After two weeks, it was Dr Bawa-Garba’s turn to give evidence.

Mr Andrew Thomas QC, for the prosecution, told Dr Bawa-Garba that no-one was suggesting that she deliberately set out to harm Jack Adcock. What was at stake was whether she fell below the standard of a reasonably competent junior doctor.

He pressed Dr Bawa-Garba on the reflection she did after Jack’s death.

“List for us, please, all of the mistakes,” Mr Thomas said.

“After this case happened, I reflected on my practice and this can be found in my e-portfolio, and I listed deficiencies that I felt were in the care that I provided on that day,” Dr Bawa-Garba replied. One of them, she said, was her failure to register warning signs in the blood tests.

Mr Thomas told her to pause as people were going to write the list down. He then pressed her further and one by one, she listed how she felt she should have done better.

“I wish that I had been clearer in my communication with the consultant,” she said

“That's two. Keep going,” Mr Thomas said.

“When I reassessed Jack, I was falsely reassured because he was alert, drinking from a beaker, responding to voice, pushing his mask away because he didn't want it on his face,” she replied. She added: “I should not have relied on the nurses to get back to me with the clinical deterioration as I normally do.” She should have looked at the nursing chart, she said.

“That’s three. Number four?”

“I underestimated the severity of his illness,” Dr Bawa-Garba said.

“Number five?”

“On the reflection I did following this incident, those were the points that I looked at,” she said.

The next day was spent exploring all the points in detail. Dr Bawa-Garba continued to describe where she should have done better.

Dr Cusack says the use of her reflections made by the prosecution has made doctors fearful about admitting their errors. “All doctors are expect to regularly reflect honestly and openly on their practice to improve patient care,” he says.

At the end of the trial, the judge summed up the case to the jury. The prosecution relied on the fact she ignored “obvious clinical findings and symptoms”; did not review Jack’s X-ray and give antibiotics early enough; failed to obtain the morning blood test results early enough and act on the abnormalities they showed; and failed to make proper clinical notes.

The judge told the jury they could only convict the health professionals in front of them if they were negligent and that their negligence significantly contributed to Jack’s death or its timing. The negligence had to be gross or severe, he said - what they did or didn’t do had to be truly, exceptionally bad.

He said they should set aside any criticisms or feelings towards others involved in Jack’s care. They had to consider the circumstances within which the defendants were working when considering if they were guilty.