The painful familiarity of key themes in Donna Ockenden’s review of maternity care failures must not detract from the urgency around this issue. The 400-page report published on Wednesday is a shocking catalogue of what went wrong at Nottingham university hospitals NHS trust. Its contents range from a excruciating case study of the errors leading to the death of baby Harriet Hawkins in 2016 – and the cover-up that followed – to trust-wide problems with staffing, culture and leadership. It also highlights flaws in the wider NHS, citing the finding of the 2022 Messenger review that political pressure can lead bosses “to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user”.
Given its around 100 action points, implementation is a daunting prospect. Next week, Valerie Amos will add to these, and the more than 700 recommendations of earlier reports, with her own investigation of maternity care in England. Wes Streeting had pledged to chair a new taskforce and his resignation as health secretary alarmed campaigners. Whoever ends up in charge, a commitment to maternity care improvement must be non-negotiable, and firmly grounded in practicalities. The review points to a damaging split between strategy and operations in Nottingham. NHS England must avoid replicating this.
