July 2026: Government declines to widen the Thirlwall terms of reference (16 July) · new 100-page insulin report to the CCRC challenging the trial evidence (9 July) · Thirlwall report still expected no earlier than September · inquests relisted to 2027 · Shoo Lee Panel: no medical evidence of deliberate harm.
Medical explainer
Sudden deterioration in preterm and unstable babies has a broad natural-cause differential. UK neonatal guidance treats unexpected collapse as a clinical emergency with several routine explanations before any unnatural cause is considered.
The Letby prosecution proposed deliberate-harm mechanisms for a series of collapses. The post-conviction expert evidence argues the natural differential was not adequately worked through count by count. The Shoo Lee Panel's case-by-case review identified natural-cause explanations for every count reviewed.
The Crown proposed a deliberate-harm mechanism for each indicted collapse — air injection, insulin, air via a nasogastric tube, or physical interference — with Letby's presence on shift offered as the connecting factor.
Panel members and named independent neonatologists have published natural-cause readings for each indicted case, addressing sepsis, NEC, twin-twin transfusion syndrome, intrahepatic catheter complications, ventilation events and prematurity-related instability.
A natural-cause differential is a list of possibilities, not a determination. The Panel's finding is that natural explanations were available and not excluded, which is a different claim from having established what caused each collapse.
The differential is broad: sepsis, necrotising enterocolitis, respiratory failure, tube displacement, intraventricular haemorrhage, coagulopathy and circulatory instability are all routine in this population.
Considering and excluding the natural explanations one by one before concluding a collapse was caused deliberately. The post-conviction argument is that this was not done count by count.
It identified natural-cause explanations available for every count it reviewed. That is not the same as proving which one operated in any given case.
No. It means an inference of deliberate harm has to survive the alternatives, and the dispute is about whether that test was applied.
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