The final report of the Ockenden Review into maternity services at Nottingham University Hospitals NHS Trust was published on 24 June 2026, marking the conclusion of what NHS England describes as the largest independent review into maternity and neonatal services in NHS history.

Commissioned by NHS England and chaired by Donna Ockenden — who previously led the review into maternity failings at Shrewsbury and Telford Hospital NHS Trust — the Nottingham inquiry examined a pattern of harm that spanned years. The central finding is blunt: poor practice persists where leadership, governance, and culture are not robust, and where investigations into that poor practice are inadequate and learning fails to follow.

That framing will be familiar to anyone who has worked through the Francis Report on Mid Staffordshire, the Kirkup review of East Kent, or Ockenden's own Shrewsbury findings. The causal chain — weak Board-level oversight, a closed organisational culture, incident reviews that produce reports without producing change — recurs with enough consistency across NHS inquiries to constitute a systemic rather than a site-specific problem. Nottingham is the latest, and the largest, instantiation of it.

What the Review Found

The Nottingham review's headline conclusion, that leadership and governance failures create the conditions in which clinical poor practice goes unchallenged, carries specific structural meaning. Governance here refers to the formal mechanisms by which a trust's Board assures itself that care is safe: incident reporting systems, mortality and morbidity review processes, external benchmarking against MBRRACE-UK data, and the escalation pathways through which frontline concerns reach executive level. When those mechanisms are weak or performative, poor practice does not generate the friction that would otherwise slow or stop it.

The finding on insufficient learning is equally pointed. NHS trusts are required under the Patient Safety Incident Response Framework (PSIRF) to move beyond root-cause analysis as an end in itself and to embed systemic learning into practice. The Nottingham evidence, as characterised in the report, suggests that gap between investigation and improvement remained wide over the period examined.

The Broader Pattern and What Comes Next

The timing of the Nottingham publication sits alongside two other significant developments. Earlier in 2026, on 10 March, Donna Ockenden was appointed to chair a further independent review — this time into maternity and neonatal services at Leeds Teaching Hospitals NHS Trust. That appointment, coming before the Nottingham report was finalised, signals that commissioners did not wait for one review to close before opening the next. The pipeline of formal maternity inquiries is, in effect, continuous.

Also published on 24 June was the government's announcement extending Martha's Rule to all maternity services — a practical escalation mechanism allowing patients and families to request an urgent second clinical opinion. The simultaneous release is unlikely to be coincidental; it offers a concrete policy response at the moment the Nottingham findings are entering the public record.

For NHS executives and integrated care board leads, the operational question is familiar but no less urgent: how does a trust move from receiving a review's recommendations to embedding them in practice before the next Care Quality Commission inspection or, more gravely, the next preventable death? The Ockenden framework — now applied at Shrewsbury, Nottingham, and shortly Leeds — is becoming a de facto national standard for diagnosing maternity governance failure. The recommendations that emerge from these reviews are increasingly consistent, which means trusts that have not yet been subject to independent scrutiny have a reasonably clear picture of what adequate governance looks like and where the gaps tend to form.

The harder problem is cultural. Formal governance structures can be rebuilt through policy, personnel change, and audit. Shifting the organisational norms that allow staff to raise concerns without fear — and ensure those concerns are acted upon — is slower and less amenable to top-down intervention. That is the work the Nottingham report, like its predecessors, points toward without being able to prescribe.