The report of the inquiry into the biggest maternity scandal in NHS history will outline “horrendous” failings in the care provided to women in Nottingham, the Guardian can reveal.

A catalogue of appalling behaviour over many years by staff at the city’s two hospitals – Queen’s Medical Centre and Nottingham City hospital – included racism towards mothers, it will say.

The NHS is bracing itself for the publication on Wednesday of a report by Donna Ockenden on 2,500 cases involving babies and mothers dying or being injured, and babies being stillborn, while under the care of Nottingham university hospitals NHS trust between 1 April 2012 and 31 May 2025.

A senior source with knowledge of Ockenden’s conclusions said: “The findings in the Nottingham report will be very bad. It’s going to be horrendous. There will be some pretty challenging stuff in the report.”

The document will stretch to more than 350 pages. Ockenden, a senior midwife and expert in maternity care failings, began her inquiry into Nottingham more than four years ago, in May 2022. About 2,505 families – more than in any previous maternity scandal – and approximately 850 staff and ex-staff of the NHS trust have given evidence to it.

Ockenden was appointed after families demanded a full-scale inquiry into what they said was the trust’s poor and dangerous treatment of women during their pregnancy, and especially when giving birth.

Nottinghamshire police are still considering whether to charge the trust with corporate manslaughter. The force’s Operation Perth has been examining the care that at least 200 families received.

In anticipation of Ockenden’s report, the Nottingham Maternity Families Group urged Keir Starmer to order a statutory public inquiry into maternity care across England as a whole.

“We have every confidence that Donna Ockenden and her team have left no stone unturned in uncovering the unsafe practices, cultural failures and inadequate leadership that have contributed to avoidable maternal and baby deaths, stillbirths and life-changing brain injuries over many years,” the group said in a statement to the Guardian.

It said Ockenden’s recommendations must be “implemented in full. Anything less would be a betrayal of the families whose suffering has made this review necessary. We know that the problems are not unique to Nottingham and the time has come for there to be a statutory public inquiry into maternity and neonatal services across England.”

The Nursing and Midwifery Council (NMC), which regulates those professions, is investigating 96 midwives and nurses at the trust for alleged misconduct. Eighty of those cases are still being assessed and 15 are under full investigation.

One midwife is the subject of an interim order and has been suspended from working while fitness to practise proceedings are under way, the NMC said.

James Murray, the health secretary, has vowed to push through major changes to maternity care and not let Ockenden’s recommendations – or those from Valerie Amos’s government-commissioned inquiry into maternity care across England, which is due to report next week – “sit on a shelf”, as many of those produced by previous childbirth care investigations have done. He met some of the affected families in Nottingham last Thursday.

“Since becoming health secretary, I’ve spent time with families who have suffered shocking failures in maternity care to hear about their experiences and to discuss with them what they want to see happen,” Murray said.

Noting the importance of Lady Amos’s national investigation, he said: “One of the things I’ve heard very clearly from families is that recommendations must not sit on a shelf – as we’ve seen so many times before – and must instead be turned into a tangible plan of action. My focus as secretary of state is to make sure that change happens.”

The government is considering setting up a full public inquiry into maternity care because so much of it is “truly shocking”, its adviser on the subject disclosed last week.

The Labour MP Michelle Welsh, who was appointed as the government’s maternity adviser last month, told a Medical Journalists Association (MJA) conference that she was “in conversations” with the Department of Health and Social Care about a public inquiry.

Such an inquiry would bridge the gap faced by Ockenden’s inquiry in that it could not compel witnesses to attend and give evidence, Welsh said. She said it had been hampered by the fact that those “in very, very senior positions” in the NHS at the time of the scandal “can personally decide that they are not going to engage in it”.

Welsh, the MP for Sherwood Forest in Nottinghamshire since 2024, told the Politics Home website about her traumatic experience when she had her son Billy, who is now six, at Nottingham City hospital.

She told the MJA event: “I was even approached by a senior obstetrician at the [Nottingham] trust who arranged a meeting at my office under a different name not to discuss solutions, not to listen to families, but to persuade me there wasn’t a problem, to convince me that maternity services at Nottingham university hospitals trust were fine, that what families were saying wasn’t true, and the midwives stepping forward to not believe them, yet every week more families came forward, more midwives came forward.”

Ockenden believes there is “an improving culture in maternity services in Nottingham in 2026 but there remains work to do”.

Anthony May, the trust’s chief executive, who took over in 2022, after the scandal emerged, has pointed to improvements including better recruitment and retention of maternity staff. But improvement remained a “work in progress”, he said last week. He has apologised to families who were harmed by the trust’s shortcomings.

In its most recent report in March, based on its inspection in May 2025, the CQC found that maternity services at both of the trust’s hospitals had improved but it continued to rate them as “requires improvement”.