Ockenden Report: insufficient investigations into deaths of moms and infants and a tradition of silence | Medical Negligence and Private Damage Weblog | Kingsley Napley

Ockenden Report: insufficient investigations into deaths of moms and infants and a tradition of silence | Medical Negligence and Private Damage Weblog | Kingsley Napley


Final week the was lastly revealed. A staff of Midwives and Medical doctors, headed by Midwife, Donna Ockenden reviewed the maternity care given to 1,148 households between 2000 – 2019. The report made for surprising studying.

The media broadly reported the findings, that repeated failures at Shrewsbury and Telford NHS Belief result in the deaths of 201 infants and 9 moms who might in any other case have been saved, leaving others with life altering accidents, such a mind harm attributable to hypoxic ischaemic encephalopathy (HIE) and youngsters later identified with cerebral palsy.  

Of the HIE instances investigated, the report discovered that in 69.5% of instances there have been important and main issues concerning the maternity care that was given. Had that care been acceptable, the end result for these infants, and by extension, their households, would possibly effectively have been totally different.   

The report finds that there was a poisonous office tradition at Shrewsbury and Telford NHS Belief, an over-confidence in employees of their means to handle complicated pregnancies and a powerful choice for vaginal beginning over caesarean sections. Certainly, the Belief’s low price of caesarean part beginning was held up as a nationwide instance.

Sadly, the Belief didn’t study from its personal investigations, which the report discovered have been typically insufficient and didn’t establish systemic and repair extensive failings to comply with acceptable procedures and nationwide pointers. This meant that there have been many misplaced alternatives to study and make enhancements to the care given to ladies and their infants.

The report rightly identifies that the NHS employees who’ve labored all through the pandemic are exhausted. It pushes for the price range for maternity providers to be elevated by £200 – £350 million a yr with speedy impact and factors out that extra must be accomplished round workforce planning when it comes to recruiting and retaining each obstetricians and midwives.

We hear typically from shoppers that one in every of their foremost causes for investigating a declare is to keep away from the identical factor occurring to anybody else. Sadly, evidently a tradition of silence persists on the Belief, with the report describing what number of employees members withdrew their cooperation with the investigation within the remaining weeks earlier than publication out of concern of being recognized. Kingsley Napley have lengthy campaigned for the Responsibility of Candour, and for a tradition of openness as being the one approach to make sure that errors are usually not repeated. 

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ABOUT THE AUTHOR

 has a diversified caseload of medical negligence and private damage issues. Her medical negligence work contains baby cerebral palsy and grownup mind damage instances, in addition to deadly claims (together with inquests), lack of sight instances, in addition to failure to diagnose most cancers and gynaecological claims.