Published on 24 June 2026, the Nottingham Ockenden Report is the largest maternity inquiry in NHS history – covering 2,500 families, 13 years of care, and systemic failures at every level. Its implications extend directly into private obstetric practice, says George Maughan, THEMIS’ director of insurance services.

What the report found

Donna Ockenden’s review of Nottingham University Hospitals (NUH) identified systemic failures in intrapartum fetal monitoring, latent phase assessment, PPH management, and post-partum communication spanning more than a decade. Maternal deaths were reviewed in 27 cases; care failures were identified as contributory in six. Women consistently described being unheard, uninformed, and excluded from decision-making.

A toxic bullying culture – particularly among labour ward coordinators – was found to have directly compromised clinical safety. NUH pleaded guilty to six CQC charges in 2025 and received a combined financial penalty of £1.67m. A police investigation, Operation Perth, remains live and includes consideration of corporate manslaughter.

The headline financial figure is stark: maternity now accounts for 51% of total NHS negligence expenditure – £2.5bn in 2024/25 – approaching the entire cost of delivering NHS maternity care itself.

The 18 immediate and essential actions

The report sets out 18 England-wide IEAs. The most significant for obstetricians in private practice:

  • Martha’s Rule to be universally available: Patients and staff must be able to request urgent additional clinical review at any time.
  • A mandatory ‘Listen to the Woman’ field in all triage documentation, recording the patient’s account and confirming it has informed clinical decision-making.
  • Standardised risk assessment throughout pregnancy, with lower thresholds for admission where additional risk factors are present.
  • A structured national framework for latent phase assessment, incorporating the patient’s preferences, social circumstances, and distance from unit.
  • Standardised obstetric anaesthetic documentation, including contemporaneous intra-operative pain scores.
  • A maternity subject-matter specialist with a standardised role description on every Trust board.

What this means for independent practitioners

The IEAs are addressed to NHS Trusts, but the clinical standards they articulate will increasingly define the baseline against which negligence claims are assessed – wherever the care was delivered. Three areas warrant immediate attention for obstetricians in private practice:

  • Documentation: The report’s emphasis on recording patient concerns, consent discussions, and clinical rationale contemporaneously is not new – but the standard is now more clearly defined and litigants will use it.
  • Escalation infrastructure: Private practitioners working without robust on-call cover, accessible anaesthetic support, or clear escalation protocols are operating in a materially higher-risk environment than the IEAs envisage.
  • Indemnity adequacy: Obstetric claims routinely reach seven figures. Practitioners with limits that have not been reviewed recently, or who hold discretionary MDO membership rather than contractual insurance-backed cover, should treat this report as a prompt to revisit both.

THEMIS’ view

The distinction between contractual insurance and discretionary MDO cover is not a technical footnote – it is the central question of financial security for any obstetrician whose single adverse outcome could exceed a career’s worth of premium income. If you have not reviewed your indemnity position since the last major maternity report, now is the time.

THEMIS Clinical Defence provides contractual, insurance-backed medical malpractice indemnity for clinicians in the UK independent sector. Our Assured tier offers £20m per claim / £30m aggregate, underwritten by QBE. To discuss your indemnity position, contact our team.