The Shrewsbury maternity scandal shows something is very wrong with the inspection of NHS trusts

In a year when the dedication and skills of the medical profession have never been more apparent, comes a sad reminder that even they are not immune from criticism. Indeed there is reason to believe that the largest scandal in the history of the NHS, apart from perhaps the mass murders of Harold Shipman, has now come to light.

The report by the senior midwife Donna Ockenden into the widespread malpractice in maternity care at the Shrewsbury and Telford Hospital Trust makes for distressing reading. It is, in fact, very hard to believe that such cruelties could have been inflicted by qualified medics working openly in an NHS institution and overseen by professional management. This was no rogue GP surgery or a bad day at an outpatient clinic, but a long-standing record of incompetence, and worse, at a major hospital. Yet the truth is now out, and the evidence is set down in plain excruciating detail in the report.  

Put at its bluntest, lives were lost and others destroyed because of a misguided policy that pushed mothers away from caesarean sections. It was not a matter of honest clinical advice in a world of balancing risks to mother and baby, but an abject failure to take the interests of the mothers and their unborn children seriously. It was rather a culture in which the families were in a sense “ordered”, treated as commodities, even dehumanised. Such is the scale of the scandal – and yet it somehow persisted for years. That it went on in this way for so long is scarcely credible, and will now be the subject of further investigations by the authorities, including the police.  

Something is obviously very wrong with the system of oversight and inspection at our largely self-governing hospital “trusts”, the operating structures brought in in the 1980s and 1990s in the name of efficiency and constantly rearranged since. For all the attention paid to performance indicators and mortality rates, it is obviously too easy for trusts to cover up failings – part of a culture of suppression and denial that becomes easy to establish itself in semi-autonomous bodies.  

Among the likes of military units, football clubs, churches, banks, political parties or newspapers, the first reaction to a discovery of any kind of scandal is defensive – to close ranks, and deny or minimise the problem, and attack the accusers. The Shrewsbury and Telford trust is not the only health institution that has suffered scandal; it has happened on a major scale at Stafford, Bristol and Liverpool’s Alder Hey. Given the natural self-preservative instincts of any institution, the Shropshire trust is not going to be the last. 

Such habits of mind are impossible to eradicate, but there is clearly a case for a radical overhaul of the inspection and audit regime for individual NHS trusts, and for stronger independent and patient representation on their governing bodies.  

The NHS remains a formidable force for good, and arguably the greatest contributor to health and happiness in Britain since it was created in 1948. Its performance during the pandemic demonstrates its extraordinary ability to respond and cope with an unprecedented challenge, and its workers have put their lives on the line to save others. All the more reason, then, that such a noble institution should be itself protected from harm.