Who Benefits From All These Maternity Reviews?

It has taken four years, and it tells us, in devastating detail, what we already knew.

Too few staff. Inadequate training. A culture of not listening to women. Concerns dismissed. Mistakes covered up. These are the same findings as the Morecambe Bay inquiry in 2015. The same findings as Shrewsbury in 2022. The same findings as East Kent, the same year. Ockenden herself has said that if the 2015 Morecambe Bay recommendations had been acted on, the scandals at Shrewsbury, East Kent, and Nottingham would likely never have happened.

So here is the question nobody is asking: who actually benefits from commissioning another report?

Donna Ockenden conducts these reviews through her own limited company, Donna Ockenden Ltd. When the Guardian investigated her fee arrangements last year, monthly invoices to NHS England were exceeding £300,000 once all costs were included.

Over four years, the Nottingham review alone has cost upwards of £14 million. That is a legitimate commercial arrangement, but it creates an obvious tension. A company whose income depends on conducting maternity reviews has a financial interest in there being more maternity reviews.

Nobody in government appears to have noticed or cared.

That £14 million could have funded roughly 40 additional midwives for a decade. The Royal College of Midwives says the NHS currently needs 2,000 to 2,500 more midwives to safely staff services. Midwives are already working an estimated 100,000 hours of unpaid overtime every week.

Meanwhile, maternity now accounts for over half of the entire NHS clinical negligence bill: £2.5 billion out of £4.9 billion last year, according to figures cited in this week's Nottingham report itself.

We are spending a fortune investigating a problem we already understand, even as it gets worse.

There is also a subtler harm. Stressed professionals make more mistakes. A major systematic review found that burnout in healthcare workers is directly linked to more patient safety failures. Subjecting already-exhausted maternity staff to years of inquiry while the ward remains short-staffed is not a neutral act. It makes the situation more dangerous, not less.

Here is what we know works: listening. Every single review has found the same root cause: women not believed, concerns dismissed, and communication failures at every level.

A 2025 study in the Annals of Internal Medicine found that poor communication contributed to a quarter of all patient safety incidents. And we know empathic communication can be improved with training, quickly, cheaply, and with measurable results.

The Nottingham report says excellent maternity care relies on "empathetic leadership, individualised care, and an unwavering commitment to systemic equity." Ockenden is right. So, let's do that - instead of commissioning the next inquiry into why we didn't.

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Professor Jeremy Howick directs the Stoneygate Centre for Empathic Healthcare at the University of Leicester.

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