'Extremely disappointed' - Chair of Shropshire maternity inquiry speaks of 'two wasted years' in wake of scandal

Donna Ockenden, whose five-year inquiry concluded that hundreds of families were failed by maternity services at the Shrewsbury and Telford Hospital NHS Trust (SaTH), has been visiting some of the families who were affected by the scandal.

She said that for over two years the trust failed to communicate sufficiently with the families who had suffered from its failings, and that the psychological support offered had fallen short of what was expected.

Mrs Ockenden's report, published in March 2022, said there were at least 201 cases where mothers or babies died in the care of the trust when better care could have led to a different outcome.

She criticised the trust for communication with families under previous executive leadership but said families had found communication to be improved since the appointment of an interim chief executive in September last year.

Mrs Ockenden stressed that her remit did not extend to monitoring improvements to maternity services, but one mother had told her there had been a significant improvement.

"The reason I am back here in Shrewsbury, meeting some of the affected and harmed families, is because families were really clear that the trust wasted two years in not communicating with them," she said.

"The trust under the previous leadership let two years go by - there was no contact with harmed and affected families. I think what families have said to me is there has been an improvement in the attitudes of the trust since the interim chief executive took over.

"However, we are still at the stage where families are reporting to me warm words, but not yet the action they would like to see.

"I think listening has improved, but families tell me that whether we're actually seeing concrete action coming out of what families are saying remains to be seen.

"I am extremely disappointed on behalf of the families, because, in all honesty, they have deserved better from the trust since the publication of my report in March 2022. 

"It will be three years in March since I was in this building for the launch of my report, and there really was a clear road map.

"Families are very clear: ‘We need to see action, concrete action, that is going to give the families the assurance that the trust is listening and learning.'"

Mrs Ockenden highlighted the lack of progress in providing psychological support for families affected by their maternity care as a major concern.

"Many families are saying they've been left without the psychological support that they need, following on from what happened and the harm that was caused to them," she said. "As families have asked me to I will be speaking very clearly on the families' behalf today, to say the plan being put in place for psychological support is not sufficient, and needs to be ramped up as a matter of urgency."

Mrs Ockenden said some psychological support was provided in the period immediately after her report, but communications between the trust and affected families did not happen post the publication of the independent report in March 2022. 

"Families have stressed to me that we have a period of time when the families are not engaged with. And now that engagement has restarted, because I am involved, I am hearing that families have still got unmet psychological needs."

Mrs Ockenden said a plan had been put in place to deal with the need for psychological support, but that from the perspective of the families it was not adequate.

"To be fair to the trust, they took professional advice on what was needed to be set up, but the staff allocated to this psychological support has not been sufficient.

"I've been saying for many months that it's insufficient, and yesterday I spoke with the interim chief executive and the medical director to set out again why I believe it's insufficient. To be fair to them action has been promised, but families and I want to see the results of those promises.

"I am confident we will get there, but we just need to transform that," she said, adding that families were very clear of the continued need for her involvement in creating a bridge between affected and harmed families and the trust.

She said that while she had no detailed information on the performance of maternity services since her review - that fell outside the scope of her inquiry - she had heard reports from a recent mother that great improvements had been made.

"I have spoken to a mother who previously suffered significant harm in maternity services, and has since gone on to have a very beautiful baby. She's said to me in her experience there's been a transformation," she said.

"She's one mother. She's recently had a baby at the Princess Royal Hospital in Telford, and says the two experiences are chalk and cheese - in a good way - but I can't comment any more than that."

Jo Williams, chief executive of SaTH, said: “We are grateful to the families who are meeting with us to share their experiences and we will continue to offer regular meetings with any families who want to be involved. 

"What I have heard has had a profound impact. I am so sorry for the pain and distress families have experienced.

“We have made significant progress in our maternity services but there is more we need to do to build trust. We will continue to listen and learn and to make sure the changes we make are real, positive and can be sustained.”

Mrs Ockenden said that during the course of her review, she had been in Shropshire on a regular basis, speaking to families about their experiences.

She said: "I honestly believed that when I said 'goodbye' to our last family - we met again yesterday actually - at the end of their feedback, that was it, it was 'goodbye Shropshire', my job had been done. 

"So to come back and hear that families are still hurting, that in over two years since my report was published they haven't been communicated with or listened to, and that they don't necessarily yet feel assured that all of the change that should have happened has happened, is extremely disappointing."