After the convicted killer was refused permission to appeal, she has few options left

• Spectators and an elephant in the room during retrial

Lucy Letby was convicted last year of murdering seven babies and attempting to kill six others at the Countess of Chester hospital in north-west England, where she worked as a nurse. She is serving 14 whole-life sentences, meaning she will never be released from prison.

In April she sought permission to appeal against those convictions at the court of appeal in London, and in May her challenge was refused. On Tuesday the court published its judgment explaining its decision. Here we explain what steps she has taken – and what could happen next.