The Nursing Times recently published an article on blame culture within midwifery, which is apparently affecting staff retention.
The article discussed a hearing of the Health and Social Care Select Committee which has been leading an Inquiry into the safety of maternity services in England.
Professor Ted Baker, Chief Inspector of Hospitals at the Care Quality Commission talked of “cultural issues” in maternity services that were causing constant difficulties, and which would continue to do so if they were not addressed. Some of this he attributed to defensive behaviour, and a blame culture when things go wrong.
A midwife or an obstetrician reading that comment might be forgiven for thinking that Professor Baker was adding to that blame culture, but he did in fact go on to say (quite rightly) that all human beings are fallible. Once that is accepted it then becomes easier to investigate what went wrong without blame, and, most importantly, to be able to learn from the mistake and prevent it happening again in future.
Professor Baker also described an environment in which bullying is common, causing tensions in teams and good people to resign. He didn’t though shy away from the need to create a culture of transparency in which staff were able to face up to issues and mistakes.
Another of the speakers was Dr Bill Kirkup, who Chaired the Morecambe Bay and East Kent Maternity Investigation. He agreed that being defensive and not admitting to mistakes was bad for all concerned. He suggested that we need a change in the workplace culture of maternity services, which should begin with undergraduate clinicians being taught about openness, fallibility, and the need to learn from their mistakes.
I am a medical negligence solicitor. Over the years I have conducted many cerebral palsy and birth injury cases, and I half expected the article to include some criticism of lawyers, and the legal system, but it didn’t. Ironically, the law does not set a particularly difficult standard for negligence. The test is whether the care fell below that of a reasonably competent practitioner in the field at the time. In plain terms, provided that midwives and obstetricians do a reasonably good job, then the care won’t be negligent, and I think that’s as it should be.
I have been dealing with obstetric negligence cases for over 30 years, and it makes me incredibly sad that I am able to say that. I firmly believe that our maternity units are staffed by hard working and decent people, who want to do the best for those in their care. Nevertheless, things still go wrong far too often, and when it does the consequences can be tragic.
For what it’s worth, if any obstetricians or midwives are reading this blog, my personal take on why things continue to go wrong is that it is more to do with how we organise and run our maternity services, than any lack of skill or care amongst staff.
For any parents reading this, the fact that you are doing so suggests that you, or your family, may have been hurt by negligence. If you have, then you will know how heart-breaking it is when what should have been one of the most wonderful moments in your life goes terribly wrong.
To both the clinicians and the parents I would say that this is why we have a legal system, and within a legal claim there tends to be very little blame attached. When maternity care goes wrong it is generally a tragedy for all concerned, and the claim is really just about identifying a fair level of compensation.
Coming back to the Inquiry, I am glad that people like Professor Baker and Dr Kirkup are giving informed and compassionate evidence, and I very much hope that improvements will be made.
In my ideal world, legal claims arising from maternity care should be very rare indeed. Being able to learn from mistakes in a blame free culture has to be one step towards that.
One final thought – staff retention is of course hugely important, but no Government should be allowed to think that it’s just about blame culture. It’s also about how we reward our NHS staff, and given the importance of the work they do, I think we should begin by paying them a whole lot more.