Regulator sounds alarm over ‘culture’ in maternity care

It comes after a series of high profile reviews into maternity services.

The regulator warned there are ‘signs’ of poor workplace cultures in maternity services (PA)

Midwifery leaders have sounded the alarm over poor workplace cultures in maternity services.

Some midwives are not always speaking up when they see something that is not right, and not communicating well enough with colleagues or people in their care, according to a new Nursing and Midwifery Council (NMC) report.

The regulator warned there are “signs” of poor workplace cultures in maternity services.

Often the actions of individual professionals are shaped by the culture and environment in which they work – with bullying, excessive workloads, burnout and unsupportive management being contributory factors in major failings of care across different sectors

NMC report

It comes after a series of maternity reviews into trusts including Shrewsbury and Telford and East Kent.

And the inquiry into baby deaths at Nottingham University Hospitals NHS Trust is expected to be the largest review yet.

The NMC, which regulates all nurses and midwives registered to work in the UK, examined details from its fitness to practise cases – which only involve a small minority of midwives – and data from other sources including the NHS staff survey.

“It is clear that organisational factors get in the way of professionals providing the kind of care that women have a right to expect,” the report states.

“We found many common themes. These include midwives not always speaking up when they see something that isn’t right, and not communicating well enough with colleagues or people in their care.”

The authors said that additional concerns include specific competencies of midwives – such as how well they can monitor the heart rate of babies and mothers’ contractions – and in some cases a lack of empathy and compassion for people in their care.

They added: “What’s clear from our case audit, wider research, and inquiries is that often the actions of individual professionals are shaped by the culture and environment in which they work – with bullying, excessive workloads, burnout and unsupportive management being contributory factors in major failings of care across different sectors.”

In maternity care, there are more signs that workplace cultures aren’t always supporting midwives to escalate concerns or communicate effectively with women and families

Andrea Sutcliffe, Nursing and Midwifery Council

The new report from the NMC highlights other problems facing nurses and midwives in the health service including a racism faced by black and minority ethnic nurses and midwives and poor levels of support for newly qualified nurses and midwives.

Some 28% of nurses and midwives registered to work in the UK are from black or minority ethnic backgrounds.

Yet the report concludes that the “health and care sector is failing to provide a just, inclusive environment in which all black and minority ethnic nurses, midwives and nursing associates can thrive and progress.”

Ms Sutcliffe added: “On the rare occasions that care goes wrong, it’s often down to common factors getting in the way of the safe, effective and kind care people have a right to receive.

“We’re shining a light on those factors, including further evidence of racism and discrimination.

“Meanwhile new starters across the professions aren’t always getting the standard of support they need to feel confident in their roles.

“And in maternity care, there are more signs that workplace cultures aren’t always supporting midwives to escalate concerns or communicate effectively with women and families.

“This is just the start of our journey toward better use of regulatory insight so we can keep on speaking up for a healthy and inclusive environment for our professions, for the benefit of everyone touched by nursing and midwifery care.”

Commenting on the report, Birte-Harlev Lam, executive director midwife at the Royal College of Midwives (RCM), said: “No health professional goes to work to do a bad job and we must all act when workplace cultures stop safe and high-quality care from happening.

“Crucial to this is supporting staff early in their careers and those from overseas.

“They should not face racism or discrimination from anyone, especially their colleagues, and when this does happen, we must root it out.

“The RCM – along with other organisations – is at the forefront of efforts to tackle these issues and drive change in our maternity services; so that staff can deliver the high-quality care they aspire to, and so that women and families get the care they rightly should expect and deserve.”

Dr Habib Naqvi, chief executive of the NHS Race and Health Observatory, added: “We welcome the approach taken by the Nursing and Midwifery Council in producing this vital and comprehensive Spotlight On Nursing And Midwifery report.

“We also welcome the acknowledgement in the report that racism affects retention of nursing and midwifery staff as well as patient care.

“Nurses and midwives provide care across the life-course and should not have to encounter incidents of racial abuse and discrimination from colleagues or patients – this includes international professionals who elect to fulfil their vocation for caring in the UK.

“Tackling racial inequities in maternal and neonatal healthcare is a key area of focus for the NHS Race and Health Observatory. We look forward to working with the NMC in transforming insights on professional learning and practice into tangible actions for change.”