Queen’s Medical Centre, Nottingham, where a report identified hundreds of maternity cases where avoidable harm occurred. Photo The Nott’m Lass/shutterstock.com.
The standard of maternity care remains a dire concern. The new prime minister sees solutions in devolution but the evidence points to problems in maternity care across Britain regardless of funding models…
June 2026 saw the publication of another major report detailing unsafe practice in maternity care: The Ockenden report on Nottingham University hospital. And then in July the National Maternity and Neonatal Investigation under Baroness Amos was published. These follow similar reports on the Telford hospital in 2022 and Morecambe in 2015.
The Amos report was not truly national – it only covered about 12 hospitals in England. However there is currently a review of maternity care in Scotland following a critical review of maternity care in Edinburgh. Likewise, a review of maternity services in Wales was announced in July 2025.
There are clear themes in the published reports: all describe a cycle of chronic understaffing and overwork. The report on Nottingham provides a striking description of how an unresolved situation can lead to appalling behaviour by workers towards each other and towards those in their care.
It described staff literally trying to push their workload of pregnant mothers away from the unit when they needed critical care. It is a painful reminder that where there is no effective collective response to safety issues in any workplace, workers can turn on each other and make a bad situation worse.
The outcomes in Nottingham were catastrophic. The report detailed systemic failings during the period 2012 to 2025: it highlighted 444 maternity cases and 76 neonatal cases where avoidable harm resulted. Failures in care may have substantially impacted on the outcome in six maternal deaths.
Deaths
The report identified 31 babies who died due to poor care and many more who suffered avoidable harm. Quite understandably it was those statistics which made the national headlines. On listening to those headlines workers will have asked why was there no collective response at Nottingham? Well, there was an attempt but it was not adequate and it is worth examining.
The attempt at a collective response was made in 2018 (nearly nine years ago!) and it is documented in the Ockenden report on Nottingham. Senior midwife Sue Brydon wrote a letter signed by 50 midwives and sent it to management detailing their concerns. It included this paragraph:
“The most important factor threatening the wellbeing of families and midwives and the cause of a potential disaster is inadequate staffing. There has been a serious and ongoing failure of workforce planning, leading to a chronic shortage of clinical midwives.”
Many Workers readers will recognise how difficult it must have been to arrange for 50 people to sign that letter. Rarely does attendance at a union branch reach that number. Many would have been reluctant to stick their neck out and many would have felt cynical about the management response.
But they were proved correct: the “potential disaster” mentioned in their letter became an actuality. The management were able to ignore and bury that letter. The signatories, seemingly without the umbrella of taking that action as trade unionists, did not have the machinery to follow through on their concern.
Management preferred to address issues raised by staff by internal reviews. There were six such reviews in the period covered by the report. Yet the situation deteriorated after each one.
The report goes on to detail how the trust was failing to properly calculate the staffing numbers – precisely the “ongoing failure of workforce planning” mentioned in the letter. Understaffing also meant that staff were not attending essential training. That contributed to the ongoing harm documented in the report.
Trade unionists, especially health and safety reps, know that persistence is essential in such situations. Often a concern has to be raised with an employer several times before action is taken. And improvement may not happen until workers down tools and strike.
If the letter signed by 50 Nottingham midwives had been part of trade union action which was persistent over time, lives could have been saved. Direct union action by front line staff is the key to safety rather than internal or external reviews.
Care avoids compensation
As well as describing the failed collective attempt to rectify the situation in Nottingham, the Ockenden report contains another critical piece of information – mentioned in the covering letter as background but not followed up and not included in any recommendation.
This is what Donna Ockenden calls the “startling statistic” that clinical negligence for maternity care is costing the NHS almost the same in legal compensation as it spends on the delivery of maternity care itself!
That is startling: it means that as a nation we pay for maternity care twice over.
‘It cannot be right to spend as much on compensation for negligence as on care itself…’
According to the NHS Resolution annual report 2024/25, over half (£2.5 billion) of the total negligence cost of harm in the NHS (£4.9 billion) relates to maternity. And that’s an increase of 49 per cent over 2023/24. Ockenden also points out that fighting these legal claims has a financial, physical, emotional and psychological cost on the families affected.
Someone has to end this madness. It cannot be right to spend as much on compensation for negligence as on care itself. Historically, the NHS has always addressed negligence claims through the adversarial court system. Other countries do this differently with no fault compensation schemes in Japan, parts of Scandinavia and Italy.
These schemes reduce the time that is spent putting families through lengthy court processes, which can take 2-3 years due to the challenge and complexity of establishing negligence in court.
No fault schemes involve a clear investigation, sincere reflection and apology, learning and prevention, and monetary compensation. But because they does not involve an adversarial legal process, the cost to the health service is much lower and the chances of accurate acceptance of causes is greater.
The case for considering something similar for the NHS is overwhelming. Inevitably there will be vested interests keen to keep the status quo; they must be challenged.
The oft-repeated claim that British workers are reluctant to fill health care roles misrepresents the position. It is a different story: we have had a recent history of training midwives and failing to employ them due to “funding shortfalls”. A Catch-22 that affects other health professions too.
The Royal College of Midwives recently publicised data which showed one in three newly qualified midwives hadn’t secured a position in the last academic year. Who would have thought that newly qualified midwives were part of the numbers for unemployed young people?
Student midwives formed an organisation with mothers called Fund Future Midwives. They have been demonstrating all year to demand jobs on qualification. They are also fighting for fair bursaries, funded tuition and debt forgiveness for midwives who qualified after 2017.
Following the Ockenden report and the national investigation, newly qualified midwives in England will have access to an extra 1,000 new roles by the end of 2026. Unfortunately the fine print says that the funding for these posts has been identified by – cutting the funding for maternity care assistant posts! Clearly, lessons have yet to be learned.