A long-awaited review into maternity services at Nottingham's health trust has revealed systemic failings, including a "bullying and toxic culture" that persisted over years. The report, led by Donna Ockenden, found that leadership instability and a lack of accountability contributed to adverse outcomes for mothers and babies.
The review team described a pervasive "toxic culture" within the trust, where some staff members formed "intimidating cliques that were well known, but not confronted." This environment was characterized by a belief in the "Nottingham way" and "tribalism" among staff groups. One staff member stated that "bad behaviours and toxic culture were normalised; people didn't even recognise it." Staff also reported "a culture of organisational denial" where poor outcomes were frequently dismissed as "known complications."
Leadership instability was identified as a significant factor affecting the quality and safety of maternity services. Between 2017 and 2021, there was "sustained turnover in senior maternity leadership positions" and senior operational roles, which the review concluded hindered consistent improvements and oversight.
Ockenden stated that "What the evidence shows is that at Nottingham, a toxic culture was allowed to take hold and was allowed to persist. A small number of powerful leaders described in both family and staff testimonies as having infected the unit, creating an environment in which bullying was normalised, speaking up was dangerous and governance was shaped by self protection, rather than patient safety."
The report highlights a pattern of denial and a lack of transparency, where critical incidents were not adequately addressed, and a culture of self-protection took precedence over patient safety. The findings underscore the need for significant cultural and structural changes within the trust to ensure the safety and well-being of expectant mothers and their newborns.