You have to lower your compassion to survive here
In Nottingham, a maternity unit entrusted with the care of thousands of expectant mothers became, over more than a decade, a place where vulnerability was met with dismissal and systemic neglect. Coded language on whiteboards, chronic understaffing, and a culture that shielded itself from scrutiny combined to produce stillbirths, maternal deaths, and life-altering injuries across some 2,500 families. The largest maternity inquiry in NHS history, led by Donna Ockenden, is poised to deliver its findings on June 24 — a moment that asks not only what went wrong, but how institutions meant to protect the most fragile moments of human life can fail so completely and for so long.
- Midwives used a coded acronym on ward whiteboards to signal that heavily pregnant women should be turned away — a practice that was not aberrant but emblematic of a culture that treated mothers as burdens rather than patients.
- Women who called in distress were told not to come in; at least one arrived to find her baby had died during a prolonged labour that left her with permanent, life-altering injuries.
- More than 50 staff members formally warned management in 2018 that dangerously inadequate staffing was a disaster in the making — and were met with deflection, while the trust quietly miscounted its own workforce to mask the shortfall.
- The trust built a parallel classification system for serious incidents to avoid reporting failures to national regulators, leaving parents to fight for their children's deaths to be officially recognised at all.
- The Care Quality Commission has upgraded the trust's rating and leadership has pledged accountability, but the Ockenden inquiry's full report — arriving June 24 — and a broader government review of English maternity services mean the institutional reckoning is far from complete.
Inside Nottingham University Hospitals NHS Trust's maternity unit, a three-letter acronym appeared on whiteboards beside the names of heavily pregnant women. It was not medical shorthand — it was a signal to send them away. A senior midwife documented the practice in a 2018 resignation letter, alongside advice she had heard given to colleagues: when worried women called fearing they were in labour, discourage them from coming in. "Don't be too kind," one colleague had said, "she'll keep coming back."
The trust now sits at the centre of the largest maternity inquiry in NHS history. Between 2012 and 2025, roughly 2,500 families received care across its two hospitals. The inquiry, led by senior midwife Donna Ockenden, is examining stillbirths, neonatal deaths, maternal deaths, and serious injuries. Sarah Hawkins called the ward repeatedly in 2016 with concerns about her pregnancy. Her calls were dismissed. Her daughter, Harriet, was stillborn. When Hawkins learned of the acronym, she said the last ward manager she spoke to might as well have said it directly to her. Another woman, told not to come in when she called to say she was in labour, arrived to find her baby had died. The prolonged labour had caused her permanent injuries; she now wears a stoma bag.
These outcomes did not arise from individual cruelty alone. Midwives described understaffing so severe that compassion became unaffordable. One said that to survive the conditions, you had to lower your compassion. Another recalled being the only person on shift able to read fetal heart monitors, running between rooms through the night without food or rest. In 2018, Sue Brydon led more than 50 colleagues in writing directly to trust leadership, warning that inadequate staffing was the single greatest threat to families and staff alike. Management blamed HR. A 2023 review found nothing meaningful had changed.
The trust compounded its failures by creating its own classification system for serious incidents, kept outside the national framework — a mechanism that allowed internal investigations to proceed without regulatory oversight. Ockenden told Panorama she had found serious cases of maternal harm that were never reported to authorities. Former staff also described racial discrimination: accents mimicked, non-white women treated more dismissively, pain in South Asian women attributed to cultural difference rather than recognised as a failure of care.
The trust's current chief executive, who arrived in 2022, has acknowledged the organisation's failures and committed to reform. The Care Quality Commission has moved the trust from "inadequate" to "requires improvement." But for the hundreds of families still waiting, acknowledgment and change are not yet the same thing. The Ockenden report arrives June 24.
Inside Nottingham University Hospitals NHS Trust's maternity unit, midwives kept a coded language on their whiteboards. Three letters—FOH—appeared next to the names of heavily pregnant women. The letters stood for something unprintable, followed by "off" and "home." It was not medical shorthand. It was a signal that these women should leave.
A senior midwife documented this practice in a resignation letter in 2018, now seen by BBC Panorama. In the same letter, she recorded advice another colleague had given: when pregnant women called worried they were going into labour, tell them not to come in. "Don't be too kind," the colleague had said, "she'll keep coming back." These were not isolated remarks. They reflected something deeper—a culture that treated expectant mothers as inconveniences rather than patients in crisis.
The trust now sits at the centre of the largest maternity inquiry in NHS history. Between 2012 and 2025, roughly 2,500 families received care there. The inquiry, led by senior midwife Donna Ockenden, is investigating stillbirths, neonatal deaths, maternal deaths, and injuries to babies and mothers across the trust's two hospitals. The findings arrive on June 24. One case illustrates the cost. Sarah Hawkins called the ward repeatedly in 2016 with concerns about her pregnancy. Her calls were dismissed. Her daughter, Harriet, was stillborn. When Hawkins heard about the FOH acronym, she said: "The last phone call I made to a ward manager, she might as well have just said that to me."
Another woman called to say she was in labour. She was told not to come. When she finally arrived at the hospital, her baby was dead. The prolonged labour had caused her perineum and vaginal wall to collapse. She now wears a stoma bag. These outcomes did not happen in isolation. They emerged from a system stretched to breaking. Midwives spoke to Panorama about chronic understaffing so severe that compassion became a luxury they could not afford. One community midwife, pulled repeatedly into the maternity units to cover shortages, said: "You have to be resilient, and to be resilient you have to lower your compassion." Another recalled being the only person on shift capable of reading fetal heart monitors. She ran between rooms, fearing someone would die. Sometimes staff worked entire nights without food or bathroom breaks.
Management knew. In 2018, Sue Brydon, a senior midwife, led more than 50 staff members in writing to the director of midwifery and the trust's chairman. "The single most important factor threatening the wellbeing of families and midwives and the cause of a potential disaster is inadequate staffing," the letter stated. The response was dismissive. "All they did was blame HR," Brydon told Panorama. The trust had miscalculated its staffing needs for years, counting midwives on sick leave or maternity leave as if they were working. External reviews were commissioned and ignored. A 2023 investigation found nothing meaningful had changed since the 2018 letter.
The trust also created its own classification system for serious incidents, kept outside the national framework. This allowed investigations to happen internally without being reported to regulators—a way to avoid external scrutiny. Ockenden told Panorama she had found "very serious issues of maternal harm that were not reported" to authorities. Parents had to fight to get their babies' deaths classified as serious incidents at all. Beyond understaffing, there was a lack of training and equipment. One midwife noticed that neonatal deaths, rare when she started in the early 2010s, became "increasingly common." Staff grew desensitized. When something went wrong, there was often no examination of what could have been done differently—just an assumption that everyone had tried their best.
Former staff also reported racial discrimination. Ockenden found "countless" examples: staff mimicking accents, non-white women treated more dismissively. There was an assumption that South Asian women complained about pain more, attributed to culture rather than recognized as discrimination. Anthony May, the trust's current chief executive, arrived in 2022 after these allegations had accumulated. He has acknowledged the failures and promised reform. "We need to take accountability as an organization for not always providing the circumstances for safe care," he said. The Care Quality Commission recently upgraded the trust from "inadequate" to "requires improvement." But the reckoning is not over. The Ockenden inquiry's full report comes this month, and a government investigation into maternity services across England is also due. The families affected—hundreds of them—are waiting to see whether acknowledgment will finally become change.
Citações Notáveis
The single most important factor threatening the wellbeing of families and midwives and the cause of a potential disaster is inadequate staffing.— 2018 letter from 50+ midwifery staff at Nottingham University Hospitals NHS Trust
We need to take accountability as an organisation for not always providing the circumstances for safe care, for not always supporting families, for not admitting our mistakes.— Anthony May, current chief executive of Nottingham University Hospitals NHS Trust
A Conversa do Hearth Outra perspectiva sobre a história
Why did midwives use coded language like FOH instead of just saying what they meant?
Because it allowed them to express contempt while maintaining a veneer of professionalism. It was a way to communicate dismissal to colleagues without it appearing in official records. The code made it feel like an inside joke rather than a serious breach of duty.
The letter from 2018 warned about staffing. Why didn't management act?
They had external reviews done instead. It's easier to commission a report than to actually hire people and restructure. The trust also miscalculated how many midwives they actually needed because they counted people who weren't working. When you don't know your real problem, you can't solve it.
What does it mean that staff became desensitized to neonatal deaths?
It means the system broke them. When you're understaffed and exhausted, you stop asking whether things could have gone differently. You assume you did what you could. That's how preventable deaths start feeling normal.
How did the trust hide serious incidents?
They created their own classification system outside the national framework. Internal investigations could happen without being reported to regulators. It meant parents had to fight to get their babies' deaths recognized as serious incidents at all.
What does Ockenden's inquiry actually change?
The report itself doesn't change anything. It documents what went wrong. Real change depends on whether the trust and the NHS actually implement the recommendations—and whether they're willing to spend money on staffing instead of just commissioning more reviews.