Brearey also gave his thoughts about his hopes for wider cultural change in the NHS in the wake of the inquiry, but indicated he remained sceptical about the speed of change in some areas.

He said Lady Thirwall had recommended "the uncontroversial duty of every manager to put patients first".

"It feels a bit of a sad indictment on the organisation when that has to be written down into the contracts of senior managers," he said.

"It's one thing writing into a contract is another thing actually enacting it into the entire organisation and that takes a cultural change and cultural changes take time, and I very much hope that the NHS and the Department of Health can make that turnaround effectively.

"But it doesn't feel like something that's going to happen overnight to me, certainly, no."

In a joint statement issued after the publication of the inquiry report, former Countess of Chester Hospital executives Tony Chambers, Ian Harvey and Alison Kelly, along with former HR director Sue Hodkinson, said: "We are carefully reviewing the Thirlwall report and its recommendations.

"Given that there are a number of investigations under way, and that the work of the Criminal Cases Review Commission has not yet completed, it would be inappropriate for us to offer any further comment at this time.

"Our thoughts remain with the families affected by the tragic events that took place at the Countess of Chester Hospital."

In a statement given after the conclusion of the inquiry, the hospital trust said: "We know that no apology or action can undo what happened at our hospital.

"We are however truly sorry for the events that occurred in 2015 and 2016. We acknowledge the findings of the Thirlwall report and will approach its recommendations with openness and a firm commitment to build on the progress we have already made in improving our hospital's governance, safety and culture since that time.

"We are a different organisation today with new leadership, stronger governance and safety processes, and a more open culture where speaking up is encouraged and acted upon."

Letby, from Hereford, who maintains her innocence, has twice been denied permission in 2024 to appeal against her convictions.

The Criminal Cases Review Commission, which investigates potential miscarriages of justice, is considering her case.