Wes Streeting: ‘The hardest thing to change in the NHS is its culture’

Each time I met the victims of Nottingham’s maternity scandal, they arranged themselves around a horseshoe table in date order. Those whose experiences went back the furthest to my left, with the most recent to my right. They would, in turn, tell me their story of traumatic experience with the Nottingham maternity and neonatal services, and their efforts to sound the alarm. Bereaved parents. Parents whose children had been disabled. Women left with lifelong injuries.

They were some of the most harrowing meetings I had as health and social care secretary. Thinking ahead to my next regular meeting with them, I would feel a pit of dread in my stomach that I would find a new family sat to my right with a new sorry story to tell, but one that happened on my watch.

The report published last week reveals just how widespread and harmful the failures in Nottingham were: 520 mothers and babies suffered potentially avoidable injuries or loss of life over more than a decade. Credit must go to Donna Ockenden for her thorough work leading the review, but the heroes of this story are the group of parents who turned their unimaginable grief into courage and persistence.

In their search for accountability, justice and lasting change, they have had to relive the most horrific moments of their lives over and over again. It is only thanks to their efforts that the truth has come to light.

There are many lessons in Ockenden’s findings: the need for public services to listen to the public they serve; the danger of a culture that places the reputation of professionals and institutions above the truth; and the depressing existence of bullying, racism and discrimination in a service built to care. Policies matter, but the hardest thing to change, especially in an institution as large and venerated as the NHS, is culture.

Almost as shocking as the failures to care for women and babies is the refusal of some senior NHS managers to provide evidence for this review. This backside-covering is far too common in the NHS; both Ockenden and Hilary Cass (in her review of youth gender identity services) say their investigations came up against a stubborn refusal to cooperate. The culture of cover-up must be ended. The government’s Hillsborough law, and its introduction of a duty of candour, will rebalance power away from those who seek to conceal state failure, in favour of honesty. Sunlight is the best disinfectant.

The rolling out of Martha’s rule – a patient safety initiative to support the early detection of deterioration – to all maternity services will mean every parent can demand an urgent investigation if the mother or baby’s condition is deteriorating and their concerns are not being adequately addressed. It gives power to the patient and means they must be listened to.

Unfortunately, these failures have not been consigned to just one hospital trust in one part of the country. I launched similar investigations into Leeds and Sussex trusts after hearing eerily similar stories from families there. And the trends across the country show this is not an isolated problem; by 2024, stillbirths were above pre-pandemic levels and maternal deaths were rising. These fall disproportionately on working-class and black women.

For all the parents elsewhere in the country who have suffered similar fates, who see their own experiences reflected in the findings in Nottingham, I hope that this week’s report from Valerie Amos will reassure them that failings are being brought into the open, so necessary changes can be made. The maternal and neonatal taskforce I pulled together will produce an action plan this year that must set our maternity and neonatal services on a safer path.

The ambition must be to ensure that women and their partners don’t need to look forward to childbirth in fear or look back on it with trauma.

Photograph by PA Images / Alamy