Murder-accused neonatal nurse Lucy Letby was 'playing god' at the Countess of Chester Hospital, her trial was told on Tuesday (June 20).

On the second day of prosecutor Nicholas Johnson KC's closing speech at Manchester Crown Court, he said Letby was "controlling things" and "happily predicting what was going to happen" with babies she had attacked.

Earlier on Tuesday, Mr Johnson said Letby was "completely out of control" on her return from her Ibiza holiday in June 2016, when she had messaged a colleague she would likely "be back in with a bang".

On three successive days in June 2016 Letby, 33, is said to have murdered two triplet boys, Child O and Child P, and attempted to murder another baby boy, Child Q.

The Crown say Letby, from Hereford, murdered Child O by injecting him with air intravenously and via a nasogastric tube, as well as using “significant force” to inflict a liver injury, and sabotaged Child P by injecting air, force-feeding him milk and dislodging his ET Tube.

Letby is also accused of falsifying medical notes to create the impression there were underlying problems with the triplets.

Mr Johnson reminded the jury about the evidence from a doctor and a remark allegedly made by Letby as the deteriorating Child P awaited a transfer to a different hospital.

The doctor, who cannot be identified for legal reasons, said Letby said to her ‘he’s not leaving here alive, is he?’

Letby had told the court she could not recall the conversation on the afternoon of June 24.

Mr Johnson said: “Ladies and gentlemen, she did say it. But why did she say it? There is only one answer – because she knew the end game.

“She knew what was going to happen. She was controlling things. She was enjoying what was going on and happily predicting what she knew was going to happen.

“She was in effect playing god."

Less than half an hour later Child P collapsed again because Letby had moved his breathing tube, said Mr Johnson, and he died soon after.

He said her offending against Child P “showed the malevolence of Lucy Letby at its height”, suggesting she did something to “destabilise him” in the aftermath of the death of his brother, Child O.

Mr Johnson said on her way home from the day shift of June 23 she texted a friend: “Worry as identical”.

The prosecutor said: “This is gaslighting at its very best or very worst, isn’t it?
“She was laying the ground for her attack on (Child P)."

Mr Johnson also referred to the cases of twins Child A and Child B, who the Crown say were attacked by Letby in June 2015 with injections of air.

He questioned why the defence, in cross-examination, had accused Dr Ravi Jayaram and Dr David Harkness of inventing skin discolouration descriptions seen on Child A.

Both doctors had told the court the type of 'flitting' rash seen on Child A "was like nothing they had seen before."

He told the court the descriptions of the rash were also made by other doctors and nurses, who also agreed they had never seen that type of rash before.

Mr Johnson said if the description of the skin discolourtion was true,  "what purpose" were the attacks on the two doctors' integrity?

He told the court it was to deflect the jury from the evidence, to make it about personalities, and to destabilise Dr Jayaram "who has been an important witness in many cases", including for Child K.

He added: "Lucy Letby knows how devastating his evidence is in the case of [Child K]."

On Monday, Mr Johnson said Letby was “caught red-handed” when Dr Jayaram walked into the nursery and saw the defendant alone stood next to the child’s incubator.

Child K’s blood oxygen levels were dropping, the alarms were not sounding and Letby was “doing nothing” as Dr Jayaram stepped in to save the infant’s life, the prosecutor said.

Letby denied any wrongdoing as she later told police she was “possibly waiting to see if she (Child K) self-corrected”, the court heard.

The trial continues on Wednesday, June 21.

The Standard will continue to provide live coverage of the closing speeches.