'Don't be too kind': Maternity staff used offensive terms to refer to patients

The midwife's notes were short and to the point.

The three letters, FOH, read she had written on a whiteboard next to the names of heavily pregnant women, but there were no women with a specific medical condition or requiring a particular type of care.

Rather, they were an acronym that stood for a three-word offensive statement implying that they wanted the women to leave Nottingham University Hospitals NHS Trust's maternity unit (NUH).

The F, a swear word. The O, standing for OFF. The H, short for HOME.

The acronym was used in a 2018 resignation letter from another member of staff, now seen by BBC Panorama, raising concerns about internal unit culture.

Another midwife was reported to have advised colleagues to go home with the advice: "Don't be too generous; she'll keep coming back.

The Nottingham Trust is currently at the centre of the largest maternity investigation in the NHS's history, investigating care provided to approximately 2,500 families between 2012 and 2025.

The inquiry has been looking at stillbirths, neonatal deaths, maternal suicides, and injured babies and mothers at NUH, which runs City Hospital and Queen's Medical Centre.

Panorama has seen previously unpublished papers and has also talked to ten midwives who worked there over the past decade, providing an interesting insight into what working conditions were like.

The probe, led by senior midwife Donna Ockenden, is set to announce its findings on June 24.

Nottingham believed that there was a Nottingham way, that they had some sort of superior NHS trust compared to others,

Ockenden says in Panorama.

Anthony May, the trust's current chief executive, who was not in possession at the time, has promised to fix the problems and told the BBC: "We have to take responsibility as an organisation.

In several of Nottingham's poor results, a consistent theme has been to keep women at home for as long as possible before giving birth.

One midwife we talked to recalled a woman calling the hospital to inform her she was in labor and that there was no need for her to be admitted at that time.

"When she first came in, her baby was dead. Because she hadn't been allowed to work for so long, the mother's perineum and vaginal wall collapsed. She now has a stoma bag.

A senior midwife wrote the 2018 resignation letter that was seen by Panorama, outlining the derogatory remarks from colleagues.

"I've never had to tell a woman so loudly, and so often, that if she didn't push, she'd have to kill her baby.

We published the letter's contents, including the FOH remarks, with Sarah Hawkins, whose fears were largely dismissed six days before her daughter, Harriet, was born in 2016.

That's quite upsetting for me to hear. She may as well have said that to me" after the last phone call I made to a ward manager, referring to the FOH initials.

Who writes that in a caring profession?

'Shopping for handbags online'

The extent to which a dysfunctional, bullying environment operated for years in Nottingham maternity services is what comes out from our conversations. One midwife recalled a junior employee who had been promised she would be cared for while caring for a complicated woman. But [she] was ignored while she buzzed [for help], the midwife explained. The coordinator and her cronies were frantically looking for handbags online.

There was persistent understaffing, particularly in light of the evidence of some midwives' poor attitudes.

They [management] would say the employee numbers were safe, but they weren't.

a community midwife who was often forced to work in the trust's maternity units due to midwifery shortages.

You have to be flexible, and to be resilient, you have to decrease your compassion.

After being told she had personally suffered with a late miscarriage, another midwife recalled being told that she had to return to the labour ward to birth babies.

There was a lack of compassion, passion, and concern, she said. A fourth midwife described it as a frightening place to work

where shifts were frantic and standards could fall, while a fifth recalled being the only one on shift capable of analyzing babies' heart rates using a monitoring device. She remembers

running in and out of people's rooms

and being worried that a mother or baby will die as a result of a lack of qualified staff.

We'd be working all night without food or a loo break. People were exhausted.

'All they did was blame HR.'

Sue Brydon, a senior midwife at the Queen's Medical Centre, wrote a letter in 2018 to the trust’s chairman, which was signed by more than 50 midwifery employees.

Inadequate staffing is the single most significant factor affecting the wellbeing of families and midwives as well as the cause of a potential disaster,

the letter said.

There has been a persistent shortage of clinical midwives as a result of a significant and persistent lack of workforce planning.

Despite their heartfelt pleas, Brydon told Panorama that the management's reaction had been inadequate. All they did was blame the HR department. The Royal College of Midwives estimated a shortage of 3,500 midwives in England at the time the letter was published. However, the Nottingham trust did not know how many midwives it needed because it had consistently miscalculated the number on each shift by including those off sick or on maternity leave. Anthony May, the incoming CEO's probe into 2023, found that no significant had occurred as a result of the letter. Rather than listening to employees, the board had relied on outside consultants to advise them on what to do but then failed to make changes.

We have a long line of external audits, many conducted at considerable expense, where the steps were clearly not put into place,

Ockenden, the senior midwife whose book this month, told us.

The trust also developed its own classification system for serious cases that were not included in the scheme used across the NHS in England. The procedure, which was described as

high-level incidents,

allowed an internal investigation to take place without being disclosed to regulators, thereby minimizing the chance of external scrutiny.

I can think of several significant areas of maternal abuse that were not disclosed [to regulators]. Parents are being forced to fight to have the death of their children declared as a serious occurrence. There are lots of examples.

said Ockenden. More than 800 trust workers have contributed to the maternity report, as well as another topic that has resurfaced, Ockenden said, was a lack of preparation and equipment. Mistakes can become more frequent in those circumstances. When one midwife first started at the hospital in the early 2010s, neonatal deaths were rare, but

increasingly normal, and staff became desensitised to what was going on, according to one midwoman. If something bad happened, [there] was often just an assertion that we did everything we could do. There was no such inclination to investigate your own practice or consider how you might have done it better.

Racist behaviour

In Nottingham, some former employees told Panorama that racial discrimination was a problem. Ockenden has already told the trust that she has seen hundreds of instances of racial profiling, including staff imitating accents and non-white women being treated more dismissively. South Asian women would complain about pain more, Ockenden explained.

But I don't think there were cultural differences at all; I think it was just discrimination. Anthony May has been leading Nottingham University Hospitals NHS Trust through the investigation, as well as attempting to establish bridges with families and work with an pending police probe.

One of the first things I did was to publicly state that we will combat bigotry in this company because it is both abhorrent and completely intolerable. And we did.

he said. The Care Quality Commission's most recent survey updated the trust's status from

inadequate to requires improvement.

We must take responsibility as an organization for not always providing the conditions for safe care, for not necessarily assisting families, and for not fully admitting to our mistakes and not always supporting our employees. We're trying to fix it right now,

May said.

A number of new initiatives have been introduced to make healthcare more accessible, including new clinical guidelines for every maternity service in England to avoid maternal deaths and injury.

The final report of a government-ordered inquiry into maternal and neonatal services in England is also expected to be published later this month.

Our thoughts are with the families in Nottingham who have been treated so badly by the Department of Health and Social Care.

We're already making strides on maternity care, with 2,000 more midwives being recruited, and £149 million to improve the maternity and neonatal care services' safety. "Get all the headlines you need to start the day with our flagship newsletter. Sign up here.