The midwife’s notes were short and to the point.
The three letters – « FOH » – that she had written on a whiteboard next to names of heavily pregnant women were not there to alert colleagues to women having a specific medical condition or requiring a certain type of care.
Instead, they were an acronym for a three-word offensive statement signalling they wanted the women to leave the maternity unit run by Nottingham University Hospitals NHS Trust (NUH).
The « F », a swear word. The « O », standing for « OFF ». The « H », short for « HOME ».
The acronym was described in a 2018 resignation letter from another member of staff, now seen by BBC Panorama, raising concerns about attitudes within the unit.
In the same letter, another midwife was reported to have advised colleagues to get pregnant women, who had arrived worried they were going into labour, to go home with the advice: « Don’t be too kind, she’ll keep coming back. »
The Nottingham trust is currently at the centre of the largest maternity inquiry in the history of the NHS – looking at care provided to about 2,500 families between 2012 and 2025.
The inquiry has been investigating stillbirths, neonatal deaths, maternal deaths, and injured babies and mothers at NUH, which runs City Hospital and Queen’s Medical Centre.
Panorama has seen previously unreported documents and has also spoken to 10 midwives who worked there, about their experiences over the past decade providing a unique insight into what working conditions were like.
Led by senior midwife, Donna Ockenden, the inquiry is due to publish its findings on 24 June.
« Nottingham thought that there was a Nottingham way, that they were some kind of superior NHS trust compared to others, » Ockenden tells Panorama.
The current chief executive of the trust, Anthony May, who was not in position when the allegations were made, has vowed to fix the problems and has told the BBC: « We need to take accountability as an organisation. »
A determination to keep women at home for as long as possible before giving birth is a constant theme in many of the poor outcomes experienced in Nottingham.
One midwife we spoke to recalled a woman calling the hospital to say she was in labour and being told there was no need for her to be admitted at that time.
« When she came in, her baby was dead. The mother’s perineum and vaginal wall collapsed because she’d been left to labour for so long. She now has a stoma bag. »
The 2018 resignation letter seen by Panorama, detailing the offensive remarks from colleagues, was written by a senior midwife.
In it, she also noted she had once overheard a colleague say: « I’ve never had to tell a woman so loudly, and so often, that she would kill her baby if she didn’t push. »
We shared the letter’s contents, including the « FOH » remarks, with Sarah Hawkins, whose concerns were repeatedly ignored over six days before her daughter, Harriet, was stillborn in 2016.
« That’s quite upsetting for me to hear. The last phone call I made to a ward manager, she might as well have just said that to me, » she said, referring to the FOH initials.
« Who writes that in a caring profession? »
What becomes apparent from conversations we have had with former staff is the extent to which a toxic, bullying culture operated for years within maternity services in Nottingham.
One midwife recalled a junior staff member who had been promised she would be supported while she cared for a « complicated woman ».
« But [she] was ignored when she buzzed [for help], » the midwife told us.
« The co-ordinator and her cronies were busy shopping for handbags online. »
Coupled with the evidence of the poor attitudes of some midwives, there was chronic understaffing.
« They [management] would say the levels of staffing were safe, but they definitely weren’t, » said a community midwife who was often forced to work in the trust’s maternity units because of midwifery shortages.
She added: « You have to be resilient, and to be resilient you have to lower your compassion. »
Another midwife recalled being told she had to return to the labour ward to deliver babies, after she had personally experienced a late miscarriage.
« There was a lack of empathy, interest and care, » she said.
A fourth midwife described a « frightening place to work », where shifts were frantic and standards could slip – while a fifth recalled having been the only person on shift capable of analysing babies’ heart rates using a monitoring machine.
She remembers « running in and out of people’s rooms » and fearing a mother or baby would die because of a lack of appropriate staff. « Sometimes we’d work all night without food or a loo break. People were exhausted. »
In 2018, Sue Brydon, a senior midwife at the Queen’s Medical Centre sent a letter to the director of midwifery and the trust’s then chairman, signed by more than 50 midwifery staff.
« The single most important factor threatening the wellbeing of families and midwives and the cause of a potential disaster is inadequate staffing, » the letter read.
« There has been a serious and ongoing failure of workforce planning, leading to a chronic shortage of clinical midwives. »
Despite their heartfelt pleas, Brydon told Panorama the reaction of the management had been « inadequate ».
« All they did was blame the HR department. »
At the time the letter was written, the Royal College of Midwives calculated a shortage of 3,500 midwives in England. But the Nottingham trust did not know how many more midwives it needed because it consistently miscalculated the number on each shift by including those off sick or on maternity leave.
A 2023 investigation by the current chief executive, Anthony May, found nothing meaningful had occurred as a result of the letter. Rather than listening to staff, the board had relied on commissioning external reviews to tell them what to do, but then failed to make improvements.
Ockenden, the senior midwife writing this month’s much-anticipated report, told us: « We have a whole long line of external reviews, probably conducted at significant expense, where the actions were simply not put into place. »
The trust also developed its own classification system for serious incidents, outside the framework used across the NHS in England.
Called « high level incidents », the process allowed an internal investigation to take place without it being reported to regulators, thereby reducing the chance of external scrutiny.
« I can think of some very serious issues of maternal harm that were not reported [to regulators]. Parents… having to battle to get the death of their babies declared as a serious incident. There are lots of examples, » said Ockenden.
More than 800 trust staff have spoken to the maternity review and another theme that has kept coming up, Ockenden told us, was of a lack of training and equipment.
In those conditions, mistakes can become more common. One midwife says when she first started at the trust, in the early 2010s, neonatal deaths were rare but became « increasingly common » and staff became « desensitised » to what was happening.
« If something bad happened, [there] was quite often just an assumption that we did all we could do. There wasn’t that tendency to examine your own practise or think about how you could have done things differently. »
Some former staff told Panorama that racial discrimination was a problem in Nottingham.
Ockenden has already told the trust she has come across « countless » examples of racist behaviour – including staff mimicking accents and non-white women being treated more dismissively.
« There was this ongoing thing that South Asian women would complain about pain more, » Ockenden told us. « But I don’t think it was cultural differences at all, I think it was just discrimination. »
Since 2022, Anthony May has been leading Nottingham University Hospitals NHS Trust through the review, as well as trying to build bridges with families and work with an ongoing police investigation.
« One of the first things I did was publicly say that we would tackle racism in this organisation, because it’s abhorrent and utterly unacceptable. And we did, » he said.
A recent report from the regulator, the Care Quality Commission, improved the trust’s standing from « inadequate » to « requires improvement ».
« We need to take accountability as an organisation for not always providing the circumstances for safe care, for not always supporting families, for not also admitting our mistakes and for not always supporting our staff. And we’re trying to fix that now, » May said.
NHS England told Panorama: « A number of new initiatives have been introduced to make care safer, including new clinical standards for every maternity service in England to prevent maternal deaths and harm. »
The final report of a government-ordered investigation into maternity and neonatal services in England is also expected to be published later this month.
The Department of Health and Social Care said: « Our thoughts are with the families in Nottingham who have been failed so badly.
« We are already making progress on maternity – recruiting 2,000 more midwives, investing £149m to improve the safety of maternity and neonatal care facilities. »
Additional reporting by Katie Langton and Katie Rice
