Nottingham University Hospitals NHS Trust has received a "requires improvement" rating for its maternity services for the second consecutive year, following an unannounced inspection by the Care Quality Commission in May 2025. The trust, which is simultaneously subject to the largest independent maternity inquiry ever conducted within the NHS, has pointed to the administrative weight of that investigation as a contributing factor in its difficulty maintaining consistent progress on current care standards.

The Ockenden Review, led by senior midwife Donna Ockenden, has been examining around 2,500 cases involving the deaths or serious injury of babies and mothers at Nottingham City Hospital and Queen's Medical Centre since 2022. Its final report is expected in June 2026. Running alongside it is a corporate manslaughter investigation launched by Nottinghamshire Police in June 2025, known as Operation Perth, which is examining whether the maternity care provided at the trust was grossly negligent. Together, these processes have placed sustained demands on senior leadership at a time when the trust is also required to demonstrate measurable improvement to the regulator.

The CQC's unannounced inspection identified three regulatory breaches at both hospital sites, covering security arrangements, staffing levels, and the overall management of maternity services. Both Nottingham City Hospital and Queen's Medical Centre were rated good for effective, caring, and responsive care, but rated requires improvement for safety and leadership. The trust was directed to submit a formal action plan.

Trust management has not contested the findings. Chief executive Anthony May acknowledged that internal mechanisms for staff to raise concerns had not been functioning adequately, after it emerged that staff had gone directly to the CQC with grievances rather than through internal channels. That disclosure preceded the inspection and informed its scope. Mr May subsequently committed to reviewing how concerns escalated within the organisation.

The CQC carries out unannounced inspections precisely to assess the quality of care as it operates in practice, independent of any preparatory activity on the part of the provider. The regulator examines staffing arrangements, patient records, safeguarding protocols, and the overall governance of a service. Its published ratings carry direct consequences for public confidence and for the trust's relationship with commissioners. The framework does not provide for reduced expectations where a provider is simultaneously managing a major inquiry, and the CQC has not indicated any intention to modify that position.

The challenge for the trust is practical rather than simply managerial. Supporting a review of 2,500 cases, cooperating with a police investigation, and implementing a series of remedial actions already directed by the regulator draws on the same pool of senior clinical and operational leadership that is also responsible for day-to-day service governance. The Ockenden Review team has itself noted that the pace of improvement has been slower than expected, and that workforce issues, particularly an over-reliance on newly qualified midwives without adequate senior support, have persisted across multiple assessment periods.

Ms Ockenden previously raised concerns about delays between CQC inspections and the publication of findings, arguing that a nine-month gap between a visit and its published report reduced the practical utility of the regulator's conclusions for a trust actively trying to implement change.

The NUH situation reflects a dilemma that has no straightforward resolution. A trust under active investigation for historic failures is simultaneously obligated to demonstrate improvement in present-day care. Both demands are legitimate. Both require significant managerial attention. The regulatory framework, designed for providers operating under ordinary conditions, does not formally account for the compounded burden of operating in both contexts at once. Neither the Department of Health nor the CQC has provided a precise answer as to whether the existing regulatory framework successfully differentiates between an organization failing to progress and one whose improvement is genuinely hampered by the immense structural requirements of addressing past harm.

The trust's well-led rating has improved since its previous inadequate assessment, which indicates some progress. For the families whose cases remain part of the Ockenden Review, pending its publication in June 2026, that incremental movement offers limited reassurance.

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