The Nottingham Affected Families Group has written three separate letters to the government's Honours Forfeiture Committee, each asking that a CBE be removed from a former senior manager at Nottingham University Hospitals NHS Trust. The requests follow the publication in June of the Ockenden Report, the independent review into maternity and neonatal care at the trust, which found that more than 500 mothers and babies suffered potentially avoidable harm and that 162 babies died after receiving substandard care. The report, running to more than 400 pages and covering cases from 2012 to 2025, describes deeply embedded systemic failures within a culture the review team characterised as toxic.

The forfeiture mechanism itself is narrow. The committee can recommend that an honour be withdrawn where its holder is judged to have brought the honours system into disrepute, and it may act on conduct that predates the award as well as conduct that follows it. It does not determine guilt or issue findings of its own; it weighs public confidence against the record already established elsewhere, in this case by a review commissioned by ministers and led by the midwife Donna Ockenden. The families' letters, reported to note that the review's criticisms are directed at the trust's leadership and governance collectively rather than at named individuals, ask the committee to treat that collective finding as sufficient grounds for individual consequence.

That framing captures the difficulty at the centre of NHS accountability more broadly. Reviews of this kind are built to establish system failure, not to apportion blame to specific office holders, and the language of culture and governance that makes for a credible clinical safety review is precisely the language that makes personal sanction hard to pursue. Nearly half of the senior directors approached by the Ockenden review declined to engage with it at all, a detail that has done as much to inflame families' sense of unaccountability as any individual finding in the report. No serving or former manager at the trust has faced disciplinary, professional or criminal sanction to date, though Nottinghamshire Police is separately running a criminal investigation, Operation Perth, examining potential offences including corporate manslaughter.

Families have been explicit that financial penalties imposed on the trust, including fines from regulators following criminal prosecution, fall ultimately on taxpayers rather than on those who ran the organisation while care was failing. The push for forfeiture is a way of directing consequence somewhere financial redress cannot reach. There is a recent precedent for this route succeeding: Paula Vennells returned her CBE after the Post Office Horizon scandal once public pressure and a parliamentary inquiry made her position untenable, and the honour was later formally stripped. Whether the Nottingham case follows a similar path will depend less on the strength of the families' argument than on whether ministers, currently confined to describing the Ockenden findings as chilling rather than acting on individual cases, choose to let the forfeiture process run its course or intervene more directly.

For NHS leadership more widely, the case sharpens a question that has followed successive maternity scandals from Morecambe Bay to East Kent and Shrewsbury and Telford: whether governance failure at this scale can continue to be absorbed institutionally, with trusts restructured and reviews commissioned, while the individuals who held office throughout move on largely undisturbed. Calls are already building for a statutory public inquiry and for new criminal penalties targeting NHS managers who withhold evidence or obstruct safety investigations. If the forfeiture committee declines to act, or moves slowly, that argument for statutory teeth will only gain force. If it does act, it will set a precedent that other trusts facing their own reckonings will not be able to ignore.