Ockenden Review of Maternity Care: Shrewsbury and Telford

Debate between Jeremy Hunt and Lucy Allan

Wednesday 15th January 2020 Commons Chamber

[Lucy Allan (Telford) (Con)]

I am delighted to have been granted this Adjournment debate on this very important issue. I want to raise it because the issue deserves the platform that Parliament affords. It concerns the safety of women and babies receiving maternity care at hospitals in Shropshire. I raise that in the context of the Morecambe Bay trust inquiry into maternity deaths in 2015, which at the time was considered to be a one-off. What has come to light at Shrewsbury and Telford Hospital NHS Trust suggests that there may be systemic problems within the NHS and maternity care, and there are without doubt significant concerns about the lack of transparency and openness around what went wrong.

The Ockenden review was set up two and half years ago to look at 23 possible cases of maternity malpractice at the Shrewsbury and Telford Hospital Trust. So far there have been no formal published findings. However, in November 2019 interim findings were leaked to the media. Those findings show not only that had some very serious failings indeed been uncovered by the review, but that the scale of the malpractice, and the number of women and babies affected by it, exceeded anything that had been expected when the review was initiated.

The interim findings stated that there had been in excess of 40 avoidable maternity deaths and 50 brain-injured babies. NHS Improvement was given that information almost a year ago and appears to have kept quiet about the findings. The findings also make reference to “widespread failings, a toxic culture and a failure to learn lessons.” Since those findings were made public, many, many more women have come forward—women who knew nothing about a review being held. The review is now looking at over 600 cases of possible maternity care malpractice.

Those interim findings directly contradict what senior management were saying publicly at the time when the review was commissioned. Senior management claimed that this was all overblown by the media, that it was all historical, and that good practice was in place now. The chief executive claimed that concerns raised about the possible scale of malpractice were “scaremongering”—his word. Senior hospital management adopted the stance that “it simply couldn’t happen here.” The CEO said that the media, particularly the BBC, had it in for them; that is what they actually said to me, the MP. How, in that kind of environment, can lessons be learned if there is no acceptance that anything has gone wrong?

We had the same response from the authorities in Telford when the scale of child sexual exploitation in the town was revealed. That denial, or perhaps being in denial, seems to be the standard response from those in positions of authority—minimising the problem, blaming the media and depicting those affected as being in some way troublesome.

Let us compare the review from Shrewsbury and Telford Hospital NHS Trust with that from Morecambe Bay, where there were 11 avoidable baby deaths and one maternal death. The Morecambe Bay inquiry reported promptly, and the then Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), came immediately to the House, made a statement, and apologised to the families. He pledged that lessons would be learned, and that the legacy of those tragic deaths would mean that such things could not happen again. My right hon. Friend is in the Chamber today, and I am grateful that he did not just accept the position taken by senior management, NHS bureaucrats, and officials from Shrewsbury and Telford NHS Hospital Trust at face value. I commend him for initiating the Ockenden review, and for his commitment to encouraging a culture of transparency and openness across the NHS. We must continue with that approach.

[Jeremy Hunt (South West Surrey) (Con)]

I wish to repay the compliment and thank my hon. Friend for her tireless campaigning on this issue. It is not easy publicly to criticise a local hospital trust, and for an hon. Member to do that, as in this case, shows enormous courage. Does she agree that the biggest mistake the Government could make when they publish and respond to the Ockenden review would be to say that this is a one-off incident? The most important thing is to consider what went wrong at Shrewsbury and Telford, and to learn those lessons for the whole NHS. The big thing that we learned from Morecambe Bay and Mid Staffs was that such lessons apply across the system.

[Lucy Allan]

My right hon. Friend makes an important point—I was going to come to it in my speech, so I will bring it in now. The Morecambe Bay inquiry was led by Dr Bill Kirkup, who said of the recent findings at Shrewsbury and Telford Hospital NHS Trust that

“two clinical organisational failures are not two one offs”,

and that that points to an “underlying systemic problem” that may exist in other hospitals. My right hon. Friend is right to make that point, and I thank him for his kind comments.

The interim findings in the Ockenden review were not published, and I understand that the hospital trust has not been told about them. The families were certainly not told about them, and neither were MPs. There has been no statement to the House, and we do not know what action is being taken to ensure the safety of women and babies at Shrewsbury and Telford Hospital NHS Trust.