Nurse Lucy Letby was “completely out of control” when she returned from a holiday in Ibiza and attacked three babies, a court has heard.

Prosecutor Nick Johnson KC said the 33-year-old had “got away with so much” at that point it gave her the “misplaced confidence that she could pretty much do whatever she wanted” at the Countess of Chester Hospital’s neonatal unit.

Letby is alleged to have murdered seven babies and attempted to murder 10 others between June 2015 and June 2016.

On three successive days in June 2016 she 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 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.

In his closing speech at Manchester Crown Court, Mr Johnson told the jury Child O’s case had similarities to Letby’s alleged murder of Child E, a twin boy who bled profusely before his death in August 2015.

“In (Child O’s) case she combined all three methods she had used to such devastating effect on all the other children in the case,” he said.

“In order to try to cover up what she did, she falsified the notes.

“We say, frankly, by this stage she was completely out of control and was determined to mete out the same treatment to (Child P) the very next day.”

‘Back with a bang’

Mr Johnson said Letby returned from her break in Ibiza with two friends shortly after the birth of the naturally conceived triplets on 21 June 2016.

On the afternoon of 22 June, Letby texted a friend: “Probably be back in with a bang lol.”

Discussing the case of Child P, Mr Johnson reminded the jury about the evidence from a doctor and a remark allegedly made by Letby as the deteriorating infant 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 24 June.

Letby ‘knew the end game’

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 moved his breathing tube, Mr Johnson said, and he died soon after.

Letby denies all the allegations.

The trial continues on Wednesday

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