Midwives: Bullying

Lord Markham Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the impact of bullying of students and newly qualified midwives in the NHS on (1) retention of staff, and (2) the treatment of pregnant women, as highlighted in the #Saynotobullyinginmidwifery report published on 12 November 2023.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

This report makes difficult reading, highlighting unacceptable levels of bullying in midwifery. We know that culture and leadership have a significant impact on retention and staff experience. NHS organisations should have robust policies in place to tackle bullying and harassment. Through the NHS long-term workforce plan and the NHS equality, diversity and inclusion plan, we are seeking to expand the workforce and make the NHS a better place to work.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister. As he says, all NHS trusts have those robust policies. The problem is that they are not coming out into practice. This report describes the experience of midwives working in a toxic culture. One newly qualified midwife is quoted as saying that they were left

“burnt out by bullying and the terror of working on understaffed wards”.

Another said:

“I would return home crying most days and became suicidal from the fear and treatment at this trust”.


Does the Minister accept that much more fundamental change is required to deal with understaffed maternity units, NHS trusts preoccupied with reputation management over patient safety, and a reluctance to take whistleblowers seriously?

[Lord Markham (Con)]

I thank the noble Lord for his work in this whole area. That is genuine appreciation, because I know that he looks not just at bullying in this area. He is a very important conduit and I am personally grateful for the work he does on this and how much he cares. It is a combination of all the things that he mentioned. I had a meeting with the chief midwife on this subject this morning because of it being brought to my attention. I was actually quite reassured. Each trust now has what is called a quad leadership team, where the chief midwife, a neonatologist, an obstetrician and the general manager spend time together in a six-month process where they work together as a team on how they will address all these vital cultural issues.

[Baroness Burt of Solihull (LD)]

My Lords, among the very disturbing elements in this report is the way that midwives are bearing the brunt of the toxic culture and dangerously low staffing levels, which are causing over half of midwives to consider leaving their organisation. Despite what the Minister just said, the Ockenden report was over two years ago. Is he satisfied with this rate of progress? Should we not consider a statutory inquiry—a recommendation of this report—before more midwives leave and more babies die?

[Lord Markham (Con)]

We have the highest level of staffing ever in midwifery, 5% up on last year and 21% up on 2010, against a background of static births. I want to address that point on staffing; staffing levels are high. However, as the noble Baroness says, there are issues around culture. On the national inquiry, again, every one of those 150 trusts was visited by the CQC in the last year or so and action plans made on how to address this. We know what we need to do; we just need to get on and implement it.

[Lord Lucas (Con)]

My Lords, I am grateful to my noble friend for his replies. I am much more grateful to the many midwives who have helped my family over the years. They give an extraordinary service. If we are not to have an inquiry, will my noble friend make sure that his ears and doors continue to be open when things are not going as well as they should? The NHS has a habit of closing doors on things and making it difficult to interact with it. Bullying is not the only problem. There is a succession of problems which need bringing out into the air, such as overmedicalisation, the failure to implement the better births policy, and the regulatory culture overseen by the NMC. The Minister could help with that.

[Lord Markham (Con)]

I agree with my noble friend. Over the last 18 months, I have appreciated the power of this House and of these Questions. Each time I get one, it sets off a process. In this case, I undertook to meet the Chief Midwifery Officer to make sure that feet are being held to the fire. I know that Minister Caulfield is doing this. It is to the credit of the House that it has this scrutiny role.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, my maiden speech in this House was on bullying in schools. Can the Minister tell me whether there is an anonymous hotline for whistleblowers to report unbecoming conduct in the health service? It is so important to have one.

[Lord Markham (Con)]

The noble Lord is absolutely correct. It is crucial. We have a whistleblowing system. It has had over 100,000 reported instances. We are trying to inculcate a culture where people feel able and free to stand up and point out an issue.

[Lord Allan of Hallam (LD)]

My Lords, workplace bullying is particularly toxic where managers are involved. This is where non-executive members of the NHS trust boards may come into their own if complaints involve executive members. What is being done to help non-executive members of trust boards be more responsive and able to deal with bullying complaints?

[Lord Markham (Con)]

The noble Lord is absolutely correct. This is the role of non-execs. Having done a bit of work on the Lucy Letby case, I understand that the non-execs should have said something. Obviously, the executives should have found out, but the non-execs clearly had a role. This is an excellent question. I have to be honest and say that I need to come back on it, if I may, so that I can give the noble Lord a full answer and make sure that this is happening.

[Baroness O’Grady of Upper Holloway (Lab)]

My Lords, does the Minister agree that we also need to tackle the conditions in which bullying can sometimes flourish? The Royal College of Midwives—the union representing midwives—published a report last week showing that over 100,000 hours of unpaid overtime are performed by midwives every week. Some 60% of midwives believe that staffing at their workplace is unsafe. Three-quarters of student midwives are expecting to graduate with £40,000 of debt. Surely it is time that we gave midwives the respect and the pay rise that they deserve.

[Lord Markham (Con)]

I agree. As ever with these things, there are a number of issues, of which pay is one. The introduction of the £5,000 a year support that we now give to all students is an important help with regard to debt. Work conditions are important, but key to it all is the culture. I have seen many examples where that has not been great. I was quite impressed by the Chief Midwifery Officer saying that every trust now has a midwife retention person whose job is to get into all these issues and make sure that they are addressed.

[Lord Boateng (Lab)]

My Lords, how many of the midwives recruited to deal with the current midwifery crisis in the NHS were trained and qualified in the United Kingdom? On a recent visit to Ghana, I visited a child oncology unit, which, in the past year, had lost a fifth of its clinical nursing staff, who were trained, qualified and paid for by the Ghanian taxpayer—to the benefit of the NHS. How is that ethical or right?

[Lord Markham (Con)]

I will come back to the noble Lord with the exact number, but he is correct: the long-term workforce plan is all about making sure that we have the right resources and infrastructure to train the required number of people. Behind that, we have funded an extra 150 spaces this year and we have a target to increase them by 1,000 by 2026. It is absolutely as the noble Lord maintains: we are putting training in place domestically, as well.

[Baroness Cumberlege (Con)]

My Lords, does my noble friend share my view about the evidence that, when midwives and other clinical staff understand the importance of continuity, it leads to safer care and better outcomes for both the mother and the baby? One of the midwives quoted in chapter 2 of the report that was sent to us—I thank my noble friend for that—says that working in a continuity team was the best, most rewarding time in their career. Continuity is absolutely critical; it comes up in a number of reports, some of which I have had a part in writing. We know that you need continuity if you are going to make a real impression on the midwifery service and that the women who are party to it must really understand what continuity does and can achieve.

[Lord Markham (Con)]

I thank my noble friend, who has been a tireless campaigner on continuity of care. I challenged the chief midwife on this just this morning, and the objective behind the long-term workforce plan is to make sure that we have the resources in place to maintain that, starting with ethnic minorities. We all know that there is a disparity of outcomes in terms of inequality, so the first priority for continuity of care is that setting, but the objective is to spread that across the whole system.