Expectant mothers at a scandal-hit NHS hospital have faced “discriminatory and racist behaviour”, including midwives imitating their accents and refusing to arrange interpreters, the head of an investigation into the hospital’s failings has said.
As part of the largest single service study in NHS history, Donna Ockenden speaks to more than 1,900 families who have experienced stillbirth, neonatal death, maternal death or babies with brain damage at Nottingham University Hospitals NHS Trust (NUH).
Ockenden, a senior midwife, said she was concerned about reports of racist behaviour that emerged during her interviews with families and 744 staff members who took part in the research.
“Both family and staff report discriminatory and racist behaviour,” Ockenden told the Guardian. “Local women of Asian descent report that white women in the bed opposite are treated more kindly. Their accents have been imitated, their facial movements have been imitated, they have been ridiculed and laughed at by staff.
“A Roma woman I met told me that a sheet was thrown at her head when she asked for her bed to be changed – this was very recent.”
According to Ockenden, women were often unable to give informed consent for difficult procedures because they were told they “understood enough” when they asked for an interpreter.
She added that she had found that women from the most disadvantaged backgrounds, of all races, “certainly reported to me very negative experiences with maternity care”.
The Nottingham maternity review was launched in September 2022 after a long-fought campaign by affected families, who asked Ockenden to chair the review following her investigation into the Shrewsbury and Telford NHS trust in Shropshire.
That inquiry found that 300 babies died or suffered brain damage as a result of inadequate care at the trust, after analysing the experiences of 1,500 families. Ockenden recently announced she was returning to the case in Shrewsbury after families complained they had had no contact with the trust since her report was published two years ago.
She said the same issues of “lifelong trauma” were present in Nottingham. Since the last review began, Ockenden has referred more than 250 people for psychological support and escalated 70 cases to the NUH chief executive for immediate action.
“I hear horrific stories every day of life-changing damage, broken relationships, siblings affected, mental health issues, some women living with terrible physical damage and injuries, with incontinence, pain and no longer being able to work,” she said.
“We see and hear a lot of raw emotion, a lot of anger. Some families are in desperate situations, caring for children with brain injuries with minimal support. Some of these children require 24-hour care.”
She added that in many cases “the poor outcomes will have been caused by poor care”. The cases included in the review date back to 2012 and her team will continue to hear new cases until May 2025. The final report is expected to be published in September of that year.
Nottinghamshire Police have also launched a criminal investigation into NUH over its maternity care.
Last year, the charity was fined £800,000, the largest penalty for maternity care, after admitting failings in the care of Sarah Andrews and her baby Wynter, who died minutes after birth in 2019.
The case followed that of Sarah and Jack Hawkins, who received a £2.8 million payout from the NHS in what was believed to be the largest settlement for a clinical negligence case involving stillbirth. Sarah was in labour for six days before Harriet was stillborn, almost nine hours after her death, at Nottingham Hospital in April 2016.
According to Ockenden, the two cases are examples of the recurring themes she hears from families about loss of trust and communication with maternity care.
“Families have told us they felt rejected by the trust. They didn’t believe they were in labour. They didn’t believe they were in pain. They weren’t allowed into the trust,” she said. “And that can have implications for services across the country, but staff just don’t know about the trauma.”
There are growing calls for a public inquiry into maternity care in the UK, particularly following the publication in May of the Birth Trauma Inquiry, a report by MPs that called for a review of maternity and postnatal care in the UK.
Ockenden said she understood people’s anger and frustration, but she did not believe a public inquiry would be the best way to improve maternity care.
“I fear that a public inquiry will postpone the problem. It would delay things when we already know what needs to be done. I call on the new government to accelerate progress on maternity care,” she said.
A Department of Health spokesperson said: “It is unacceptable that too many women are not getting the maternity care they deserve. This Government is determined to change that by ensuring all women receive safe, personal and compassionate maternity care.
“We will ensure that trusts that fail in maternity care are given strong support to make rapid improvements, while training thousands more midwives. We will also take action to close the maternal mortality gap for black and Asian women and tackle unacceptable inequalities in care.”
Anthony May, the chief executive of NUH, said: “I would like to apologise to these women and families for the failings that were identified and the pain that was caused. I also apologise to anyone who has experienced racism in our hospitals.
“I want all of our patients and their families to use our services knowing that they are free from discrimination. I know that doesn’t always happen, but we are calling on our communities to learn from the populations we serve. We have plans to improve translation and interpretation services, to better reach out to communities that are rarely heard, and to be more culturally aware.”
He added that recent inspections by the Care Quality Commission and feedback from mothers using the services showed that the situation was improving, with 98% of patients in a survey of friends and family in June saying they had had a positive experience.