‘Democratic trade union and community control must replace the heartless priorities of capitalist economics’
Jon Dale, Unite the Union Notts health secretary
The review of Nottingham’s maternity services by the well-respected senior midwife Donna Ockenden makes grim reading. Over 2,500 families were involved, their experiences mostly between 2010-2025.
500 families gave testimony, the review reporting in detail some harrowing stories. Poor treatment led to catastrophic outcomes – stillbirths, maternal deaths, lifelong disabilities.
800 current and former staff were also interviewed. Outrageously, their concerns had been raised for years but swept under the carpet.
A staff member who left in 2016 recalled: “Worked 12-hour shifts with no breaks. Didn’t feel able to care for women properly. Caring for two women in labour at the same time with no support.”
Another said: “Stress caused people to behave badly to each other [with bullying] … we started to turn on each other. I witnessed poor culture, bad behaviour. Overwork was not being addressed when escalated.”
Black and immigrant women, including staff, were subject to racist mistreatment with sometimes tragic results.
Concerns were raised by the consultants: “In 2015 about capacity – approached Freedom to Speak Up Guardian in August 2017 re inadequate staffing, relationships, lack of continuity and approached again in 2021. Didn’t feel like anything changed after any of these. In 2021 they were 13 consultants short.” In 2024 “… to deliver Continuity of Care would need additional 73 midwives.”
“In 2018, fears of the impact of staffing on safety led to 50 maternity staff from one hospital putting their names to a letter to the Chair of the Board… The lack of any meaningful response only reinforced the disconnect between midwives and the Board. We heard from many that they felt ‘fobbed-off’.”
The Review summarised staff views. “Insufficient staffing is at the heart of unsafe practice, with insufficient time to train, to review cases, to complete observations, to listen to women and to learn. Moreover, staff all agree that senior and executive managers have been routinely made aware of these challenges over many years, but have either ignored or have been unable to respond to the concerns being raised.”
As one staff member put it: “Perception is Trust was more concerned with finance.”
It was no mistake senior management (the Trust) put money before babies’ and mothers’ lives. They were carrying out policy dictated by successive governments, intent on cuts after the huge bank bailout in 2007-09 by Labour.
Former Tory Health Secretary Andrew Lansley (in coalition with the LibDems) wrote to Trust Boards in 2011: “They must show that they are delivering high levels of annual productivity savings… I have a stark warning… The Secretary of State has the power to remove and replace management teams that fail to deliver and I will not hesitate to use that power if needed.”
Nottingham families and burnt-out staff paid the real price for their unheeded stark warnings – not bankers, politicians or senior managers.
This maternity services report joins those on Morecambe (2015), Shrewsbury and Telford (2017) and East Kent (2022). Reviews on Leeds and Sussex are in the pipeline.
An immediate injection of funds is needed nationally to reverse past cuts and ensure full staffing. Staff need time for rest and for continuing training. Bullying management methods start at the top and need rooting out.
Throughout the whole NHS the voices of patients, their families and staff must be listened to. Democratic trade union and community control must replace the heartless priorities of capitalist economics.
Retired midwife: ‘Heartbroken and angry’
The report was only procured after an extensive campaign by families of mothers and babies who had been harmed or died under the care of Nottingham University Hospital (NUH) over a 14-year period. This is not the only report into maternity services, we can all recall Morecambe Bay. Heartbreakingly, there were six external reviews of NUH maternity department from 2015-2022 . But findings were never acted upon. In 2018, 50 midwives collectively wrote to the Trust board with their concerns but were ignored.
The top issues identified in this latest external review were invisible, unapproachable, unresponsive, bullying managers; poor staffing ratios and a theme of extremely poor governance.
As a retired senior midwife who strove for the best possible care, I am heartbroken and so angry. This report is so distressing to read. I don’t really believe anyone arrives at work to deliberately cause harm and yet this is what happened.
The crucial role of regulatory bodies is paramount but are they fit for purpose? At NUH junior midwives were routinely allocated the most complex cases with little support, a longstanding culture of fear to speak out existed, with incidents of cruelty and bullying on a massive scale. There was no time to attend mandatory training.
Ironically, as I write, newly qualified midwives are unable to secure a job in England and Wales due to underfunding and austerity cuts.
The writing has been on the wall since Thatcher, turning the NHS into a business model was a big clue. Subsequent governments have continued to introduce changes that fundamentally assist them to destroy the NHS.
Judith Byrne, Royal College of Midwives registered midwife (retired)
