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Issues around the workplace culture in maternity services are driving midwives away from the profession and impacting the safety of care delivered to pregnant women, a committee of MPs has heard.
A panel of experts today presented oral evidence to the Health and Social Care Select Committee as part of a new inquiry into the safety of maternity services in England.
“We need to change that culture and accept that everyone has fallibility”
The work is set to build upon investigations that followed maternity incidents at East Kent Hospitals University NHS Trust and Shrewsbury and Telford Hospitals NHS Trust, as well as the inquiry into the University Hospitals of Morecambe Bay NHS Trust.
Speaking during the virtual meeting, Professor Ted Baker, chief inspector of hospitals at the Care Quality Commission, stressed that if “cultural issues” within maternity services were not addressed there would be a “constant stream of services running into difficulties”.
Across the country, 38% of maternity services are currently rated as “requires improvement” for the safety domain.
“That is a significant number and larger than any other specialties and I think that is a reflection of the cultural issues in maternity services nationally,” Professor Baker told the group of MPs.
On the whole, the health watchdog had not seen “safety improve as rapidly” in maternity services as it had across other services, he noted.
These services were “driven by a lot of defensive behaviour”, said Professor Baker, which in turn led to a “blame culture” when things went wrong.
It was incredibly important that staff and organisations accepted their own “fallibility” and that of their colleagues, he said, otherwise clinicians would end up working “defensively because they were so worried about making a mistake”.
“We need to change that culture and accept that everyone has fallibility and that would improve the wellbeing of frontline staff,” said Professor Baker.
“We have got to accept the fact that humans are fallible, and that the professional response is to investigate thoroughly, openly and honestly and learn from that to try and prevent similar mistakes being made by others.”
The CQC chief inspector went on to stress that such workplace cultures were forcing maternity staff out of the profession altogether.
He also acknowledged there was a “big attrition rate” in both midwifery and trainee obstetrics.
According to Professor Baker, these professions reported “a lot of bullying” which he believed were linked to the culture and safety problems in maternity services.
A culture where staff were bullied “creates tensions in teams that makes it actually very difficult to work”, he said.
“I suspect we lose a lot of good people from some units [and] from the profession entirely, because of the way we look after them in terms of the culture in which we make them work,” he added.
“But if we support them and their fallibility, help them learn and improve over their professional lifetime I think we can keep them in the profession.”
Overall, he said as part of his role with the CQC he wanted to “create transparency” where staff faced up to issues or mistakes.
“I’m very taken with the notion that we need to do more to protect and retain the staff that we have”
During the meeting, experts also discussed training of maternity staff and whether more was needed to improve services.
Dr Bill Kirkup, who chaired the Morecambe Bay and East Kent maternity investigations, said that coping with mistakes should be a mandatory part of training for staff.
“We are all brought up in the specialties that we do, to think that we have to be perfect; we are all conditioned to think that mistakes are unacceptable,” he told the committee.
To change workplace cultures, Dr Kirkup said more needed to be done in undergraduate training to teach clinicians that they had to be “open” and learn from their mistakes.
Dr Kirkup said he wished someone had told him when he was about to qualify that he was going to make mistakes and that “being defensive about it and not admitting it and trying to explain it away, is absolutely not the best response to that”.
During the meeting, MPs also asked to what extent recruitment of staff had impacted the quality and safety of maternity services.
Dr Kirkup stressed that this had been “a feature” at Morecombe Bay and at other investigations he had been involved in.
“There are locations where it is very difficult to recruit staff and that can become a serious factor in their standards slipping,” he said. Though he stressed this was not a problem isolated to maternity services.
He added: “I’m very taken with the notion that we need to do more to protect and retain the staff that we have.
“The turnover we have in some units is very high indeed and if we could do anything to make those more attractive places to work, I am sure that we would reap the rewards.”
The inquiry continues with further hearings expected in due course.