Letby, who is accused of murdering seven babies, was asked by prosecutors whether she believes the death of one of her alleged victims, Child E, could be put down to incompetence in the neonatal unit.

Letby told the court: “Collectively the doctors could have acted sooner to react to his bleeding issue.”

Prosecutor Nick Johnson responded: “When are you suggesting that something that wasn’t done should have been?”

Letby told the court: “Once Child E was profusely bleeding after 10pm, maybe a blood transfusion could have been given sooner, maybe that would have made a difference.”

She added that it is an “important factor to note there were often plumbing issues within the unit”.

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Asked what this has to do with the death of Child E, or any other children, Letby claimed to the court that there was “raw sewage coming out of the sinks” in the intensive care unit.

This may have had an effect on the baby, as staff would have been unable to wash their hands in the proper manner, Letby claimed.

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Child E was the twin brother of Child F, with the former allegedly being murdered by an injection of air into his bloodstream.

Child E died on August 4, 2015, while his brother Child F was allegedly attacked via insulin poisoning one hour later. He survived.

The prosecution has alleged that Letby did not escalate bleeding suffered by Child E until around one hour after it began.

“If I had seen blood at any point I would have escalated that to someone,” Letby told the court.

Child E’s mum claims she saw blood on her child’s lip at around 9pm, while Letby told the court there was no blood before 10pm.

The court was then shown a text by Letby reacting to Child E’s death, which read: “Not a lot I can do really. He had a massive haemorrhage could have happened to any baby x.”

The trial continues.