NHS England is exploring changes to managers' contracts to enhance accountability for failings in maternity care, according to NHS England chief executive Sir Jim Mackey. The proposed alterations aim to address difficulties in sanctioning or compelling cooperation from individuals who leave their posts after adverse events.

Sir Jim acknowledged at an Institute for Public Policy Research (IPPR) conference that maternity report findings have become "horribly repetitive," drawing parallels to persistent failures in child protection. He emphasized the need for clearer expectations and standards for both individuals and NHS trusts, alongside robust mechanisms for holding them accountable. "Everybody needs to be accountable for their actions. We're looking at changes we can make to leaders' contracts," Sir Jim stated.

This initiative follows the recent publication of a report by former midwife Donna Ockenden, detailing the most significant maternity scandal in NHS history. The report found hundreds of mothers and babies died or suffered serious injuries at Nottingham University Hospitals NHS Trust. Ockenden's findings described a "toxic" culture where women's concerns were often dismissed and mistakes were concealed. It was noted that approximately half of the 60 former senior executives and directors approached for the inquiry declined to answer questions.

. Sir Jim described the inquiry's findings as "shocking" and highlighted the NHS's "inability to listen and tailor services to respond appropriately."

He is scheduled to meet with NHS trust leaders and nursing and medical directors to discuss improvements, vowing swift action. "There have been 'repeated horrors and failures in the service in lots of ways' with a 'lot of repetition' and 'probably too little action'," Sir Jim remarked. He stressed the necessity for clarity on responsibilities to achieve desired outcomes.

Several NHS trusts, including Shrewsbury and Telford, East Kent Hospitals, and Mid and South Essex, have previously faced high-profile maternity scandals. Sir Jim noted that the proliferation of different review reports makes it challenging to track progress and define desired standards.

It comes after former midwife Donna Ockenden this week published her report into the biggest maternity scandal in NHS history, which found hundreds of babies and mothers died or were left seriously injured at Nottingham University Hospitals NHS Trust. The health service plans to consolidate standards and regulations, particularly in light of the forthcoming Amos review into maternity care at 14 trusts. The aim is to establish a unified set of actions and expectations for all levels of the NHS.

Sir Jim also pointed to "professional tribalism" between doctors and midwives as a contributing factor to poor maternity care, underscoring the need for improved interprofessional relationships. He additionally noted a deficiency in basic compassion and suggested that previous leadership could have been more effective in synthesizing recommendations for easier implementation.

With over two decades of experience as an NHS chief executive, Sir Jim indicated that the current number of oversight and regulatory bodies for maternity care is excessive. He advocated for consolidation to achieve a "single version of the truth."

He emphasized that it is "a time for action" and that NHS leaders must collaborate and implement changes immediately. Furthermore, Sir Jim suggested that the model of NHS maternity care requires modernization to accommodate demographic shifts, such as an increase in older mothers and those with drug and alcohol issues, moving away from systems designed decades ago.