RCM calls for a seismic NHS cultural shift to improve maternity safety

on 17 February 2022 Maternity Services Midwives RCM RCM Member MSWs - Maternity Support Workers Government Safety Maternity Safety Champions NHS Staff Multi-disciplinary care Midwifery Maternity Safety

Poor NHS cultures that put safety at risk must be challenged and stopped. That’s the message from the Royal College of Midwives (RCM) as it publishes new guidance for its members to raise concerns about maternity care, outlining steps staff can take and what to do if they feel they are not being listened to or their concerns are ignored.

Working environments, including poor working relationships between midwives and doctors, have regularly been cited in reviews of maternity services, including the most recent report into Shrewsbury & Telford Hospital Trust. The RCM has been at the forefront of efforts to tackle this issue, including recently producing guidance on nurturing a positive culture. It is also working with other organisations, including the Royal College of Obstetricians & Gynaecologists, to develop a shared vision for positive working relationships.

Gill Walton, Chief Executive of the RCM, said: “Safe care is everyone’s business, and all staff must be able to speak up and speak out when they believe things are not right. All of us – professional bodies, trade unions and NHS employers – must work together to ensure that staff feel able to do this without fear of personal consequences. Standing up for high standards, particularly in a workplace which doesn’t have the best culture, can be daunting, so if staff they feel they haven’t been listened to, they can lose faith and stop raising concerns. Not only does that bake in that poor working culture, but we know that, in some circumstances, it can have tragic consequences.

“This isn’t just about midwives and other staff. NHS employers - trusts and boards – must make it easier for staff to raise concerns and listen to them when they do. Investigating and, where necessary, acting upon them is fundamental to ensuring that women and families receive safe, good quality care. Staff who raise concerns should be supported and respected for doing so.”

The RCM guidelines outline situations in which staff should speak up to their line managers and employers, including when staffing levels are unsafe, where leadership support is reduced and when there is pressure to overlook staff concerns. They also point staff to where they can take their concerns if they are not being heard supported by RCM representatives, through their internal freedom to speak up mechanisms and if necessary, via formal whistleblowing processes.

Despite multiple structures in place to support staff to raise issues, including the Nursing and Midwifery Council’s duty of candour and NHS whistleblowing policies, staff are too often still being ignored and stifled when trying to raise concerns. In some cases, they have even faced reprisals, whether from their employers or other staff.

Gill Walton added: “We have seen too many occasions where legitimate concerns have been raised and ignored – and sadly, occasions where the staff raising those concerns have been vilified for doing so. This is unacceptable and the RCM will not stand for it. Working with our local reps, we will ensure that staff feel able to speak up and will continue to support those that do. We are committed to rooting out poor workplace cultures, sharing a vision and ethos with the Royal College of Obstetricians & Gynaecologists that ensures all voices are listened to and all staff are respected. We are leading from the top of the professions, but the truth is that the real change has to happen on the ground, in maternity units, hospitals, Trusts and Boards if we are going to bring about meaningful change. By setting out to our members how and when to raise concerns, we are giving them the power to do just that.”

The newly published Standing up for high standards is part of the RCM’s rolling programme of guidance and initiatives aimed at improving the safety of maternity services across the UK. These include joint programmes with the Royal College of Obstetricians & Gynaecologists focussing on improving outcomes and experience for women and babies.



To contact the RCM Media Office call 020 7312 3456, or email [email protected].


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The Royal College of Midwives (RCM) is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team.  We provide workplace advice and support, professional and clinical guidance, and information, and learning opportunities with our broad range of events, conferences, and online resources. For more information visit the RCM | A professional organisation and trade union dedicated to serving the whole midwifery team