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Widespread ‘toxic culture’ is forcing us out, say staff

Published on: 13 Nov 2023

Large numbers of midwives report being left feeling undervalued and afraid to speak up due to bullying and widespread staffing shortages, which some say is putting mothers’ and babies’ lives at risk, according to a new publication shared with HSJ.

The Say No to Bullying in Midwifery report comprises hundreds of accounts, ranging from students, newly qualified and senior midwives, heads of midwifery, maternity support workers and more. It aims to publicise and share concerns they have raised online.

The document, published today, was shared exclusively with HSJ.

The report said: “Midwives have described their experiences of toxic cultures within their workplaces, with cliques, preferential treatment, unfounded allegations and poor working conditions leading to a negative impact on their health and wellbeing, including suicide attempts and midwives leaving their job or profession.

“Midwives’ lives are being decimated and women and babies’ care is being negatively impacted. Long-term interventions that are resourced and sustained over months and years are needed to address this distressing and pervasive phenomenon.”

Its foreword says NHS’s maternity services are in a “perilous state with massive staffing shortages”.

A newly qualified midwife felt as though they were “waiting for a serious incident to happen” and said: “On my first ever clinical shift as a qualified midwife, I was left alone on [the] delivery suite with a woman with numerous risk factors.

“No support, no break, terrified to leave the woman to escalate to the on-call consultant. [It] ended in a shoulder dystocia and a flat baby who sadly died 12 hours later.”

A student midwife said: “Since starting my training, I have cared for families and facilitated births alone through severe understaffing. I have pressed call bells that haven’t been answered.”

Another newly qualified midwife said they were left “burnt out by bullying and the terror of working on understaffed wards”, while another said: “I would return home crying most days and became suicidal from the fear and treatment at this trust.”

It comes as the NHS’s maternity services have come under increasing scrutiny over recent years, including high-profile scandals at East Kent, Morecambe Bay, and Shrewsbury and Telford hospital trusts.

Donna Ockenden, who led an investigation into Shrewsbury and Telford in late 2020, is leading an inquiry into maternity services at Nottingham University Hospitals Trust.

The annual NHS staff survey has also recorded a particularly steep deterioration in midwives’ morale across different measures in recent years.

Findings after the Ockenden review found more than half of midwives were thinking of leaving their organisation. Fewer than a third of them were satisfied with their work, while just 6 per cent believed their organisation had enough staff to do their jobs properly.

NHS England has told trusts to employ more midwives over the next five years so that they meet safe staffing requirements, but many have reported problems funding them and recruiting staff.

A three-year NHSE delivery plan, launched in March this year, asked leaders to fill vacancies with “newly qualified staff and clinicians who want to return to practice”.

The Say No to Bullying in Midwifery report was authored by Amanda Burleigh alongside several other clinical midwives and academics. Ms Burleigh is a midwife who successfully campaigned to change immediate cord-clamping practice in the 2010s, and says she was bullied out of the profession.

She has more recently been struck by concerns increasingly raised by many current midwives she said. The accounts were collated from a private Facebook bullying support group comprising of over 4,000 members which she is involved with running.

Today’s report says it is a “cry from the heart by women who simply seek to care for birthing women, presented by midwives who seek to care for their colleagues”.

An NHSE spokesman said it was “completely unacceptable for any member of staff to feel silenced or unable to speak up about issues affecting them”.

A statement added: “The NHS long-term workforce plan sets out a need to grow midwifery education and training in line with the conclusions of the Ockenden review, and we continue to take action to strengthen maternity services across the country through £186 million investment each year to grow the workforce, strengthen leadership and improve culture.”

Jacqui Williams, senior midwifery advisor at the Nursing and Midwifery Council, said the first-hand accounts were “very concerning and adds to the evidence base for improvement”.

recent NMC report found a lack of “consistently effective” preceptorship programmes for early career professionals, as well as a need for “inclusive working environments”.

Dr Williams added: “These experiences undermine safe and effective care for women and babies. Working with our approved education institutions, their placement partners and wider stakeholders to help address these issues is a key priority for us.”

A spokesman for the Department of Health and Social Care said bullying, harassment or misconduct of any kind is “unacceptable and has no place in the NHS, adding: “NHS leaders have a statutory duty of care to look after their staff and patients and prevent harassment, or abuse in the workplace.

“We expect employers to be proactive in ensuring staff and patients are fully supported, their concerns listened to and acted on, with appropriate action taken where necessary.”

Updated 15.39 and 20.16: This article has been updated to include comments from the Nursing and Midwifery Council and the Department of Health and Social Care