The Nottingham Ockenden Review: A Further Wake-Up Call for Maternity Services.
On 24 June 2026, Donna Ockenden published the findings of her independent review into maternity services at Nottingham University Hospitals NHS Trust (NUH). The review, which examined approximately 2,500 cases spanning the period from 2012 to 2025, is the largest maternity review in NHS history.
The findings are deeply concerning. The report identified 520 cases where mothers or babies suffered death or serious harm that may have been avoidable, including 444 mothers and 76 babies. The review concluded that many of these outcomes were linked to failures in clinical care, delays in treatment, inadequate fetal monitoring, poor communication, and a persistent failure to listen to the concerns of women and their families.
Beyond the clinical failings, the report highlighted significant cultural problems within the Trust. Donna Ockenden described a "toxic" environment characterised by bullying, defensiveness, poor leadership, and a reluctance to learn from mistakes. The review also identified concerns regarding racism, stereotyping, and inequalities in maternity care, with some women reporting that their concerns were repeatedly dismissed.
A particularly troubling theme was the repeated failure to investigate serious incidents properly. The report found evidence that opportunities to learn from adverse outcomes were missed over many years, allowing unsafe practices to continue. Families described feeling ignored, blamed, or excluded from investigations following the death or injury of their babies.
The review has prompted renewed calls for a national public inquiry into maternity services across England. Donna Ockenden herself warned that the issues identified in Nottingham are not unique and may reflect wider systemic problems within maternity care nationally. In response, the Government has announced measures including the expansion of Martha's Rule to maternity settings, giving patients and families greater access to rapid second opinions where concerns about care arise.
For clinical negligence practitioners, the report reinforces many of the themes that continue to emerge in maternity litigation: failures in fetal monitoring, delayed escalation of concerns, communication breakdowns, inadequate staffing, and failures to learn from previous incidents. The review is likely to generate further scrutiny of maternity services and may influence both future claims and wider patient safety reforms across the NHS.
The Nottingham Review serves as a stark reminder that despite the lessons identified in the original Ockenden Report into Shrewsbury and Telford, significant challenges remain. For affected families, the report provides long-awaited recognition of their experiences. For the NHS, it represents a further call for meaningful and lasting change.
See the Official report here:
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