Blog: Building a more open culture in maternity services: the role of the regulator

Having a baby can be the most joyous of times for people. But it can also be deeply worrying, and desperately sad when things go wrong.

At the NMC we regularly hear about the positive impact of skilled, kind and compassionate midwives, who provide great care for women and families in the best of times, and in most difficult of circumstances. But, we also hear about the challenges some maternity services face, and the devastating impact that has on families. Some of that is reflected in today’s report from the Care Quality Commission (CQC). The effect of poor maternity care is profound, and long-lasting.     

Recently, the Health and Social Care Select Committee looked into safety issues in maternity care in England. Its important conclusions included the recommendation that health and care services should focus on an end to ‘a persisting culture of blame’. I couldn’t agree more.

Our role in promoting a positive culture

As the regulator of midwives, nurses and nursing associates, we have an important role in setting standards and investigating concerns about the professionals on our register.  When a concern about an individual is raised, we ask whether they are fit to practise – do they have the right skills, knowledge and behaviour to work and meet our standards?  That might sound like we’d be pointing the finger of blame, and we appreciate that’s how it can feel when someone is under scrutiny.

But we know services are stronger when professionals are able to admit mistakes, learn from them and improve. I firmly believe making people afraid of their regulator prevents openness and doesn’t lead to good, safe care.

At the NMC, we want midwives, nurses and nursing associates to know our focus is on understanding what has happened when mistakes are made, not on assigning blame. We’ll always take action if needed, including removing professionals from our register in the most serious cases. But we also need our processes to drive learning and improvement so care becomes better and safer for everyone.

We’ve made a good start with our new approach to fitness to practise but our legal framework is not helpful and focuses on blame instead of understanding why things went wrong. That’s why we’re seeking changes to our legislation and have welcomed the government's proposals for regulatory reform.

Collaborating to create sustainable change

Blaming one person is the easy way out. So often when something goes wrong, the cause of an issue is much more complicated than just a rogue individual. More likely, when tragedy hits, it’s down to a complex combination of issues.

Our evidence-based standards explain what we expect professionals to know and be able to do at the start of their careers. For midwives, that’s the new Future Midwife standards. I’m confident these standards will have a positive impact as they start to shape current midwives’ future practice, as well as the education of the next generation of midwives. 

The role of professionals as collaborative leaders and colleagues within the multi-professional team are at the heart of these standards. Which is why they work best in positive and supportive workplace cultures.

When things go wrong in maternity services, it often reflects broader problems, like poor leadership and culture, stretched workforce capacity, lack of continuing professional development or underlying failures to recognise or escalate concerns. These concerns are apparent in the CQC’s latest report.

To tackle these challenges, we have to work together to deliver sustainable improvements. The best maternity services have great leadership, adequate staffing, time and resources set aside for learning, and a supportive culture that enables different professions to collaborate and innovate.

No one person – no one organisation – can create this model maternity service on their own. But whether we deliver a service, run it, or regulate it, we can work together listening to women and their families and do better.

This isn’t a quick fix – changing culture and building sustainable improvement doesn’t happen overnight.  But our commitment is clear – to work in partnership to support the professionals on our register to speak up when mistakes are made and help create an environment that enables learning and improvement.

Women and their families who depend on maternity services and the midwives who want to provide great, safe care deserve nothing less.

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