and that a rapid review had not been carried out for some of the cases within five days. 

In cases of unexplained deaths or patient harm, a review is usually carried out within five days so that immediate remedial action can be taken. 

Dr Stephen Brearey, the head of the neonatal unit, claimed he had tried to flag serious concerns about the increase of deaths by October 2015. 

The Telegraph understands that the staff also tried to alert CQC inspectors to the spike in deaths arising from a patient safety issue in February 2016, saying they had informed hospital management but were struggling to be heard. 

According to a source inside the hospital the CQC did not ask for any details about what the patient safety issue was, and despite telling the doctors they would return to discuss it at a later date they never did.

The CQC told The Telegraph that consultants had not raised increased deaths during the February 2016 inspection, and it was not aware of the issue until the end of June.

A spokesman said: “Some consultants (including those working in the neonatal unit) at the trust shared concerns with CQC during a focus group held as part of the 2016 inspection. 

“Those concerns related to staffing levels, a lack of support from senior management and consultants who felt there was a culture of bullying and where concerns they had raised with management were ignored. 

“We followed up directly with the trust’s medical director that same day to relay those issues so that action could be taken in response.”

The Royal College’s investigation found there had been little attempt to get departments together to “deal proactively with the increased mortality” and the trust appeared so unconcerned by some of the deaths that they were recorded in its risk register as “green-low risk of harm”.

In July 2016, Letby was removed from the ward and the trust downgraded the unit to a Level One, meaning it was only allowed to deal with babies who did not need intensive care, and mostly those born after 32 weeks’ gestation.

There was an immediate improvement and no more babies died unexpectedly after this point. 

“Since the temporary redesignation, staff reported feeling calmer and more confident and morale/sickness has improved,” the Royal College’s report said. 

“The pressure has reduced and the unit is operating more in line with BAPM (British Association of Perinatal Medicine) staffing standards.”

A neonatal consultant told The Telegraph that the decision to downgrade must have been made long before July 2016, showing a long-term concern that went beyond the spike in deaths attributed to Letby. 

“You don’t wake up on a Monday and say, ‘actually, on Friday, we’ll downgrade’,” he said.

“The unit knows it a year in advance at least. And if you want to appoint people in place you have to get your business cases approved or lined up at least six months to a year in advance.

“Which makes me think that there was enough worry there – 2016 happened to be the year when it went down, but the planning to do that would have been happening over the last couple of years, which would mean that they were already worried about the unit, irrespective of the presence of this person (Letby),” he added. 

In court, Letby’s barrister, Ben Myers KC, argued that “suboptimal care” played a part in the deaths of seven of the infants and that Letby had been scapegoated to cover up failings on the unit. 

Mr Myers said that the Countess of Chester Hospital “failed” in 2015 and 2016 and “blame for absolutely everything” had been “heaped” on Ms Letby.

The unit was “understaffed”, treatment was “hurried”, “mistakes made” and records “not kept”, Mr Myers claimed. 

He told the jury there had been a “marked increase” in the number of babies on the unit during 2015 and 2016, “too many” of which had had “additional requirements”.

Referring to Baby J he said the hospital was “well out of its depth” while he claimed that  With another – Baby K “should not have been in the Countess of Chester Hospital in the first place”. 

Mr Myers said “one way or another”, the unit had “failed” and the case against Letby was a “prime opportunity” to “hide” poor outcomes.

There were also concerning examples of poor care before the rise in deaths in 2015 and 2016.

An inquest for a newborn who died in 2014 found that doctors had inserted a breathing tube into the baby’s oesophagus rather than his trachea, ignoring several indications that the tube was misplaced. 

Medics ignored five warning signs – assuming the equipment was faulty. The baby’s mother said staff shortages meant blood tests and X-rays were not assessed for seven hours and there was only one consultant on duty when her son began to deteriorate. 

Beyond the staffing issues, there were also problems with the plumbing on both the neonatal and maternity wards. The pipes often leaked or were blocked, causing sewage to rise up into the toilets and sinks. 

Giving evidence at Letby’s original trial, Lorenzo Mansutti, the hospital’s plumber, said that on one occasion he recalled human waste or sewage entering the neonatal intensive care room from the drains of a ward above.

Asked by Mr Myers how often he was called out for “these sort of issues” in 2015 and 2016, Mr Mansutti replied: “For the whole building it was maybe weekly.”

Even years after the death spikes, there have continued to be problems in the hospital. 

In a 2022 CQC inspection report, the trust was served with two warning notices and told it had to make significant improvements in its maternity care. 

Dr Dewi Evans was the prosecution’s key expert witness, whose evidence in the trial was central to the case against Letby.

But questions have been raised about Dr Evans’ expertise and impartiality, with a judge in another case in which he was involved describing his evidence as “worthless” and accusing him of making “no effort to provide a balanced opinion”.

A former paediatrician, he retired in 2009, setting up a company called Dewi Evans Paediatric Consulting providing expert medical advice in legal matters such as child abuse cases and criminal trials.

In 2017, just a month after the first report had been made to Cheshire Police, Dr Evans read about the investigation in the local paper and sent an email to the National Crime Agency, which read: “If the Chester Police have no one in mind I’d be happy to help. Sounds like my kind of case.”

After being invited to review some of the deaths on the neonatal ward, it was Dr Evans who suggested the possibility of air embolus as a cause of death. This was despite acknowledging he had never actually seen a case himself.  

In other deaths, it was Dr Evans who determined likely methods of murder, including deliberate over feeding and smothering.

Prosecutors relied on him to explain the complex medical evidence to the jury and ensure they did not become bamboozled by the science.

But Letby’s lawyers became concerned that rather than serving as an expert witness, Dr Evans had been acting as an investigator, putting forward theories rather than expressing a view on them.

At one stage in the trial, Ben Myers KC, Letby’s barrister, asked for his evidence to be struck out, but the judge, Mr Justice Goss, dismissed the application.

Further doubts over the credibility of Dr Evans’ testimony were raised when it emerged that his expert evidence in another case had been lambasted by a Court of Appeal judge.

In February 2020, a newborn baby sustained nine fractures to his arms and legs, and a court ruled that the injuries had been inflicted by the parents.

The family appealed against the ruling and instructed Dr Evans, who submitted a report claiming the injuries could have occurred accidentally because of the baby’s low vitamin D levels.

He suggested a fracture to the baby’s arm could have been caused when it moved during breastfeeding, while a broken ankle could have been the result of a parent gripping too tightly during a nappy change.

But in a damning ruling, Mr Justice Jackson wrote: “It is of great concern that the parents and the wider family might have been encouraged by this opinion… The report is, I regret to say, worthless.”

The judge criticised Dr Evans for a “lack of transparency”, and accused him of being ill-informed about the case.

He concluded: “Finally, and of greatest concern, Dr Evans makes no effort to provide a balanced opinion. He either knows what his professional colleagues have concluded and disregards it, or he has not taken steps to inform himself of their views.

“Either approach amounts to a breach of proper professional conduct. No attempt has been made to engage with the full range of medical information or the powerful contradictory indicators. Instead, the report has the hallmarks of an exercise in ‘working out an explanation’ that exculpates the applicants.

“It ends with tendentious and partisan expressions of opinion that are outside Dr Evans’ professional competence and have no place in a reputable expert report.”

When this was raised during the Letby trial, Dr Evans said: “This is the first judgment that has gone against me in 30 years. I have prepared dozens and dozens of reports for the family court. I’m in huge demand for opinions in the family court because of my track record as a witness. This is a one-off for me.”

In Letby’s appeal, the defence reiterated its concerns that Dr Evans did not have the relevant expertise to give evidence in the trial.

However, Court of Appeal judges ruled: “He was a highly experienced paediatric consultant with decades of clinical hands-on experience with neonates. He certainly had sufficient knowledge to render his opinion of value.”

When jurors are asked to determine if a medical professional has killed their patients, they are not only deciding if a clinician is a killer, but whether a murder has taken place at all.

According to statisticians it is extremely difficult to distinguish if clusters of deaths arise from criminal acts, or coincidentally from other causes.

While a group of deaths may seem extraordinary, the chance that a serial killer is roaming a ward is also extraordinary. 

In the 2022 Royal Statistical Society (RSS) report, the authors warned that even if there was a one in ten million chance that a cluster of deaths would implicate a health professional, there are so many doctors and nurses that “it is inevitable we will falsely incriminate innocent people”.

“The prosecution’s theory is typically that a medical professional, previously trusted to perform critical life-saving functions has unexpectedly, and sometimes inexplicably, chosen to murder patients in his or her care,” the authors wrote. 

“While history has shown that humans are capable of such behaviour… proven instances are extremely rare.

“In the absence of any other evidence of misconduct the prior odds of any other medical practitioner engaging in such conduct must be considered extremely low, in the order of one chance in millions.”

The failure to understand coincidence and the correct interpretation of statistics and the science has led to several serious miscarriages of justice. 

The Dutch nurse Lucia de Berk was convicted of seven murders and three attempted murders in 2004, after a criminologist claimed the chance of so many deaths occurring when she was on duty was one in 342 million.

Prominent statisticians came forward to state that the modelling was over-simplified and unrealistic, calculating the real probability of such deaths occurring was as high as one in 25.

The case was retried in 2010 and, in light of the revised statistical evidence alongside new medical evidence, de Berk was acquitted. 

Criminologist Professor Wilson said one of the problems with the Letby investigation was that it was never obvious from the outset whether any crime had actually taken place.

“Rather than say that the deaths and incidents were a consequence of the infrastructure; of the staffing levels; or the experience of the consultants; or the lack of finance to upgrade the facilities… they alighted on the idea that the incidents and deaths were the result of someone deliberately taking a child’s life,” he said.

“It seems to me that should be the last thing that one would consider.

“I have studied nurses who kill in a hospital setting academically and produced peer reviewed research about that phenomenon and it seems incredibly rare, so the idea that this must be the cause of what was happening in Chester was always a very weak basis on which to begin.”

The RSS report warned that investigators “must always bear in mind” that there may be innocent explanations for apparent and even striking correlations between a medical professional’s presence and deaths or other incidents. 

In the early 80s, a cluster of 43 deaths at a neonatal unit at Toronto’s Hospital for Sick Children led many to suspect a nurse was poisoning the babies with digoxin. 

It was later discovered that new artificial latex products in feeding tubes and bottles could have been responsible.

Likewise an increase in neonatal deaths in England raised suspicions until a statistician linked the timing of the deaths to a change in the supplier of milk formula.

In 1999, English solicitor Sally Clark was found guilty of murdering her two infant sons after  paediatrician Roy Meadow testified that the chance of two children from an affluent family suffering unexplained cot death was one in 73 million.

Meadow had based his calculations on the children’s deaths being independent of each other, but the Royal Statistical Society issued a statement stating a second case in a family is far more likely because of shared genetic and environmental factors.

After serving more than three years in prison, Clark was released, although developed severe psychiatric problems and died of alcohol poisoning four years later. 

In 1988, Jane Bolding, an American nurse who worked at Prince George’s Medical Centre in Maryland, was charged with murdering patients, allegedly with potassium chloride.

The key evidence was that she had been on duty when 57 cardiac arrests had taken place, and the US Centres for Disease Control concluded that her patients were 47.5 times more likely to die on her watch.

However a judge threw out the case saying that the statistical evidence had “failed to supply the missing link that would connect the defendant with the alleged criminal act” and warned that “the state’s reach hopelessly exceeded its grasp”.

The judge came to the conclusion even though Bolding had originally confessed to the killings, an admission which she later retracted. 

Letby also appeared to confess on a Post-It note found at her home which read: ‘I am evil, I did this.”

But Prof Wilson pointed to the case of Kathleen Folbigg, an Australian mother who was convicted of murdering her four children, despite the fact there was no direct evidence.

The prosecution presented her diary entries, written at a time when she was clearly in trauma in which she made statements such as: “All I wanted was to shut her up.”

She was pardoned in 2023 after it was shown that her children all had a genetic mutation that had caused their deaths.

“If you have been accused of something of this magnitude there are all kinds of ways you express how you are feeling because you are experiencing trauma, have depression, are reacting to stress and the (Letby) notes seem to me to reflect that as much as guilt. In fact I didn’t think they did reflect guilt,” added Prof Wilson. 

“Letby didn’t share the other common features of healthcare serial killers that we have uncovered. She did not make her colleagues feel nervous. Healthcare serial killers often come with an institutional history, a kind of institutional culture where the other nurses would go ‘Oh I don’t like being on shift with him or her’, they feel uneasy being around them.”

More recently, in 2016 the Italian nurse Daniela Poggiali was found guilty of killing two of her patients, with the prosecution claiming the death rate soared on her watch. 

After a lengthy appeals process, in which statisticians showed the flaws in the shift rota evidence, both convictions were eventually overturned with the judges ruling that no murders had taken place. 

Prof Green, co-author of the RSS paper said: “As the RSS report makes clear, correlation is not causation, and it is essential to consider alternative explanations for the observed outcomes.

“(In the case of Letby) there may have been no crime in the sense of any malice by any one clinician or nurse. 

“There may have been incompetence, you can’t actually rule that out – but it’s not a crime to be bad at your job. And remember that these were desperately ill babies in a really sick, badly managed, hospital.”

He added: “Misuse of statistics in court can be very damaging to British justice.” 

Letby’s defence team did not call any scientific, medical or data experts. Experts said they were concerned that there may have been a miscarriage of justice.

The RSS has repeatedly warned there is little training in matters of statistics for legal professionals and said it would like to see further interaction between legal and statistical communities.

Defence expert Dr Hall added: “I don’t know whether Lucy Letby is guilty or innocent, but what I do feel is she did not have a fair trial. And the reason is that some of the information given to the jury was flawed, and some was misinterpretation.

“My concern is that the legal system allowed it to happen.”

Questions have emerged over the impartiality of Joe Biden’s doctor after the White House was accused of stonewalling journalists over repeated visits by Dr Kevin Cannard, an expert in Parkinson’s disease.

Republicans in Congress have demanded that Dr Kevin O’Connor, the president’s personal physician, testify over his relationship to Mr Biden and why he has declined to order a cognitive test for the 81-year-old.

The scrutiny over Dr O’Connor’s position has increased since details of his past business dealings with the president’s brother emerged.

Dr Cannard performed neurological examinations on Mr Biden during the three annual check-ups he has received since becoming president, the White House said.

It comes as Mr Biden aims to reset his ailing re-election bid with what the White House termed a “big boy” press conference on Thursday to mark this week’s Nato summit.

The president’s team hopes the rare solo press conference will offer a chance to dispel concerns over his agility following a disastrous debate performance against Donald Trump last month.

Karine Jean-Pierre, the White House press secretary, said the president would field multiple questions from reporters as she responded to claims Mr Biden was being shielded from the press.

But her White House press briefing descended into a shouting match with reporters on Monday.

She said the check-ups found no signs of Parkinson’s but refused to go into further detail on Dr Cannard’s other recent visits to the White House complex, prompting testy exchanges with reporters.

Dr Cannard has visited the White House eight times from July 2023 to March this year, according to visitor logs, including one January meeting with the president’s personal doctor.

The press secretary described the probing questions as “inappropriate”, but suggested his visits might be connected to treating other government personnel.

Dr Cannard has been an on-call neurologist for the White House since 2012 and visited the Barack Obama White House at least 15 times between 2012 and 2013, according to visitor logs, and was twice signed in by Mr Obama’s doctor.

Mr Biden has not been evaluated for Parkinson’s, a neuro-degenerative condition which affects the brain, since February and never outside of the annual checks, the White House said.

However, medical experts have suggested the president has some symptoms consistent with Parkinson’s and there are calls for him to take a public test to demonstrate his ability to discharge his role as commander-in-chief.

Mr Biden hit back during a media blitz, calling in to MSNBC’s Morning Joe on Monday to insist that every day as president amounted to a neurological exam and said people questioning his fitness “drives me nuts”.

Dr O’Connor, the White House doctor, who met Dr Cannard in January, also released a letter to quash speculation over Mr Biden’s condition.

“President Biden has not seen a neurologist outside of his annual physical,” Dr O’Connor said, adding the “extremely detailed” exam had not detected any “central neurological disorder”.

However, Dr O’Connor’s “independence” has been questioned by Republicans in the House of Representatives, who cited “mixed and confused messaging” from the White House as they demanded he explain whether or not he can provide “accurate and independent” assessments of Mr Biden’s health.

A former army colonel on the White House medical staff, Dr O’Connor first acted as Mr Biden’s official government doctor while he was serving as Mr Obama’s vice president.

He also assisted in the treatment of Mr Biden’s eldest son, Beau, following his terminal brain cancer diagnosis.

The doctor described the Biden clan as “a really important part of my life” in a farewell letter when Mr Biden left the vice presidency in Jan 2017.

His contact with the Biden family did not end there, with Politico reporting Dr O’Connor assisted the president’s brother, Jim, with a business venture aimed at securing a US government contract in 2017.

He returned to the White House to serve as the president’s official doctor following his election in November 2020 and is responsible for declaring him “fit for duty” in his annual check-ups.

Two experts told Politico that Dr O’Connor’s intimate relationship with the Biden family posed questions over a potential conflict of interest.

Matthew Algeo, a historian and author, called it a “lose-lose situation”. 

Dr Bert Park, an author and advocate for independent oversight of presidents’ health, said: “We cannot depend on the presidential physician to come clean”.

The White House has dismissed suggestions Dr O’Connor’s medical advice has been influenced by his business dealings with Jim Biden, calling it a “discredited conspiracy”.

Separately on Tuesday, it emerged a junior sailor attempted to access Mr Biden’s medical records three times on a government database.

The US Navy said the sailor had been disciplined but an investigation concluded the president’s medical information had not been compromised.

It is hard to imagine that Dame Shirley Bassey – who has headlined the London Palladium with The Beatles, performed for John F Kennedy and recorded three James Bond theme songs – could be any more celebrated after seven decades in the public eye.

Yet the Welsh singer has spoken of her nerves before being made a Companion of Honour by the King for her services to music, joining members of a club limited to just 65 luminaries who include Sir David Attenborough, JK Rowling and, most recently, Gordon Brown.

She said: “I think it’s more nerve-racking to receive the award from him than to sing in front of him. I mean, it’s new, different, whereas singing I’ve been doing since I was a child.

“I forgot to curtsy, but that’s why I grabbed his hands because I forgot to curtsy. Instinctive.”

A beaming Dame Shirley, defying her 87 years with her striking beauty and sparkling Isabell Kristensen dress, attended the Windsor Castle ceremony with her daughter Sharon, 69, grandson Sebastian, and great-granddaughter Sofia.

Dame Shirley has explained how she maintains her youthful appearance. “I try to eat healthily. I am a gym fanatic. A trainer comes to my apartment in Monaco three times a week. I try to go to the gym three times but make it twice if I am lucky. I feel it when I don’t go,” she said in a 2020 interview.

“I don’t have diet secrets. I just watch what I eat. At weekends I go mad – ice cream, caviar with lots of cream. I have a lot of facials and a lot of body massages. And it’s working. It is worth all the money.”

The smiles on display at Windsor on Tuesday belied the tumultuous family life Bassey has had since being born into abject poverty, but with a remarkable voice, in the Tiger Bay area of Cardiff in 1937.

Dame Shirley fell pregnant with Sharon when she was on tour with the Hot from Harlem show, aged 16, and gave birth in September 1954. Such were the mores of the time that she was forced to quit touring and move back to her native Cardiff to work as a waitress. Dame Shirley gave her daughter to her sister, Ella, to raise her as her own until she was nine.

She has never publicly identified Sharon’s father – because she “gets touchy if I mention it” – and we only know that he was Jewish and married with two of his own children when they had the affair. Those details emerged in 1998, when Sharon was in her mid-40s, and Dame Shirley was accused by a former personal assistant of anti-Semitism.

Sharon and her younger sister, Samantha, were eventually adopted by Dame Shirley’s first husband, Sergio Novak, assistant manager of the Excelsior Hotel in Venice. The couple also adopted Mark, Dame Shirley’s grand-nephew.

Samantha’s father has also never been named, though Novak suggested that she was the product of an affair Bassey conducted with the Bafta- and Oscar-winning Anglo-Australian actor Peter Finch.

Samantha, born nine years after Sharon, was found dead in the River Avon near the Clifton suspension bridge in 1985, aged just 21. Although she had been struggling with drink and depression, police suggested the death was an accident, and Dame Shirley has always maintained it wasn’t suicide. In 2010, Avon and Somerset Police started fresh inquiries into the case, but eventually concluded that there was “no evidence of any criminal act involved”.

The shock of her daughter’s death caused Dame Shirley to lose her voice for six months.

A cyclist has told a court he was only travelling at 3mph when he crashed into an elderly woman who later died. 

Oxford Crown Court heard Polly Friedhoff died 12 days after she collided with cyclist Edward Bressan, 56, on a towpath.

Giving evidence on Tuesday, Mr Bressan, a university lecturer, told jurors Ms Friedhoff had “panicked” and walked into his path as he slowly cycled past her and a friend.

The court heard she sustained serious injuries to her head, arms and ribs after Mr Bressan tried to overtake her on the left-hand side.

Mr Bressan is charged with causing bodily harm by “wanton or furious driving” during the incident in November 2022 – which he denies.

The charge is a Victorian law originally designed to deal with horse-drawn carriages.

Ewa Huggins, who had known Ms Friedhoff for 40 years, claimed that the impact had sent her friend “flying”.

Mr Bressan denied this and claimed Mrs Friedhoff had fallen “flat on her face where she stood”.

Mr Bressan, who is married with one child, said he had been cycling home from Sainsbury’s at around noon when he saw the two women walking along the towpath.

He said: “[I was cycling] very slowly. Approximately 4mph. It was quite busy that day as it was sunny and it was Sunday lunchtime, so people were out for a walk and there were quite a few cyclists as well.

“Ewa Huggins was closer to the water than Polly Friedhoff. She was on her left. I rang my bell and then in reaction to my bell, Ewa Huggins moved slightly further to the right and Polly continued walking straight.

“And then two or three metres later, as I was approaching them, Ewa turned to Polly and alerted her to the fact there was a cyclist who was approaching. Polly panicked at first, for probably a second or two.

“And then she darted across, right in front of my bike at which stage I was practically next to her. Then she tried to rebalance. My bike came along and brushed off her – then I witnessed her fall.”

Asked by his barrister Kuljeet Dobe how Mrs Friedhoff fell, he said: “She fell where she was standing. She did try to rebalance but was not able to. Then she just fell quite slowly, but determinedly, flat on her face.”

He added: “I was expecting her to perhaps try to block her head or take some type of action to prevent falling flat on her face. But the impact when she hit the ground, it was concrete tarmac. It was quite strong.”

The cyclist told jurors he is a lecturer at the University of Law, which has 17 campuses in the UK including London and Bristol.

He previously worked for Oxford Brookes University as a principal lecturer and academic director in English language and linguistics, jurors heard.

Mr Bressan told the court: “I haven’t got a vivid memory which part of the body or which part of the bicycle made contact with her. [The collision] was unavoidable as both of us were moving and both of us were trying to take some kind of evasive action.

“At that stage I was cycling even slower, probably 3mph.”

He said there was “certainly enough room” on the towpath – which the court heard measured just over two metres wide – for him to pass.

He said he had also “manoeuvred as far left as I could go” with his handlebars turned so that “one third” of their width was facing away from the path.

Denied falling off his bike

He denied falling off his bike after the collision and said he had put it to the side of the towpath to keep it out of the way.

Mr Bressan said after the collision he had draped his jacket over Mrs Friedhoff to keep her warm, adding: “I approached [Ewa] and gave her a hug and said: ‘I’m so sorry about this. This is awful.’

“I did everything I could to help. I was deeply concerned and deeply upset. I was traumatised, probably.”

Giving evidence on Monday, Ms Huggins denied hearing any bell or shouts of warning from the cyclist.

Describing the collision, she said: “Polly was on my left, we were chatting, walking fairly close together, the path isn’t very wide and suddenly, I saw Polly basically flying in front of me and falling flat onto the towpath.”

Asked by Andrew Jordan, prosecuting, if Mrs Friedhoff fell in front of her, Ms Huggins said: “Yes at an angle and with incredible force actually, I can still hear her scalp hit the ground.”

She later added: “It was more than just a knock.”

Friends and family of both Mr Bressen, of Oxford, and Mrs Friedhoff sat in the public gallery to observe the trial.

The trial continues.