He questioned why the doctors did not personally approach the management team.

Richard Baker KC, the barrister representing some of the families of Letby’s victims, pointed out that Ms Townsend’s meeting with Dr Jayaram took place around the time Letby attacked Baby P.

He asked her: “On reflection, do you think you need to take immediate action to remove Lucy Letby (from the neonatal unit)?”

Ms Townsend replied: “So I didn’t know any of the things you clearly stated.

“I couldn’t see and I didn’t hear anything. My conversation with Dr. Jayaram was very brief.

“He, Dr. Brearey, and some of their colleagues had some concerns.

“We didn’t go into any detail, and there were absolutely none of the details you just stated.”

Mr Baker asked how much detail a doctor would need before taking action if a nurse said he was concerned about a nurse attacking babies.

He said: “The terms ‘attack’ and ‘harm’ were never used.”

Letby, originally from Hereford, was convicted of murdering seven babies between June 2015 and June 2016 and attempting to kill a further seven, including two attempts on the same victim.

He is serving 15 life sentences and has appeals against convictions rejected by the Court of Appeal.

The investigation continues.