Why NHS Maternity Staff Need More Psychological Safety
Over the past 20 years, numerous inquiries into maternity care have promised to “find answers”, “learn lessons”, “do better” and “provide justice”. What they actually produce is more paperwork, more regulations, more targets, more compliance schemes and more criticism for frontline staff. What makes for effective political soundbites rarely leads to better clinical outcomes.
This takes a huge psychological toll on frontline staff. Not only do they have to deal with whatever complaint, tragedy or litigation claim is underway, but they are also expected to continue working whilst under investigation, intense scrutiny, and public criticism, as though none of this affects them personally or professionally.
This isn’t just unfair, it’s dangerous.
The concept of psychological safety, now widely recognised in healthcare settings, offers a framework for understanding why our current approach is failing and what we need to change.
What Is Psychological Safety?
The phrase “psychological safety” was coined in the early 1990s by Amy Edmondson, a Professor of Business Studies at Harvard University. She observed that successful organisations cultivated environments where workers felt accepted, respected, and able to raise concerns or question processes without fear of repercussion.
When we apply this framework to NHS maternity services, the scale of our failure becomes clear. We’ve created an environment where frontline staff cannot possibly feel safe because they cannot raise issues without fear of repercussions and there is no shared purpose with managers and patients. Until we address these fundamental deficits, all the protocols, targets, incentive schemes and reorganisations in the world won’t improve outcomes.
When speaking up destroys careers
Every independent maternity inquiry has noted the fate of whistleblowers: at first, they’re ignored, then silenced, and then if they do not concede, they are actively punished for speaking out.
This creates a climate of enforced silence that pervades every interaction. Staff tell patients what they want to hear rather than what they need to know, fearing accusations of coercion, dismissiveness, racism, or scaremongering. And they tell Care Quality Commission (CQC) inspectors what management wants them to say rather than what they’ve actually observed, knowing that contradicting official lines could cost their unit its rating and their job security.
The psychological cost of this enforced silence is devastating. And when staff can’t speak honestly about problems, those problems don’t get solved. Stress and burnout become endemic. Performance deteriorates. Absenteeism rises as people take sick leave to cope with psychological pressure. Staff leave the profession entirely, creating the very staffing shortages that inquiries identify as problems, whilst ignoring the hostile environment that creates them.
The absence of shared purpose
For frontline staff, the primary goal has become simply surviving each shift intact. Excellence and innovation can’t flourish when your main concern is making it through the day without being blamed for something going wrong.
Meanwhile, service organisers operate according to different priorities: requirements set out by financially driven incentive schemes, CQC ratings, and metrics relating to compliance and patient feedback that often bear little relationship to good clinical outcomes.
And patients increasingly arrive with predetermined expectations that may conflict with clinical reality. In the absence of clarity, honesty, and time with experienced clinicians, patients turn to online narratives that promote ideological experiences over evidence-based care. Do clinicians push back on those dangerous narratives and risk a complaint? Or do they prioritise patient choice even when it risks mothers and babies lives?
With each group pulling in different directions, psychological safety becomes impossible. Staff can’t feel safe to challenge processes when managers prioritise metrics over clinical judgement. They can’t feel safe to give honest advice when patients frame clinical guidance as coercion.
The result is a system where nobody gets what they actually need.
With frontline staff focused on survival, managers chasing metrics, and patients pursuing ideological experiences, is it any wonder that maternity services are failing? Each group has rational reasons for their priorities, but collectively they create a dysfunctional system where nobody wins.
The path forward
Real reform requires wholesale change in how all three stakeholder groups approach maternity care. Staff need protection from the blame culture that currently paralyses decision-making. Managers need metrics that reward psychological safety rather than compliance with CQC metrics. Patients need education about the reality of modern maternity care rather than ideology-driven fantasies not relevant to today’s demographic.
Most importantly, we need to rebalance the maternity safety debate. The voices of harmed and bereaved patients are important, but they’re not the only voices that matter. The opinions of staff struggling to provide safe care in impossible conditions, managers trying to balance competing demands, and crucially patients who’ve had positive experiences with NHS maternity services also need to be included.
Until we create an environment where all stakeholders feel psychologically safe to contribute honestly to improving care, we’re condemned to repeat the same cycles of blame, investigation, and futile reorganisation.
ABOUT THE AUTHOR:
Dr. Lorin Lakasing is an NHS consultant in obstetrics and fetal medicine. She draws on her 30 years of clinical experience in maternity care to give an insider’s view of the current worrying situation and its development, and suggests how we might move towards the safe, effective NHS maternity service that everyone deserves. Her latest book, “Delivering the truth: Why NHS maternity care is broken and how we can fix it together” is about the stories behind the headlines, revealing the reasons why major stakeholders in this vital service have inadvertently been encouraged to pursue different agendas, and how that has made effective, collaborative working towards optimal clinical outcomes almost impossible.
Web: https://lorinlakasing.com/publications.html
Amazon: https://amzn.eu/d/g1dX9rh
