Ockenden 2022: if we want to see real change, then transparency and accountability is key

10am on Wednesday March 30, 2022: the final Ockenden Report is published.

12.45pm the same day, the Secretary of State for Health and Social Care, Sajid Javid, stands up in the House of Commons to apologise to the families involved for the failings set out in the report, and to announce that the Government accepts in full the report’s recommendations.

Little pause for thought. Little pause for reflection. Little pause to gather stakeholder views. Little sense of needing to do some detailed work to understand what extra information the report offers, or to understand the true nature of the action now needed, both within and beyond our maternity services, to really make a difference.

This smacks of desperation. Of a Government wanting to be seen to do the right thing.The governing classes have been caught out by ‘us little people’, in this case the courageous, passionate and tenacious families who were harmed, who have spoken up and demanded action. Thanks to them, we now have a detailed report exposing the scale of harm they have suffered, detailing the myriad ways in which families are let down by the systems that we believe are there to support us.

The immediate reaction from the Government is to apologise profusely - as they should, having presided for so many years over a national maternity service which was known to be dysfunctional. To say ‘we’ll do what we’re told’. Nothing to see here, our people will be sorting this out. At first glance, this may seem reassuring, especially to the families directly affected by the failings of the Shrewsbury and Telford Hospital NHS Trust. And they surely deserve to be reassured.

This Government response may also be politically expedient. But it doesn’t feel satisfactory. Whilst giving the impression that the Government takes this report seriously, it offers little genuine reassurance that the necessary improvements will be made.

To put this report into context, NHS England has a Maternity Transformation Programme underway. That’s because we already knew that we have a maternity service that is in crisis. Previous task forces and review teams have told us this, and more reviews are currently underway. And what rightly shocks many about this latest report is how its conclusions resonate with those previous reports.

So here’s the conundrum. The Maternity Transformation Programme has been developed to respond to the toxic mix of problems addressed - once again - by the Ockenden Report. Yet we know that some of the recommendations from previous reviews remain outstanding. There is now a need to consider carefully what changes or additions should be made to the existing Programme, including in the light of the new Immediate and Essential Actions (IEAs) identified in this latest report. This in itself is a complex piece of work, if it is to be done effectively. But will the melding of these recommendations into the work plan really make a difference?

That depends. One key question is whether the Programme Board has the insight, the courage, the clout, and the access to the cash, needed to secure the necessary radical change nationwide. And importantly, whether it has the influence to effectively demand - and see delivered - the changes needed within and beyond the maternity care system, for example within bodies - such as the CQC - charged with assessing the quality of the maternity services.

The Maternity Transformation Programme - overseen by a Board chaired by Sarah-Jane Marsh, CEO of Birmingham Women and Children’s Hospital - has arguably made a valiant effort. Over the last six years, it has made a start on responding to previous reviews and their recommendations, taking into account a wealth of evidence about what works, refashioning our maternity services as demanded by the report of the National Maternity Review, Better Births. It has correctly identified that improved leadership is key, and has a programme of work in place that has started to deliver on this. It has made a good start on supporting Trust boards to better understand how to effectively organise, oversee and scrutinise the performance of their maternity services. It has been working hard to bring onstream a wide range of important initiatives that will all contribute to maternity service improvement. But is this enough?

For AIMS, what seems still to be missing is transparency around the work of the Maternity Transformation Programme, and the maternity services more generally, so that Ministers - and the public - can be assured that the Programme itself is fit for purpose and operating effectively.

For us, that means it’s time for a detailed look at the progress that has been made by the Maternity Transformation Programme Board, and to use this to drive greater accountability. What have been its achievements? What are the barriers to further progress, both within and outside of its control? And - most importantly - to what extent has the Programme been able to support and influence local maternity services in undertaking the profound changes required to deliver on the holistic Better Births vision? This, at its core, demands that dysfunctional organisational cultures must be tackled, because we know this is what too often stands in the way of hard-working maternity staff delivering the personalised, safe and equitable care we need.

As part of this progress report, we must reach an early shared understanding of the impact of the work that has taken place in response to the national Immediate and Essential Actions (IEAs) set out in the interim Ockenden Report. Have they been actioned as intended? Is this work making the hoped-for impact, and how is that being measured and evaluated at both local and national level? What have we learnt, in undertaking this work, that will help Trusts who are now embarking on implementing the new raft of Actions?

More specifically, we ask that every Trust is instructed to publish in full on its website a detailed explanation about its level of compliance with the interim IEAs, in parallel to reporting this to the local board. Local residents must be able to access this information easily, so that they can scrutinise it against their own experiences and make their own assessment about the quality and impact of this work. We would hope that local residents would then feed back their views, perhaps via the local Maternity Voices Partnership, so that all feedback gets to those who need to hear it. Local Maternity Voice Partnerships may also wish to offer their ‘critical friend’ services in this key area; to do this, they too need access to the necessary information.

When reports such as the Ockenden Report are published, there is a collective desire to trust that change will be forthcoming. In the face of a report that details so many stories of failings, it is perhaps impossible to believe that nothing will be done. In our gratitude to the families and the review team who have worked so hard to achieve this public reckoning, it is hard to admit that there remains the possibility that this will not be enough. Sadly, however, we learn time and time again that such reports do not inevitably lead to positive change. We must now work to ensure that the transformation agenda is underpinned by cross-party support. Those in charge of reform must proceed within a framework of transparency and accountability, at both the national and local level. Only that will offer us the required level of assurance that the Government really is serious about change.

By the AIMS Campaigns Team

April 7, 2022

Further reading: AIMS Campaigns Team comment on the Ockenden Report and next steps