What next for troubled Nottingham NHS trust after £1.6m fine?

The NHS is largely funded by public funds paid through taxes and national insurance.

In February, one of the most frequented and larger trusts in England received a record fine of 1.6 million pounds sterling on maternity failures as part of the death of three babies.

NHS Trust of Nottingham University Hospitals (NUH) is already at the center of the largest maternity review of the genre in the NHS, after hundreds of deaths and baby injuries.

When he was sentenced to a fine in the Court of First Instance in Nottingham, the judge said that the trust operated on a deficit of around 100 million pounds sterling and added that there was “no money to pay substantial fines without obliging the trust to make new discounts”.

District judge Grace Leong examined other judgments and judicial directives for comparable offenses before transmitting the fine.

So, why has a service already in difficulty and funded public was given such a fine, and what justice has it brought the fine for families that trust has dropped?

Adele O’Sullivan died on April 7, 2021 – just 26 minutes – Kahlani Rawson died on June 15 at four days and Quinn Lias Parker died on July 16 at two days.

Nuh pleaded guilty to six charges of non-supply of safety and treatment care to babies and their mothers, in a pursuit provided by the healthcare dog, Care Quality Commission (CQC).

The court learned that there were similar failures in the three cases, including non-compliance with the delivery of babies, and not recognizing serious conditions, communication problems and staff not being equipped to interpret anomalies in fetal heart surveillance.

It was the second time that the trust was prosecuted by the CQC for maternity failure.

In 2023, the trust was sentenced to a fine of £ 800,000 for the death of Wynter Andrews, who died shortly after his birth at the Queen’s Medical Center in 2019.

Until this year, this fine was the most important transmitted for maternity failures.

NUH prosecutions constitute two of the five criminal proceedings linked to the maternity unit brought by the CQC.

Watchdog obtained powers under the 2014 law of the 2014 Health and Social Services law (regulated activities) in 2015.

This pursuit by the CQC is distinct from any prosecution which could result from a guilty manslaughter, which was opened earlier this month.

On June 2, Nottinghamshire police said they were examining whether the maternity care provided by Nuh had been roughly negligent.

In her remarks of condemnation, the district judge Grace Leong said that she should resolve an “important financial sanction” to mark the gravity of the offenses, but also had to find “a delicate balance”.

“I cannot ignore the negative impact that the fine will have on patient services at a time when the NHS continues to deal with unprecedented challenges both in terms of insufficient financing, the backwards of patients awaiting processing and requests imposed on the trust services of an aging population,” said the judge.

There was no ceiling at the level of the fine that the judge could impose.

This meant that the sentence was a question of discretionary power, the judge considering other sources of orientation – such as any judgment of the High Court or the Court of Appeal – and other directives of determining the sentence for comparable offenses.

It was reduced by a starting point of 5.5 million pounds sterling, because the judge took into account the financial implications on the public organization and his guilty pleas.

Nuh only wanted anyone for maintenance and did not want detailed how the fine could have an impact on the services.

However, in response to the BBC, a declaration by the CEO of NUH, Anthony May, said: “We fully accept the conclusions of the court, including the fine transmitted by the judge.

“The mothers and families of these babies had to endure things that no family should after the care provided by our hospitals who failed them, and for that, I am really sorry.

“We will work to minimize the impact of the fine on our patients, including continuous efforts to improve our maternity services.”

Roy Lilley, former president of the former Homewood NHS Trust in Couttsey, Surrey – who then merged with Ashford and St. Peter’s Hospitals NHS Trust – and now an independent commentator on health services issues, said that an impact on services would be “inevitable”.

“It is clear that a part of money as 1.6 million pounds sterling will have an impact on the ability of the trust to work.

“The daily functioning of the trust is, of course, quite difficult with all financial pressures, but for this type of money to be removed from its income sales, this makes it even more difficult,” he said.

Mr. Lilley – Who did not work for Nuh – added: “It will certainly slow down some of the plans they had in terms of improvement.”

“Generally, it has a very bad effect, a great impact on the ability of the trust to respond,” he said.

Lilley said that it was possible for the trustees to ask for loans from the Ministry of Social Coins (DHSC) in the face of financial difficulties.

The BBC understands that NHS trust should comply with their legal and financial obligations – including prosecution fines – they can access loans in some cases.

The annual trust budget is 1.8 billion pounds sterling.

Families affected by NuH maternity failings have always called for responsibility.

After the conviction, the lawyer Natalie Cosgrave – representing the parents of Baby Quinn – said in a statement that the accusation was “the only system that exists” to obtain it.

Sadie Simpson, an associated lawyer for clinical negligence that represented the families of Adele and Kahlani, told BBC that the guilt of the trust of the trust was “a certain level of responsibility, but it is only part of a much greater image”.

For the bereaved families, it is the people who should be held responsible, not only the trust as an organization, said Ms. Simpson.

Ms. Simpson also represented the families of Adele and Kahlani, as well as others, in civil complaints against Nuh.

At each stage of the various surveys and procedures they have endured – including surveys, internal exams and court hearings – families have called for more change and careful examination.

Ms. Simpson said: “The judge was very clear that a fine is the only sentence she can impose, and no fine will never be sufficient when you have lost your child.”

During the conviction in February, the previous case of Wynter Andrews – who died 23 minutes after birth – was referenced several times.

His parents Sarah and Gary Andrews watched the audience of the public gallery “as parents concerned”, but did not know that the case of their daughter would be mentioned “completely obvious”.

“I think that for us, it is important to emphasize that this process is the only avenue that families must obtain some responsibility,” he said.

“The judge is in a really difficult position, I think, but we count cents on the lives of babies.”

The fine is paid to HM Treasury – the Government Ministry of Finance which controls public spending – as for any fine of prosecution.

Families affected in this case will not receive any money from the accusation.

The trust was also invited to cover the prosecution fees of £ 67,755.23 and a compensatory suramende from £ 190.

The prosecution costs in this case will be paid to the CQC.

The compensatory suramende – which is imposed on offenders to ensure that they assume a certain responsibility towards the cost of victims of support and witnesses – go to the general fund and not directly to the persons involved.

This money makes a contribution to the support services funded by the Ministry of Justice to victims and witnesses.

The fine of 1.6 million sterling pounds is distinct from the tens of millions of pounds that the trust has paid into damages for civil complaints concerning maternity care.

The Nottinghamshire police investigation into the maternity services of the trust – called Operation Perth – has seen more than 200 family cases which have been returned to it so far.

Meanwhile, the maternity magazine distinct from the senior midwife Donna Ockenden is currently examining the testimony of more than 2,000 cases.

The exam started in September 2022 and closed to new cases at the end of May.

The final report of Ms. Ockenden’s results should be published in June 2026.

And last week, the Trust announced its intention to reduce at least 430 jobs to try to save 97 million pounds Sterling next year.

The expected job cuts follow the government’s instructions to all the trusts to reduce the size of their business and support services, and were not following the Fine Record, the trust said.