A public inquiry has found that Ian Harvey, medical director at Countess of Chester Hospital, altered a medical review without the author's knowledge to conceal evidence that babies murdered by neonatal nurse Lucy Letby had been deliberately harmed. Harvey used the falsified document to mislead the hospital board into allowing Letby to return to work, though she ultimately never did after pressure from doctors forced senior executives to contact police. Lady Justice Thirlwall's 822-page report condemned Harvey and other hospital leaders for a "dysfunctional" response that "completely failed" to protect patients, and stated that three infants could have been saved had managers suspended Letby and involved police sooner.

Harvey, a retired orthopaedic surgeon paid £175,000 annually, commissioned consultant neonatologist Dr Jane Hawdon to review medical notes of 17 babies (13 deaths and 4 near misses) who collapsed between June 2015 and June 2016. Dr Hawdon initially identified five babies' deaths as unexplained and requiring forensic review, but Harvey amended her report without her consent, changing findings on Babies D and E from "unexplained" to "natural causes." Baby D had been murdered by Letby through air injection in June 2015, and Baby E (a twin) through throat trauma and air injection in August 2015. The inquiry revealed Harvey made multiple alterations, including adding a diagnosis Dr Hawdon had never written, and that she was unaware of his changes until the inquiry informed her.