What a Major Hospital Investigation Reveals About NHS Maternity Care

The Ockenden Review into maternity services at Nottingham University Hospitals NHS Trust published its final report on 24 June 2026. It is the largest independent review into maternity and neonatal services in NHS history, according to NHS England.

Donna Ockenden, who led an earlier investigation into maternity failures at Shrewsbury and Telford Hospital NHS Trust, chaired this inquiry. Her team examined years of harm across Nottingham's maternity services and reached a straightforward conclusion: poor practice persists where leadership, governance, and culture are not robust, and where investigations into that poor practice fail to drive real change.

This finding echoes earlier major hospital inquiries — the Francis Report on Mid Staffordshire, the Kirkup review of East Kent, and Ockenden's own Shrewsbury findings. Each time, the pattern is the same: weak Board oversight, an organizational culture that doesn't invite challenge, and investigations that produce reports rather than improvements. Nottingham is the latest, and the largest, example of what appears to be a systemic issue across the NHS rather than a problem unique to one hospital.

What the Review Found

The Nottingham report's key finding — that leadership and governance failures create spaces where poor clinical practice goes unchallenged — has a specific meaning. Governance refers to the formal systems a hospital's Board uses to make sure care is safe. These include incident reporting (when things go wrong, they are logged), mortality and morbidity reviews (examining why patients die or suffer complications), and pathways that carry concerns from frontline staff up to senior leaders. When these systems are weak or just performed for show, poor practice can continue without being questioned.

The report also highlighted a gap between investigating problems and actually fixing them. The NHS now requires hospitals to move beyond simply finding the root cause of a failure and instead embed lessons into daily practice. At Nottingham, evidence suggests that gap — between finding out what went wrong and making it better — remained wide during the period the review examined.

What Happens Next

The timing of the Nottingham report connects to two other developments. Earlier in 2026, on 10 March, Donna Ockenden was appointed to lead another independent review — this time into maternity services at Leeds Teaching Hospitals NHS Trust. That appointment came before the Nottingham report was finished, suggesting that commissioners are not waiting for one review to conclude before starting the next. A series of formal maternity investigations is now underway.

On the same day as the Nottingham publication, the government announced it was extending Martha's Rule to all maternity services. This is a practical tool that allows patients and families to request a second clinical opinion urgently if they are worried about their care. Releasing this policy alongside the Nottingham findings was likely deliberate — offering a concrete step forward at the moment the review enters public discussion.

For hospital executives and health leaders, the practical challenge is familiar and urgent: how does a trust actually implement recommendations from an independent review before the next inspection or, more seriously, before the next preventable death occurs? The Ockenden framework — now applied at Shrewsbury, Nottingham, and soon Leeds — is becoming the standard way to diagnose where maternity governance has failed. Because the recommendations from these reviews are consistent, hospitals that have not yet faced independent scrutiny can see what good governance should look like and where problems tend to emerge.

The harder challenge is cultural. Governance structures — the formal systems and rules — can be rebuilt through policy changes, staffing decisions, and audits. Changing an organization's norms so that staff feel safe raising concerns, and know those concerns will be acted on, happens more slowly and resists top-down fixes. That is the deeper work the Nottingham report points toward but cannot mandate.