NMC pledges ‘meaningful and lasting change’ following Nottingham review

The Nursing and Midwifery Council (NMC) has pledged to play its part in delivering ‘meaningful and lasting change’ following publication of Donna Ockenden’s review into maternity services at Nottingham University Hospitals NHS Trust.

The review, which examined the experiences of more than 2,500 families and is the largest investigation into NHS maternity and neonatal services in NHS history, identified repeated failures in care, including poor communication with women and families, missed opportunities to recognise deteriorating patients and failures to escalate concerns.

It also found evidence of a culture in which parents and staff who raised concerns were not always listened to.

Responding to the findings, the regulator acknowledged that it had previously been ‘too remote and too slow’ to recognise the scale of concerns raised by families and apologised for falling short of the standard they deserved.

The NMC insisted that feedback from affected families had prompted significant changes in how it listens, engages and responds when concerns are raised, including the creation of a specialist Sensitive and Complex Casework Team and a series of case surgeries designed to help families discuss their experiences directly with the regulator.

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These surgeries have led to 57 fitness to practise (FtP) cases being opened.

The regulator is currently handling 96 (FtP) cases linked to maternity care at Nottingham University Hospitals NHS Trust, including 80 at the screening stage and 15 under investigation.

One case has progressed to adjudication, with an interim order in place preventing the midwife concerned from practising while proceedings continue.

Paul Rees, the NMC’s chief executive and registrar, said: ‘The experiences shared by families through the Nottingham maternity review are deeply shocking in describing harm and loss that should never have happened.

‘I’m clear that the NMC of the past was too remote and too slow to recognise the depth of the issues in Nottingham – failing families as a result.

‘The new NMC has listened and changed how we engage with families, and how we use the information they’ve shared, taking a family first approach.’

The government has announced a number of measures following the review, including extending Martha’s Rule to all maternity and neonatal settings in England.

The measure allows patients and families to request an urgent independent review if they believe a mother’s or baby’s condition is deteriorating and concerns are not being acted upon.

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The Department of Health and Social Care (DHSC) has also announced plans to compel NHS staff to cooperate with future maternity investigations. Staff who refuse to engage with reviews or deliberately withhold information could face up to two years in prison.

The DHSC said the measure would help ensure maternity reviews in Leeds and Sussex are comprehensive and would address the culture of silence highlighted by the Nottingham review, in which more than 800 staff gave evidence but some described being silenced when raising patient safety concerns.

Health secretary James Murray said the review had exposed ‘a culture where too many voices went unheard, too many opportunities to prevent harm were missed and too many lives were lost’.

The government said it would publish a full response to Ms Ockenden’s national recommendations in September as part of a wider programme of maternity and neonatal care reform.

The review findings have been published amid growing concern around maternity capacity, recruitment and provision.

A recent survey by the Royal College of Midwives (RCM) found around three-quarters (72%) of midwives said staffing levels have felt ‘unsafe’ on more than half of their recent shifts.

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At this year’s NHS ConfedExpo, England’s chief nursing officer Duncan Burton  recognised ongoing issues relating to a lack of jobs for newly registered midwives and suggested a ‘solution’ was being worked on.

There are also signs that the spotlight currently placed on services is taking its toll on staff. Midwives at this year’s Royal College of Nursing Congress shared anxiety over external reviews, saying they were adding pressure to ‘overstretched’ teams.

One midwife revealed that her team had experienced death threats following a review.