The Prime Minister was asked during a visit to a nursery in North Yorkshire if the government was too slow to change the law to force her into the dock.

“The first thing is to extend my condolences to all those affected by this,” he said. “I think, like everyone reading about this, it is shocking and heartbreaking.

“Now, I think it is cowardly that people who commit such horrendous crimes don’t face their victims and hear firsthand the impact their crimes have had on them and their families and loved ones.

“We are looking at and have been changing the law to make sure that happens, and that is something that we will present in due course.”

It is understood that Letby was transported to the court building from the prison, but refused to appear in court to face the families of her victims.

Although she is not in the courtroom, it is understood that the prison service still has to physically bring her to court so that they are not responsible for her failure to attend.

Last week, Letby refused to return to the dock as the jury continued to return verdicts, and the court was told that he did not want to take part in his sentencing hearing and would not follow the hearing via video link from prison.

The mother of child E, who died, and child F, who survived, told the court: “The trial felt like a platform for Lucy to relive her crimes and it feels cruel that we had to endure a 10-month trial when she knew all along that she intentionally killed and harmed my babies. She has repeatedly disrespected my son’s memory.

“Even in these final days of the trial she has tried to control things. The lack of respect that she has shown to the families and the court shows what kind of person she is.

“We’ve been to court day after day, but she decides she’s had enough and stays in her cell, just one last act of evil from a coward.”