Advising with empathy and experience

News and Events

Key Findings of The Ockenden Report

View profile for Kim Daniells
  • Posted
  • Author

The Ockenden Report published today, Wednesday, 30 March 2022, was commissioned after a series of problems were identified in maternity care at the Shrewsbury and Telford  NHS Trust.

Senior midwife, Donna Ockenden, completed the report after examining failures in maternity care as part of a review which examined almost 1,600 cases spanning about 20 years.  It is probably the largest review of its kind ever carried out in NHS history.

In publishing the report Ms Ockenden  identified 60 areas in which improvements could be made and said that the Trust had “failed to investigate, failed to learn and failed to improve”.  

The key findings of the Ockenden report are:-

  • There was a culture at Shrewsbury and Telford NHS Trust where mistakes were not investigated and where there was a lack of effective external scrutiny.
  • Parents who raised concerns or complaints about the care they received were not listened to.
  • Where complaints were looked into,the responses provided lacked “transparency and honesty”.
  • There was a failure on the part of the Trust to learn from its own mistakes which led in turn to those mistakes being repeated and a series of almost identical failures.
  • The culture at the Trust (one of bullying, anxiety and a fear of speaking out) discouraged staff from raising concerns or identifying problems that had occurred.
  • This culture continues to the current time.
  • That caesarean sections were discouraged.

In our next article we will summarise the Ockenden report in numbers in order to show the scale of the problem at Shrewsbury and Telford Trust and the challenge facing maternity units throughout the NHS.