Significant concerns from consultants over Lucy Letby’s “association” with numerous baby collapses were raised eight months before she stopped working on a neonatal unit, a court has been told.

Letby, 33, is accused of murdering seven babies and attempting to murder 10 others at the Countess of Chester Hospital between June 2015 and June 2016.

On Tuesday, consultant Dr Ravi Jayaram told Manchester Crown Court: “We had significant concerns from the autumn of 2015. They were on the radar of someone as senior as the executive director of nursing as far back as October 2015.

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“As clinicians, we put our faith in the system… in senior management to escalate concerns and investigate them. The initial response was, ‘It’s unlikely that anything is going on. We’ll see what happens’.

“We said, ‘OK’ – against our better judgment in retrospect.”

The Crown says Letby murdered two children and attempted to kill six others from November 2015 onwards.

Dr Stephen Brearey, head of the neonatal unit, reviewed the circumstances surrounding the case of Child D shortly after her death in June 2015, the court was told previously.

Dr Jayaram said the review identified Letby’s presence at a number of collapses but it was “an association, nothing more”.

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On Tuesday, he said concerns were flagged a second time in February 2016, to the medical director and the director of nursing.

He said: “My colleague Dr Brearey requested a meeting with them. They didn’t respond to that for another three months and we were stuck because we had concerns and didn’t know what to do.

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“In retrospect, I wished we had bypassed them and gone straight to the police.

“We by no means were playing judge and jury at any point but the association was becoming clearer and clearer and we needed to find the right way to do this. We were in an unprecedented situation.

“Eventually, we reached a point in June 2016 when we said, ‘Something has got to change’, but that’s not for me to talk about now.”

Ben Myers KC, defending, said the doctors were “grown adults” who could have gone straight to the police.

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Dr Jayaram replied: “We were also beginning to get a reasonable amount of pressure from senior management at the hospital not to make a fuss.

“In retrospect, we were all grown-ups and we should have stood up and not listened.”

Letby, originally from Hereford, denies the allegations.