Maternity failures: Corporate manslaughter and accountability in the NHS

As a former NHS midwifery matron and now as a litigation midwife working in clinical negligence, I have reviewed countless cases of avoidable harm in maternity care. But the recent developments around a police investigation into potential corporate manslaughter at the Nottingham University Hospitals NHS Trust mark a sobering and significant shift in how maternity failures are now being scrutinised.

In a huge step, we are seeing a police-led investigation into whether organisational failings in a maternity service may have reached the criminal threshold for corporate manslaughter. This implies a systemic breakdown in duty of care at the highest level—where senior leadership may have failed to ensure the safety of mothers and babies, resulting in avoidable deaths. Reputational damage and financial penalties are one angle of the consequences of a corporate manslaughter conviction, but also this could also fundamentally alter how NHS maternity services are overseen and held to account. It sends a clear message: where death results from systemic neglect, there may be criminal consequences.

From a medico-legal perspective, this is a pivotal moment. Traditionally, maternity-related litigation has focused on civil claims—seeking financial compensation for families where negligence has caused injury or death. These cases, while vital and important to the individual families for recovery and closure, do not always lead to structural change. A criminal investigation into corporate manslaughter, however, places the responsibility directly on those in charge of governance, risk management, and culture within NHS Trusts.

This change in approach reflects what many midwives working in the field have long suspected: that some maternity scandals are not simply about isolated clinical errors, but point more towards institutional neglect. In the Nottingham case, years of warnings, whistleblowing, and external reviews were reportedly overlooked or dismissed. Women and families raised concerns, and many were met with silence or even hostility. The quantity of missed opportunities and cases of avoidable harm are yet to be quantified, but this figure will undoubtedly be significant.

This direction in maternity care investigations demands serious reflection from all of us working in the field—but especially from those at the top. It is no longer sufficient for maternity units to review safety incidents in isolation. We must ask: were warning signs ignored? Were staff concerns dismissed? Was the culture one of learning, or of defensiveness? Crucially, we must not direct these questions solely at maternity leaders, who are often left carrying the weight of accountability. Instead, the focus must shift upward, toward Trust executives and board-level decision-makers. It is essential that any escalation of concerns or requests for service development from maternity leadership to the executive team is formally recorded, creating a clear audit trail of responsibility. Only then can we truly understand where breakdowns occur—and ensure that those with the power to act are also held to account.