Another maternity scandal shames Britain

It is rare for an official inquiry to be criticised by its own chair, and more unusual still for doubt to be poured on its credibility by its own architects before it is even under way. However, Donna Ockenden, the senior midwife who is leading a review into maternity care failings at the Nottingham University Hospitals NHS Trust, has been compelled to do just that.

Ms Ockenden has rightly warned that only a fraction of the Black and Asian women potentially affected by shortcomings (and worse) in care have come forward to tell their stories.

The matter at hand could hardly be more serious or upsetting. An investigation by The Independent has uncovered repeated examples of inadequate care over more than a decade, which left dozens of babies dead or brain-damaged. Fatal or life-changing injuries, in other words, that may well have been avoidable.

Nor are the problems at Nottingham isolated. Ms Ockenden also led the review into the notorious Shrewsbury maternity scandal, while a number of other trusts around the country, such as East Kent and Morecambe Bay, have also been criticised for their failure to properly look after the mothers and babies in their care.

All of these examples are obviously disturbing, and traumatic for the families affected, but the Nottingham case also speaks to a wider, long-standing problem in UK maternity care, relating to the experiences of mothers from Black and minority ethnic backgrounds.

The disparities are stark and difficult to rationalise. The House of Commons health select committee, for example, found in 2021 that, while UK has one of the lowest maternal mortality ratios in the world, there are “glaring and persistent disparities” in outcomes for women depending on their ethnicity.

Maternal mortality among Black women is currently almost four times higher than it is among white women. Significant disparities also exist between white women and those of Asian and mixed ethnicity.

These disparities have existed, and been documented, for at least 20 years, but they have only received mainstream attention and prompted government action quite recently. The sorry Nottingham episode raises the question of how much difference the various scandals, and the laudable campaigns by groups such as Five X More and Birthrights, have made.

The Nottingham inquiry, therefore, takes on an added significance as it asks whether the issue is being taken seriously enough. Thus far, it seems the answer is no.

Ms Ockenden concludes that the Nottingham NHS trust must do more to increase the “wholly insufficient” number of responses from ethnic minorities if it is to learn from the scandal. She points out that the “mistrust” of the hospital among members of these communities has “deepened”, leaving the review team “climbing a mountain” in its efforts to engage with them.

Letters were sent in English – and only in English – to families who were not only unable to understand the language but who also had no access to translation services. In such circumstances, and set against the national picture of persistent ethnic disparities, extraordinary efforts should have been made to reach out to every mother who might have been affected.

The danger Ms Ockenden identifies is that her inquiry into the Nottingham trust will be undermined by the failure of said trust to collect sufficient data and evidence from ethnic minority patients. Ironically, this confirms the very bias that some have suggested exists within the trust. The flaws in the investigation are doubly regrettable given the national debate on maternal inequalities. At least this additional aspect of the maternity scandal has been acknowledged in all its appalling reality.