'Don't be too kind': Maternity staff used offensive terms to refer to patients

Nottingham University Hospitals NHS Trust has become the subject of a significant investigation revealing systemic issues within its maternity services, with former staff members disclosing the use of dehumanising language and disrespectful treatment of pregnant women and new mothers. The BBC's Panorama programme obtained internal documents and conducted interviews with former midwives that expose a troubling culture within the trust's obstetric departments. This investigation emerges at a critical moment when maternity care standards across England remain under intense scrutiny following numerous high-profile failings and scandals that have prompted widespread institutional reforms and regulatory tightening across the National Health Service.

The revelations at Nottingham University Hospitals represent a concentrated example of broader cultural problems that have plagued maternity services nationally over the past decade. The context for this investigation is crucial: in recent years, numerous inquiries including the Ockenden Review into Shrewsbury and Telford Hospital NHS Trust exposed patterns of dismissive attitudes toward patients, inadequate staffing, poor communication, and systemic failures that contributed to significant harm. Maternity care has become emblematic of deeper governance and cultural challenges within certain NHS trusts, where hierarchical structures and insufficient accountability mechanisms have allowed poor practice to persist. The timing of the Nottingham investigation is particularly significant given that the NHS has committed to sweeping reforms in maternity services, including mandatory safety improvements, enhanced training requirements, and strengthened inspection protocols. Understanding what occurred at Nottingham therefore provides valuable insight into whether existing improvement initiatives are reaching all trusts effectively, or whether pockets of concerning practice remain inadequately addressed.

The documentary evidence obtained by Panorama reveals specific examples of the language and attitudes that characterised the trust's maternity environment. Former midwives described instructions that appeared calculated to maintain emotional distance from vulnerable patients, with suggestions that staff should "not be too kind" to women in their care. The internal documents and staff testimonies indicate that this problematic culture extended across multiple aspects of patient interaction, affecting how women were spoken to, listened to, and ultimately treated during one of life's most significant medical experiences. These details are not merely matters of professional etiquette but represent fundamental breaches of the duty of care that healthcare professionals undertake when they enter the profession. The phrase itself, as disclosed through these accounts, encapsulates a troubling philosophy that appears to have permeated departmental culture at an institutional level.

For maternity patients specifically, and for the broader population relying on NHS maternity services, these findings carry profound practical implications that extend far beyond abstract concerns about workplace culture. Pregnant women and new mothers in maternity settings are among the most vulnerable patient groups, experiencing physical exhaustion, hormonal changes, emotional intensity, and profound dependency on clinical staff during labour, delivery, and the immediate postpartum period. When the organisational culture systematically discourages kindness and emotional attunement toward these patients, the consequences manifest in measurable harms: women report feeling unheard regarding their concerns, pain management becomes inadequate, warning signs of serious complications may be overlooked or dismissed, and the psychological impact of dismissive treatment can contribute to post-traumatic stress and postnatal mental health problems. The specific Nottingham case thus translates into real consequences for real women who accessed care at that trust, potentially affecting their physical safety, psychological wellbeing, and lifelong relationship with healthcare systems. For women considering where to access maternity services, or for those planning pregnancies, the investigation highlights that structural accountability and cultural change remain inconsistently implemented across the NHS.

The Nottingham investigation illuminates a critical pattern within NHS maternity services: that high-profile external reviews and national policy changes do not automatically translate into changed behaviour or reformed cultures at individual trust level. While the Ockenden Review and subsequent policy initiatives created frameworks for improvement, this investigation suggests that without sustained monitoring, clear enforcement mechanisms, and genuine accountability for cultural change, some trusts may have continued problematic practices relatively undisturbed. The tendency to deprioritise patient experience and emotional care within certain maternity units appears connected to broader organisational issues including staffing pressures, inadequate training in communication skills, and institutional hierarchies that discourage staff from raising concerns about how patients are treated. This pattern also connects to longstanding gender dynamics within healthcare, where maternity services have historically been under-resourced relative to other specialties despite serving a fundamental healthcare need. The investigation thus reflects not merely individual failings but systemic weaknesses in how the NHS prioritises maternity care and holds trusts accountable for both clinical safety and the relational quality of care provision.

Going forward, several specific developments warrant close monitoring by healthcare regulators and maternity advocates. The Care Quality Commission, which conducts regulatory inspections of NHS trusts, will presumably examine maternity services at Nottingham University Hospitals with renewed intensity, providing an important test case for whether external inspection regimes can detect and drive meaningful change in institutional culture. Additionally, the trust's own response to the Panorama investigation, including any internal reviews or disciplinary actions, will indicate whether organisations are treating cultural failings with appropriate seriousness. Beyond the immediate Nottingham case, the investigation should prompt the NHS nationally to examine whether current maternity safety improvement initiatives—including the implementation of the Ockenden Review recommendations across all trusts by 2024—are adequately addressing cultural and relational aspects of care, not merely structural and clinical protocols. Patient safety bodies and maternity charities will likely demand greater transparency regarding how trusts assess and improve workplace culture affecting patient care, and whether maternity staff receive adequate training in compassionate care delivery. The specific findings from Nottingham should catalyse questions about what mechanisms currently exist to detect whether similar cultural problems persist in other trusts, and what enforcement powers regulators possess to mandate rapid cultural change where problematic attitudes toward patients have become embedded in departmental practice.