Parent Blame in the NHS
The Kirkup Report[1] – published earlier this week – identified the scandalous treatment of mothers in maternity and neonatal services in East Kent. It uses the words ‘blame’ / ‘blaming’ on 46 occasions; ‘culture’ on 76 occasions and the word ‘toxic’ four times (‘toxic culture’ / ‘toxic environment’).
Examples include:
- Professionalism means putting the needs of mothers and babies first, not the needs of staff. It means … not blaming women when something has gone wrong (para 1.25);
- Had any of these opportunities been grasped, there would undoubtedly have been benefits in terms of death, disability and other harm avoided, and in terms of the mental wellbeing of many families who were disregarded, belittled and blamed (para 1.119);
- Time after time, we heard that staff not only failed to show compassion, they also denied responsibility for what had happened, or even that anything untoward had occurred. Similarly, we have found instances where the mother was blamed for what had happened (para 1.37);
- Blaming women and families, or making them feel to blame, for what had happened to their baby (para 3.13);
- being blamed by individual doctors or midwives for aspects of events, or being made to feel to blame for what had happened to their baby and being unable to challenge hierarchical systems and individuals with professional knowledge (para 3.58).
Sadly, as this report demonstrates, parent carer blame was a default position in this NHS Trust. What is clear is that blame was not just directed at parents – it was endemic and indiscriminate – in that when things went wrong junior obstetricians and midwives were also scapegoated. The working environment was toxic – as one anonymous complainant stated (9 years earlier):
I work on maternity at the William Harvey. I’m ashamed to say that I feel intimidated at work. … I feel completely unsupported by our most senior staff. At times I dread going to work with certain people … Management and those with authority are not approachable, there is a blame culture, a just get on with it and shut up attitude, slog your guts out and still get grief. … the unit is [an] awful place to be
And if you want to be shocked – read what a manager said about the attitude of senior consultant obstetricians to midwives (para 4.42).
The Ockenden Report published in March this year[2] – concerning the equally scandalous treatment of mothers in maternity services in Shrewsbury and Telford – uses the words ‘blame’ / ‘blaming’ on 11 occasions; ‘culture’ on 91 occasions and the word ‘toxic’ once.
Examples include:
- repeatedly throughout this review we have heard from parents about a lack of compassion expressed by staff either while they were still receiving care or in follow-up appointments and during complaints processes. Examples include clinicians … justifying actions or omissions in care and in some cases even including explanations which laid blame on the family themselves for the particular outcome (page x);
- [a parents complaint] they often lacked compassion and in a number of responses it was implied that the woman herself was to blame (para 4.55);
- [concerning a mother’s death, the family] felt the Trust ‘blamed’ the mother and her husband for her death, because had the mother not got pregnant she would not have died (para 10.30).
Sadly, as this report also demonstrates, blame was not just directed at families. One staff member is quoted as saying ‘there is a very toxic culture within the place and it seems impossible to break despite some individuals trying to raise as an issue – myself included and part of the reason I have now left’ (para 8.59).
These are two major reports for 2022 – but this is not a new phenomenon: the Francis 2013 Report[3]– concerning the scandalous failings of the Mid Staffordshire NHS Foundation Trust uses the words ‘blame’ / ‘blaming’ on 34 occasions and ‘culture’ on 439 occasions.
It is not only Public Inquiries that identify blame – particularly parent blame – and toxic cultures within NHS and social services authorities. Coroners’ courts have also felt it necessary to draw attention to this issue – for example in the 2021 ‘Factual Findings’ concerning the death of 14 years old Oskar Nash[4] the Senior Coroner for the County of Surrey was at pains to reject allegations that the suicide of a young person with extremely complex needs was in any way attributable to his mother’s failings – but in fact due to the failure of the professional support that he needed.
It is over 170 miles from Surrey to Stafford, and 220 miles from the East Kent maternity unit to the Telford and Shrewsbury unit: the culture of blame within many health (and social care) systems is pervasive and endemic – as is the resulting trauma experienced by parent carers, disabled people and many front-line staff.
And it is not simply an English phenomenon.
Reports suggest that in Wales, parents with disabled children have been bullied and subjected to unfounded allegations by the Cardiff and Vale University Health Board[5] and the Swansea Bay University Health Board.[6] In the case of Swansea, it was treatment that an independent (2021) review[7] considered to be ‘completely unacceptable’. The full review report – which does not appear to have been published – considered a number of serious allegations made by parents, including in one case that Health Board staff:[8]
made anonymous and bogus claims to social services, wrongly withdrew care, made threats to remove children from their parents and even sent police to the door of one family for complaining of their treatment on social media.
What we learn from these examples – is that they exemplify systems failures and that the trauma of blame experienced by parents is also shared by many staff – particularly front-line junior staff. Toxic organisational cultures foster an environment where parent carer blame flourishes – they are inseparable.
[1] Kirkup, B Reading the signals Maternity and neonatal services in East Kent – the Report of the Independent Investigation HC 681 (House of Commons 19 October 2022).
[2] The Ockenden Report Findings, conclusions and essential actions from the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. HC1219 (House of Commons 2022)
[3] The Francis Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry HC 898-I, II and III (The Stationery Office 2013)
[4] Mr Richard Travers H.M. Senior Coroner for the County of Surrey In the Inquest Touching the Death of Oskar Miles Nash. Factual Findings and Conclusions 10th September 2021 – and see also Coroner criticises ‘Working Together 2018’ (11 February 2021) and Blamed and criticised for her parenting 20 December 2021.
[5] Dean Thomas-Welch Grieving mum claims Cardiff nurses failed to care for son and harassed her when she complained ITV News 26 April 2022.
[6] Dean Thomas-Welch Actions of senior nurses caring for disabled children in Swansea “completely unacceptable ITV News 23 November 2021
[7] Swansea Bay University Health Board Response to Children’s Community Nursing Services report (2021).
[8] Dean Thomas-Welch Actions of senior nurses caring for disabled children in Swansea “completely unacceptable ITV News 23 November 2021; see also Dean Thomas-Welch Police to review report revealing ‘completely unacceptable’ actions of senior nurses in Swansea ITV News 21 December 2021; and Dean Thomas-Welch Mum ‘devastated’ head nurse at scandal-hit children’s service in Swansea re-employed by health board ITV News 13 October 2022.
Posted 22 October 2022.