Healthcare regulators are meant to protect the public but their toxic cultures perpetrate so many of the key problems rife in maternity care.
“A culture of fear and anxiety”
“I couldn’t take it anymore”
“forced out of her job due to bullying, harassment and racism”
What do these quotes all have in common? They all refer to regulators that exist to enforce standards across professions to ultimately protect the public. Just weeks ago, Rise Associates published its review into the Nursing and Midwifery Council (NMC). The report documented a culture marred by racism, bullying and burnout, which it states is having a direct impact on public safety. More recently still we have seen the Health Secretary Wes Streeting describe the CQC as “not fit for purpose” after interim findings of a review commissioned to understand the suitability of the regulators’ methodology for inspections.
Point of crisis
Since news of these reviews, Birthrights has received enquiries from people wanting to contact the NMC or Ombudsman to get their complaints heard, but who now have doubts about the efficacy of the regulators.
This lies at the heart of the issue – if there is no trust in the institutions charged with upholding standards of safety, then there can be no faith in the services that are intended to provide care at such a crucial point in our lives.
Regulators are there to minimise failures in our services, to ensure safe and effective practice and uphold the standards regulated professions must meet. When we see failure on the scale that has been revealed at institutions like the NMC and CQC, it is perhaps unsurprising that we find ourselves at a point of crisis in maternity care.
The experiences of racism and wider discrimination shared within the NMC review reflect the cover-up culture we hear too much about in the NHS and mirror the experiences of healthcare professionals we documented in our Systemic Racism, Not Broken Bodies report. In this, we heard about the lack of opportunities for midwives to escalate their concerns and for these to be heard. Where people did escalate we also heard about how their faced harassment as a result of their actions, forcing some to leave their jobs.
The contradiction between the stated values of the NMC and the experience of its staff echoes the stark disconnect between the language of person-centred care and the experiences for too many women and birthing people.
These issues are deep-rooted and will require a long-term and focused commitment to overhaul culture and practice.
Change starts with the basics
At Birthrights we believe that change starts with the basics. The first step must be for regulators to understand how the law applies to maternity care and what it means for those managing and delivering maternity care to centre the rights of women and birthing people. If regulators do not have this grounding in human rights, they cannot ensure maternity services are operating within the law, nor ensure that those healthcare professionals working against the odds to centre the rights of women and birthing people in their care are not penalised.
Last year, we worked with a regulator to revisit the fundamental human rights that all women and birthing people hold through their pregnancy and birth. This provided the foundation for us to then support investigators to feel more confident talking to women, birthing people and their families to understand whether they had experienced breaches in their rights and whether they felt that systemic racism had played a part in their care.
The NMC’s acceptance of the review findings and all the recommendations is a good start, but we implore both the NMC and CQC to acknowledge systemic racism and discrimination within their organisations and how this impacts their ability to uphold standards of care. The regulators must also recognise and invest in all staff understanding person-centred and rights-respecting care and make sure this is at the centre of any inspection regime.
If you are concerned about the maternity care you are receiving and believe your rights are not being respected, you can contact Birthrights’ advice and information team.
Birthrights also delivers training to those who design, deliver, manage and regulate maternity care to increase awareness and understanding of how Human Rights law applies to maternity care and why this is critical to the delivery of safe care.