Baby deaths and toxic culture - the Nottingham maternity report at a glance

Baby deaths and toxic culture - the Nottingham maternity report at a glanceImage source, PA MediaImage caption, Donna Ockenden led a press conference on Wednesday to mark the review's publicationByGavin BevisEast MidlandsPublished32 minutes agoHundreds of mothers and babies suffered potentially avoidable harm or died due to "deeply embedded systemic failures" at maternity units in Nottingham, a review led by senior midwife Donna Ockenden has concluded.The inquiry - the largest of its kind in NHS history - found leaders at Nottingham University Hospitals (NUH) NHS Trust knew there were serious issues in its maternity department going back to "at least 2010", but failed to take action to prevent more harm and deaths.Ockenden said she hoped her conclusions would "drive real and lasting change to maternity services in England".Here are some of the main findings at a glance.Hundreds of affected familiesAbout 2,500 families and more than 800 members of staff contributed to the inquiry, which started in 2022.Overall, experts concluded there were "potentially avoidable" outcomes for mothers and babies in 444 maternity cases leading up to May 2025 alongside 76 neonatal cases.All these cases were graded as two or three for harm - with grade two representing "significant concerns" and grade three "major concerns" over care.Different care may have altered the outcome for 260 babies, who died or were harmed, the review team told the BBC.Of that number, 155 babies died while 105 suffered serious injury due to substandard care, with some left with permanent brain damage.Multiple factors to blameThe review concluded the harm was rarely the result of a single issue or specific failing.Experts found adverse outcomes were linked to multiple factors, including failures in the monitoring of babies, poor interpretation of heart monitoring, a failure to recognise babies were in distress during labour and a failure to escalat...