Exclusive: Staff report 'dictatorial' culture in maternity department

A review by the Royal College of Obstetricians and Gynaecologists into maternity services at Walsall Healthcare Trust also flagged concerns over an “established hierarchy” within maternity teams that was difficult for staff to challenge.

The review, obtained by HSJ under freedom of information laws, was commissioned in October 2017 after the Care Quality Commission found evidence of an “oppressive” culture within the department and rated it “inadequate”.

In its report, RCOG said midwives had described “a strong dictatorial culture in which job satisfaction and willingness to ask for assistance is dependent of which team leaders are on duty.”

They said there was a hierarchy which was difficult to challenge and that some staff felt there were team members who were “untouchables” and immune from sanctions.

While the trust was commended for work carried out to improve its culture, the review said “there are still several members of staff whose behaviours are divisive and not conducive to a supportive team working environment”.

The report said “no concerns were expressed about the clinical skills of these individuals” and highlighted that the trust had a significantly lower perinatal mortality rate compared to other trusts.

Among several recommendations made in the report, the college advised the trust to review the culture and leadership behaviours within its teams.

The provider was also advised to rotate midwifery staff between wards to help reduce tensions between staff in the delivery suit and inpatient wards.

Walsall Healthcare had previously sent HSJ a short summary of the review which described the report as “essentially positive [and] reflecting a move in the right direction”. It later provided the full report following a freedom of information request.

A spokesman for the trust said the provider had now started work on 48 out of 53 recommendations made in the review, including launching personal development plans for staff.

The trust has also made changes to its senior leadership team, including a new matron and making substantive consultant appointments.

In 2016, a review of the trust’s neonatal unit, by the Royal College of Paediatrics and Child Health, found chronic staff shortages.

Separately, experts have criticised elements of the RCOG review for making “dangerous” recommendations around the normal birth agenda.