How messages between two dads helped expose the largest NHS maternity scandal

They knew about the problems before the incident as there was a report:

He said, to his understanding, the report itself was never put into the public domain and was marked for internal use only. He said it had been presented to a quality committee, which feeds information to the public board.

But it took half a thousand child deaths for them to “apologise”.

NUH apologised and said major changes would be made.

Given that they had known about the problems and did nothing, I doubt they would suddenly change course. And this isn’t even the first time.

In February last year, the trust became the first to be prosecuted by the CQC more than once, when it was fined £1.6m for “avoidable failings” connected to the deaths of three other babies in 2021.

At every level an enormous amount of money and effort is spent on avoiding responsibility and doing the as little as possible. I don’t know how to change that yet, but looking at other countries where it works might be a lead.