27th April 2023
1st March 2023
15th February 2023
Statement from Donna Ockenden 27th January 2023
‘The death of Wynter Andrews so soon after her birth in 2019 is a tragedy, the effects of which will remain with her parents Sarah and Gary and her little brother Bowie forever. We are already clear from the inquest held in 2020 that Wynter’s death was an avoidable tragedy; put simply it should not have happened.
Since Wynter died Sarah, Gary and their family have campaigned tirelessly for improvements to maternity safety and for better bereavement support for families when a child or baby dies. This will be the legacy that Wynter leaves us all.
As Chair of the independent review of maternity services at Nottingham University Hospitals NHS Trust my team and I give our wholehearted commitment to support improvements in maternity services at the Trust and across Nottinghamshire.
Already, in the early days of our independent review we are aware of the pain and anguish suffered by other families like Sarah and Gary. We promise them that their voices will be heard and their experiences will make a difference. ‘
13th October 2022
I am pleased to announce that today the Independent Review will be launching the Staff Voices initiative.
In addition to anonymised accounts from those affected by care in the Nottingham University Hospitals NHS Trust, the experiences and concerns of staff, both past and present, are absolutely central to our Independent Review.
That is why today, I am asking any member of staff who worked within or close to Maternity services at NUH that has concerns to come forward and speak to our Review team. Your confidentiality will be respected throughout this process. What you tell us will be kept confidential unless you were to share with us very serious concerns about patient safety or other very significant issues, which would of course have to be escalated appropriately.
I know that I speak on behalf of all members of my team, when I say that our staff voices initiative will be both professional, and most importantly, a confidential space, in which you can come forward and tell us about any concerns you have. When you engage with my team you will be speaking to review team members who can fully appreciate every aspect of your story, and are able to understand anything you share with them. So please, if you have information you wish to share, please submit a questionnaire, and we will get in contact with you in the near future.
Within the Staff Voices initiative there is an opportunity to meet (virtually) with members of the Independent Maternity Review team. We hope to be able to speak with a number of current and former staff.
Click here to go to the survey
Download Staff Voices Privacy Notice
Download Staff Voices Interview Protocol
12th October 2022 – Announcement from Donna Ockenden.
Today, letters will start to be sent out to all families who may have made contact with or joined the CCG commissioned maternity review that stopped its work in June of this year. Families may remember that our Independent Maternity Review started its work on the 1st September 2022
The letter to families will be sent by the commissioning support unit (‘CSU‘), an organisation that worked alongside the clinical commissioning group (‘CCG‘) in Nottinghamshire. There are two parts to the letter, consisting of a covering letter from the CSU and an introduction to the new review from me, Donna Ockenden, as Chair of the Independent Maternity Review.
My review team and I feel it is important to give all those families who were part of the initial review the opportunity to join our Independent Review, if this is what they would like to do.
Read the letter about the first review
Read the letter from Donna Ockenden
Would you like to join our Independent Review?
The letter will explain how to either join or not join the new independent review.
If you wish to join the independent review, my team and I will make you very welcome. Please be aware that if you do not respond to the letter saying that you wish for your details to be shared, your information would not be shared with the Independent Maternity Review team.
What will our Independent Review do and how can I find out more?
If you would like more information about our Independent Review, please look at the information, which can be found here. You can also contact our review team on [email protected]
The purpose of our Independent Review is to find out if the trust adequately investigated cases, learnt lessons and whether those lessons have been acted upon. The ultimate aim of our Independent Review is to make sure that the Trust’s maternity service improve.
Listening to families across Nottinghamshire ensures that ‘family voices’ will be heard and acted upon. This will remain our focus throughout the Independent Review and, will be reflected in anonymised accounts, in the final published report.
What should I do next?
Please read the letter from the CSU and let them know what your decision is about whether you wish to join our independent review. Once your decision has been received, next steps to sharing your information will begin for those families who choose to join our review.
10th October 2022
Announcement from Donna Ockenden – 6th October 2022
I am pleased to announce that this week we have appointed the first three members of the Nottingham Maternity Review ‘Family Voices’ team . Our family voices team will be ‘experts by experience’ or have had a great deal of experience working with and supporting families.
We are honoured that Baroness Shaista Gohir OBE, James Titcombe OBE and Sandra Igwe have agreed to join our team and help to ensure the family voices are heard throughout everything we do, from the start to the finish of the review. Our ‘Family Voices’ team will help us reach out and engage with all of Nottingham’s diverse communities, and very importantly to involve the voice of all the fathers who have been affected by the events in maternity services at Nottingham University Hospitals NHS Trust (NUH).
ANNOUNCEMENT FROM DONNA OCKENDEN – 13th September 2022
The purpose and the approach of the independent review of maternity services at Nottingham University Hospitals NHS Trust are outlined in our Terms of Reference (available here).
Identification of clinical cases for the review will be based on the ‘Open Book’ approach as used in the review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. The Trust will be providing the review team with a large amount of information including cases in the following 5 categories:
- Term and intrapartum stillbirths
- Neonatal deaths from 24 weeks gestation that occur up to 28 days of life; the review team will also consider neonatal serious incident reports and neonatal never events
- Babies diagnosed with Hypoxic Ischemic Encephalopathy (Grade 2 & 3) and other significant hypoxic injury
- Maternal death up to 42 days post-partum
- Severe maternal harm to include cases such as all unexpected admission to ITU requiring ventilation, major obstetric hemorrhage e.g. cases where blood loss exceeds 3.5L, peri-partum hysterectomy, and other major surgical procedures arising from the maternity episode, cases of eclampsia and clinically significant cases of pulmonary embolus requiring further treatment
The review team will contact families to ask for their consent to be involved in the review. The wishes of families, whether to be involved in the review, (or not) will be completely respected by the maternity review team.
We ask all families whose experience falls into one (or more) of the 5 categories above to please contact us via email: [email protected]
If your maternity experience is outside of these 5 categories, we will still be able to consider your case, and important learning from your case can be used to improve maternity care at the Trust.
Please let the review team know about your maternity care by completing the online form below or email us on [email protected] .
All of your messages will be delivered directly to the review team and will be read carefully. Your experience will help the review team to build a wide and clear picture of maternity care provision at the Trust.
*Please note that the review team is only able to support with concerns raised in relation to maternity care provided at the Nottingham University Hospitals (NUH) NHS Trust. If you query is regarding a different Trust or is related to a different department at the Trust we will not be able to help. We recommend you contact the relevant Trust directly.
My team and I will be in touch with you if we have any questions or if we feel we need additional information from you.
Thank you very much for your assistance
With best wishes
The Independent review into maternity services at Nottingham University Hospitals (NUH) NHS Trust
ANNOUNCEMENT FROM DONNA OCKENDEN – 1st September 2022
Today, Donna Ockenden and her review team officially open the Independent Review into Maternity Services at the Nottingham University Hospitals NHS Trust.
Donna and her team are making a public appeal to anyone that has serious or significant concerns about maternity care in the Nottingham University Hospitals NHS Trust (NUH) to come forward to the review team. This request also applies to staff members, both current and former, who should feel confident in reaching out to the review team.
It is of paramount importance that this review triggers local improvements in care that are both timely and effective, so that local families and staff working in maternity services at NUH can once again feel pride and confidence in the safety of their local maternity services. Donna wishes to extend a heartfelt thanks to everyone that has contacted the review team so far – your contact, accounts and information are so important to us and we look forward to working with and for you to improve maternity services in NUH in a timely manner, for families and NUH staff now and in the future.
ANNOUNCEMENT FROM DONNA OCKENDEN – 26th August 2022
Today, Donna Ockenden and her review team made contact with all Nottinghamshire MPs and City Councilors in the Nottingham area. Donna has also contacted a number of community groups.
Donna believes it is of paramount importance that the Independent review into Maternity Services at the Nottingham University Hospitals (NUH) NHS Trust is comprehensive, leaving no voices unheard, and in order to achieve this, it is essential that Donna and the review team are in contact with as many families and current and former staff in maternity services as possible.
That is why, today, we are asking a number of representatives to please urge anyone in their community who has serious concerns about the maternity care that they received at the Nottingham University Hospitals NHS Trust (NUH) to please contact us as soon as possible. Current and former staff at Nottingham University Hospitals NHS Trust NUH can also reach out to the review team in confidence.
Please note that this review is considering maternity services in Nottingham University Hospitals NHS Trust (NUH) only. We will be unable to help if you or your family have concerns about care in another area of the Trust, or in another Trust across England.
ANNOUNCEMENT FROM DONNA OCKENDEN – 15th August 2022
Families who believe they have been seriously affected by their maternity care and treatment at Nottingham University Hospitals NHS Trust (NUH) can now contact the independent review team by email [email protected]
Former and current staff at the Nottingham University Hospitals NHS Trust (NUH) can also contact in confidence via this email address too.
All emails will be responded in the near future. The Independent review is due to commence in early September 2022 and further information will be released closer to the time.
Message from Donna Ockenden – Chair of the Independent maternity review
The Shrewsbury and Telford Maternity Review has now concluded and published its final report. The Chair, Donna Ockenden, and her team thank all the families and stakeholders for their cooperation, support and assistance.
As the review has now concluded the maternity review team will not be in a position to deal with any further communications and enquiries. We are now completely focused on providing feedback to our families who are already within the review. You are invited to read the Final Report, a link to which can be found here, if you would like to know more about the conclusions of the Review.
If you are a patient or a family member of a patient and you have a new enquiry about the Shrewsbury and Telford Hospital NHS Trust, we encourage you to direct these to [email protected]. Alternatively, if you have a complaint about your care please refer to https://www.nhs.uk/using-the-nhs/about-the-nhs/how-to-complain-to-the-nhs
If you have queries or concerns about any other NHS Trusts or services, please contact the Chief Executive’s Office or the PALS department at the correct Trust.
Unfortunately we are not able to answer queries or deal with concerns outside of the original Terms of Reference of our maternity review. We can now only answer emails and other communications from our group of families that are already part of this review.
With thanks and best wishes
Message from the Independent Maternity Review Team
We are currently receiving hundreds of emails in our maternity review inbox and via all forms of social media. Thank you for all your kind and positive messages about our final report. They are very much appreciated by the team.
We have also received multiple speaker enquiries for Donna. We are prioritising contact with (and emails from) our review families and we will respond to all the other queries as soon as we can.
With best wishes The Maternity Review Team
Following the publication of the final Ockenden report, please see below a letter which was sent by Amanda Pritchard, NHS Chief Executive, Ruth May, Chief Nursing Officer and Professor Stephen Powis, National Medical Director, to all Trusts across England on Friday 1st April 2022.
Read letter here
Publication of the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust
Today, Wednesday 30 March 2022, marks the publication of our final report of the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Our independent multi – professional team of midwives and doctors including obstetricians, neonatologists, obstetric anaesthetists, a physician, cardiologist, neurologist and others have examined the maternity care and treatment provided to 1,486 families over two decades at the Trust.
This report identifies more than 60 Local Actions for Learning for the Trust and another 15 key Immediate and Essential Actions to improve all maternity services in England, including financing a safe and sustainable maternity and neonatal workforce and ensuring training for the whole maternity team meets the needs of todays maternity services. We state that trust Boards must have oversight and understanding of their maternity services. Trust boards must ensure that they listen to and hear local families and their own staff.
NHS announces £127m maternity boost for patients and families
On 24 March the NHS in England announced a £127 million funding boost for maternity services across the England that will help ensure safer and more personalised care for women and their babies.
Donna Ockenden is a respected and high profile health care leader in the UK and internationally. Her expertise includes the leadership and management of Maternity services and Women and Children’s Divisions and she is well respected within the field of elderly care.
Recent and current work in the field of elderly care includes:
- Development of an Elderly Falls and Fracture Reduction Strategy (across 3 CCGs and a population of circa 1 million);
- Development of quality and contract standards for nursing homes across 2 CCGs;
- Recently published an extensive Governance review (July 2018) of the events leading to the closure of Tawel Fan ward in December 2013 and a review of the current Governance arrangements in Older People’s Mental Health in Betsi Cadwaldr University Health Board;
- In February 2021 Donna Ockenden has been named as a Fellow of the Royal Society for the Encouragement of Arts, Manufacture and Commerce. The accolade has been awarded to Donna Ockenden for her work which has touched the lives of many throughout her career. Her work has been a catalyst for change to improve the quality of care for a broad section of people who use healthcare services across the UK;
Other recent work includes:
- Current Chair originally reviewing 23 maternity cases of concern at the Shrewsbury and Telford NHS Trust. The review has been commissioned by the Secretary of State for Health. Following a much larger number of cases of potential concern coming forward and confirmation that the original review was to be extended, Donna has increased the numbers within the expert team to include an anaesthetist, infection prevention, an ambulance expert, two paediatricians and a physician as well as increasing the number of midwives, neonatologists and obstetricians.
- Completed a review of the leadership team, effectiveness and function in a pharmacy department of a large NHS Foundation Trust in the South of England where all the recommendations made by Donna Ockenden were accepted by the Trust Executive team;
- Undertook and completed a review of the leadership, management and effectiveness of the multidisciplinary team in a large Emergency Department where the recommendations made by Donna Ockenden were all accepted by the Trust Executive Directors;
- Successful working across multiple CCG’s and a large acute provider Trust in the development of an agreed pathway for paediatric emergency care;
- Development of a number of Paediatric workstreams and successfully agreed a structure for implementation of those workstreams across an STP involving multiple commissioners and providers and complex commissioning and working relationships;
- Support of a CCG in ensuring safe provision of care with a year long ‘deep dive’ into (and ongoing review of) a large maternity service following a number of maternal deaths and serious incidents;
- Completion of a review into housekeeping services across the 3 sites of a large Trust where staff morale was low and employee relationships generally were of concern to the Executive team. Multiple recommendations were made to and accepted by the Executive team.
Donna’s area of particular interest, across all clinical specialties, is the leadership of multi-disciplinary teams. She is adept at working with a wide range of medical, nursing and midwifery colleagues. Her extensive experience consists of:
- working with teams in difficulty or crisis
- leading services against a background of extensive reconfiguration
Being highly skilled in supporting services Donna can demonstrate broad learning from clinical incidents and service user complaints. She also has experience of providing advice on the timely resolution of complex or seemingly intractable clinical complaints or serious incidents.
Donna has over a decade of experience in leading large and complex maternity and gynaecology departments and over five years’ experience of leading entire Women and Children’s Divisions. This includes the management of the various consultant groups and professions allied to medicine within the Division.
Donna has a comprehensive knowledge and practical experience of supporting services in difficulty with the ability to rapidly stabilise them; at the same time developing a blue print for safe, sustainable and cost effective clinical care. She has worked on a number of projects with externally appointed ‘Turnaround Directors’ and has a wealth of experience in delivering on cost improvement plans whilst ensuring the delivery of safe and effective care.
In addition Donna has a of history of developing successful and sustainable recruitment and retention campaigns across all professions and has delivered these successfully against a backdrop of services with historically high vacancies and turnover.
Donna is now available for full time and part time advisory and consultancy work across a number of areas and clinical specialties. Donna has recent and current experience of working with both commissioners and providers and is therefore cognisant of both perspectives in a challenging economic environment.