Our response to Ockenden Maternity review

The final report of the Ockenden review into maternity services at Nottingham University Hospitals NHS Trust was published today, based on a review of 2,500 cases of maternity and neonatal care. It found ‘a persistent failure to listen to and believe mothers and fathers and a corresponding failure to investigate, and therefore learn from, mistakes’.

The Government has accepted one of its key recommendations, to roll out Martha’s Rule to all maternity services in England, to ensure every parent can request a rapid review from an independent medical team if a baby or mother’s condition is deteriorating and they are concerned this is not being responded to. The Government will fully respond to the Ockenden review by September.

Chris McCann, our acting chief executive welcomed news of the Martha’s Rule roll out. He added: 

“Today's findings reinforce concerns that have been repeatedly highlighted over the past decade through at least six national maternity investigations and reviews. Despite numerous recommendations, the same failings continue to emerge: women are not listened to, their concerns are dismissed or downplayed, and racism and bias within some teams and organisations contribute to significant inequalities in care and outcomes for Black and ethnic minority women.

"These ongoing and persistent failures raise serious questions about the NHS's ability to learn from mistakes, respond effectively to patient complaints, and act on concerns raised by whistleblowers. Time and again, opportunities to improve safety and prevent harm have been missed.

"For the 2,500 families affected by the failures in Nottingham, and for all women, babies and families who have suffered following maternity and neonatal care failings across the country, there must now be a sea change in how inquiry recommendations are implemented. Reports and reviews alone are not enough. Meaningful change requires robust accountability, with trust leaders held responsible for delivering improvements, embedding a culture of openness and learning.”