Reports of substandard care within the NHS are, sadly, part of our modern narrative. The Kirkup report into serious maternity care failings at the hospital in Morecambe Bay found that the unit was ‘dysfunctional’: ‘many clinical staff were failing to provide an acceptable quality of care in an environment of trust and respect.’ (Kirkup, 2015: 64).
A Care Quality Commission report into another Trust (CQC, 2011: 62) stated that:
‘One midwife told us that she had overheard a colleague say to a woman in labour: “Hurry up or I'll cut you”. Another midwife told us that she was ashamed to work at the unit and hadn't realised how poor practice was until she observed care at another hospital.’
The report noted (CQC, 2011: 7):
‘The trust receives a high number of complaints about the quality of patients' experience in maternity services, especially with regard to poor staff attitude.’
A Royal College of Midwives (RCM) (2011) survey of student midwives cited some disturbing comments, too: ‘rude mentors’, ‘rude beyond comprehension to students'. Sadly, it is not difficult to find media reports of midwives being rude. O'Hare (2012) quotes an NHS matron whose leaked letter concerning midwives at her Trust stated:
‘Patients describe scenarios where they believe staff have been rude to them, abrupt with them and have been very unhelpful.’
User feedback
User feedback is a feature of the modern NHS, with employers asking for comments on the care people have received, and while many positive responses are obtained, this is not always the case (Box 1). Rightly, people complain when they feel they have been treated disrespectfully.
Box 1.Online feedback from maternity service users
| Hospitals routinely ask service users for their views of the care they received. While there are many ‘Thank you’ and ‘You're wonderful’ messages, not all responses are encouraging. The following comments, all posted within the last year, are taken from the NHS Choices website and relate to one hospital. |
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| ‘I had my little boy here and lots of different times the midwives and their helpers were really rude to me and my boyfriend… I couldn't wait to get home because I stopped asking for help because I was scared someone would moan at me.’ |
| ‘The midwife didn't even introduce herself to me barely spoke to me… (my) baby was stuck the midwife didn't explain anything to me all she said was your still gonna have to push they're gonna (sic) use forceps… that midwife let the hospital down I will never go there again and I won't be keeping quiet about what happened!’ |
| ‘I did feel a little neglected by the midwives when on the main post-labour ward—some seemed quite abrupt and unfriendly even though I was a first time mum.’ |
| ‘I do not feel that I was treated with not with even an ounce of respect, dignity let alone any warmth or just common courtesy.’ |
The following story from the US is about a doctor who was successfully sued for her rudeness. While it is not a maternity care case, the lessons are salutary.
A patient who attended for a day-care colonoscopy was anxious that after the procedure he would not be able to recall the post-operative instructions, so he took his smartphone to the pre-operative consultation to record the conversation. Being rather anxious, he then forgot to switch his smartphone off, and it recorded the doctor and her colleagues talking while they carried out the procedure, he being under sedation.
The anaesthetist, Dr Ingham, who had taken a strong dislike to the man, said:
‘After 5 minutes of talking to you in pre-op I wanted to punch you in the face and man you up a little bit… People are into their medical problems. They need to have medical problems.’
When one of the assistants at the procedure noted the man had a genital rash, Dr Ingham warned her not to touch it, saying she might get ‘some syphilis on [her] arm or something’, then added, ‘It's probably tuberculosis in the penis, so you'll be all right.’ The assistant then reported that the patient had indicated becoming queasy on watching a needle being placed in his arm, to which Dr Ingham retorted, ‘well, why are you looking then, retard?’ A link to the audio clips is available in Jackman's (2015)Washington Post article.
This is an obvious breach of professional ethics, but is also one which may never have come to light had the accidental recording not taken place. Looked at one way, the ubiquity of smartphones means that we are all potentially being recorded some of the time. And yet professional ethics demand that practitioners hold to high standards of care. Dr Ingham's rudeness cost her dear when the man sued and was awarded US $500 000.
Several issues are raised by this case: communication (almost always a feature when things go wrong), trust, dignity and respect. The bottom line may simply have been that Dr Ingham no longer cared, and in the ‘caring professions’ that is a real problem.
There are fewer occasions in maternity care when the service user is sedated or unconscious so it may be thought that staff will take greater care when providing care. However, the examples with which this article began indicate that some midwives do not accord others sufficient respect, whether they are pregnant or in labour, new mothers, or students who are there to learn and who, one would hope, would look up to qualified staff as role models.
The code
The Nursing and Midwifery Council's (2015)Code is unmistakeable in this regard: those receiving midwifery care are entitled to have their dignity preserved, and their needs recognised. They should be treated with respect, and any discriminatory attitudes and behaviours towards them should be challenged. Rudeness clearly does not match up to these requirements. While the Ingham case went beyond rudeness—she was held to have defamed the patient—the core issue is the same: a lack of respect for those to whom a duty of care is owed. The recording of the insulting language is almost incidental: as long as there is evidence of such behaviour it is not necessary for there to be a physical or electronic record.
It is very unlikely that women will come into your workplace with an electronic device intent on recording your conversation in order to trap you, but it is worth bearing in mind that there is almost universal ownership of smartphones in people under the age of 40 today, and they are fairly discreet instruments. Comments, quips, off-the-cuff remarks and ‘jokes’, perhaps made during a lengthy labour, may not seem quite as innocent a day or two later. It is even feasible that it is the partner who decides to record conversations or events. While filming a birth in a maternity unit usually requires permission, there is no clear guidance on audio recordings, and given the widespread ownership of the technology and the fact that they are everyday objects and therefore easy to ignore, it's conceivable that it could happen without anyone else being aware of it.
The intention here is not to cause fear or distrust between midwives and those who attend for care: the very opposite is needed. That, however, requires an attitude from caregivers which, as we have seen, is not always present, despite it being mandatory according to professional guidance. Being sued for being rude may be a rare occurrence in the UK; but if rudeness is thought to be unprofessional enough to constitute misconduct, then referral to the NMC is certainly a possibility.