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A recently uncovered report has brought to light significant issues concerning workload, staffing levels, and workplace culture within the maternity services at Nottingham University Hospitals (NUH) NHS Trust, which operates Nottingham City Hospital. Donna Ockenden, who leads the ongoing review of maternity care at NUH, emphasized that many of these concerns were already apparent at the time of Harriet Hawkins’s tragic death. The report, though historic and previously unpublished, raises important questions about whether these early warning signs were adequately addressed.
Conducted between December 2015 and March 2016 by an external workplace psychologist, the review praised staff dedication while also drawing attention to problems with excessive workload, inappropriate behaviors, and a problematic workplace environment. It involved confidential interviews with 49 staff members, including midwives and doctors, and was prompted by unusual occurrences such as healthcare inspectors finding an energy drink can in a sterile delivery room and butter smeared on a birthing pool. The Care Quality Commission inspectors also raised concerns about the unit’s culture during their assessments.
Among the troubling findings, the report highlighted persistent staffing shortages, with one employee describing chronic under-staffing and another revealing the emotional toll, sharing that staff often left their shifts in tears and supported each other through private social media groups. The allocation of patients was another critical issue, as newly qualified midwives were reportedly assigned to high-risk cases while more experienced staff handled less complex ones. Additionally, the review recorded instances where senior personnel were unsupportive or even belittled junior colleagues. Equipment shortages, such as insufficient thermometers, were also noted, although staff expressed satisfaction in mentoring students, underscoring their commitment to nurturing the future workforce.
The external reviewer characterized the passion and dedication of the maternity unit staff as striking but acknowledged the presence of a harmful culture that required urgent attention. The report produced eight recommendations, focused on engaging all staff in shaping the service’s vision, enhancing professional development, and improving management support. Just days after the report’s completion, Harriet Hawkins was stillborn at Nottingham City Hospital. An external review into her death revealed 13 failings, concluding her stillbirth was “almost certainly preventable.” This tragedy triggered what has been described as the largest investigation into a single NHS service since the health service’s inception and led to one of the largest clinical negligence payouts relating to a stillbirth.
In response, Harriet’s parents, Dr Jack and Sarah Hawkins, have been advocates for maternity safety reform. Sarah described the hospital’s culture as “toxic,” recounting mistreatment during her labor, including an insensitive remark from a senior staff member. Jack expressed disbelief at the practice of assigning the most complex tasks to the least experienced staff, stressing that such issues should have been widely known within Nottinghamshire at the time. Donna Ockenden acknowledged that the problematic patterns identified in the 2015-2016 report took considerable time to resolve and said the entrenched fear of certain senior staff contributed to ongoing cultural difficulties. Although progress has been made by 2026, Ockenden noted that cultural improvement remains a work in progress.
This focus on culture is not new; previous revelations have
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