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Internal review warns of midwife ‘clique’ at Wirral trust


A “clique” of midwives at a teaching hospital maternity department has led to other staff feeling ostracised and unable to raise concerns, according to a leaked report.

A cultural review of maternity services at Wirral University Teaching Hospital NHS Foundation Trust also found senior managers were aware of the clique and had “reinforced” its behaviour rather than challenging it.

“There appears to be a group of staff, described by many as a ‘clique’”

Cultural review report

The independently produced report said the group had become an “elephant in the room”, with senior managers aware of its impact which included some staff feeling de-valued when raising concerns.

The review was conducted after concerns were raised in a Care Quality Commission report last year. After enquiries by Nursing Times’ sister title Health Service Journal, the trust agreed to share a full copy of the cultural review.

Nursing director Gaynor Westray also said the concerns were being addressed, including taking “appropriate management” action against individuals identified. She also stressed that the report had identified positives about the maternity department’s culture.

The review, which was carried out in January and February this year, interviewed 33 staff within the department including healthcare assistants, doctors and midwives.

“Appropriate management processes have been implemented by myself personally following the findings”

Gaynor Westray

It said: “There appears to be a group of staff, described by many as a ‘clique’, particularly within the delivery suite, who are very close to one another. While creating a strong and supportive in-group, this has also resulted in the exclusion, and at times, ostricisation of others.

The review added: “The influence of this group of staff also appears to have been reinforced at times by senior members of staff within the trust as the group, at times, develop a collective view upon which they campaign to have changes made.

“Whether this group have at times been right, or wrong, is not particularly of note, it is the climate, culture and tone that this creates for others in the working environment which needs to be acknowledged,” it stated.

The review also said: “While some [staff] highlighted an openness to raising questions and alternative views, this tended to be in the context of clinical decision making. There were some examples of when this had been done and more junior/inexperienced members had been made to feel de-valued.

“However, the willingness to raise behavioural observations or concerns is much less prevalent and welcomed. In the conversations there were examples of behaviour that people had been unwilling to challenge for fear of the reaction they may receive,” it said.

“In addition, it was clear that a number of people felt senior managers were aware of counter-productive behaviour but had chosen not to address this, and that knowledge of the group was somewhat of an ‘elephant in the room’,” said the review.

Robertson Cooper, a business psychology company, was asked to carry out the review after the Care Quality Commission raised concerns about maternity services.

The trust’s Arrowe Park Hospital maternity unit handles over 3,300 births a year and employs 119 whole-time equivalent midwives.

The CQC identified a number of positives about the unit and said many staff had pride and satisfaction in their work.

But it also identified concerns about the workload for staff, despite improved staffing levels and concerns that change was not managed well and relationships between staff and communication with senior managers could be improved.

“A number of contributors also commented that they felt that managers do not listen to them,” it said. “This particularly related to raising concerns or difficulties about changes or decisions that appear to have already been concluded.

It added: “There were several instances of managers either choosing not to address, or feeling unable to address issues with particular members of staff.”

It also said root cause analysis was not managed well and some individuals “felt that the process created feelings of blame and criticism rather than being a more clinically neutral process of creating shared understanding and learning”.

University Teaching Hospital Foundation Trust

Major nurse recruitment drive launched on Wirral

Gaynor Westray

Ms Westray, the trust’s director of nursing and midwifery, said she was keen to tackle the concerns after being appointed in February this year.

She said: “There are a lot of positives in the report and the majority of the workforce said they had a purpose, they felt they had a reason to come into work and they liked working in our hospital and providing the care they do to mums and babies.”

But she accepted there were issues of concern, adding: “I have done a lot since the report and [the clique] does relate to a very small number of people.

“Of those staff who have been identified, appropriate management processes have been implemented by myself personally following the findings of the report,” she said.

The trust also has a new head of midwifery and matron and is introducing a new e-rostering system to ensure better workload and staffing skill-mix in maternity.


Readers' comments (8)

  • It is refreshing to read that workplace 'cliques' are being acknowledged and dealt appropriately. It tends to be tolerated and seen as the norm in many other places.

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  • I don't understand this. I know what a clique is, but for the article to make sense it should give an indication of which people are excluded from which decisions. All we are told is that there are midwives, health care support workers and doctors. HCSWs are exactly that, support workers, and cannot expect to have an equal voice in nursing decisions. Doctors have their own professional area well defined and have enough authority over medical decisions not to be affected by a clique. The nursing staff in the delivery unit are a naturally separate entity, so how can they be a clique? A clique would be a sub group of nurses within the delivery suite nursing staff.

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  • very interesting! a review of every unit's culture from an outsider's perspective should be compulsory

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  • Interesting comments from Ben McDonnell. Rather than focus on the destructive atmosphere and concerns within the department, he concentrates on the definition of "clique" and tries to downplay the experience of those involved.

    Ben clearly has a great future in NHS management.

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  • My interpretation of the article is that the recent graduates of Midwifery, and more recently employed practioners, are made to feel devalued by the staff who have been midwives for many years and have worked there for a lot longer. Therefore a 'clique' has formed.

    I liked the article. There is a tendency in nursing of any description for some people to rise above their station. More mentoring of new staff and graduates would in turn mean less turnover. And more job satisfaction in the long term.

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  • Those who doubt the potential harm that a "clique" of midwives can cause should read the Morcombe Bay report.

    "managers" who tolerate "cliques" should be removed.

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  • Cliques are very harmful and can contribute to low morale, undermining behaviour and must me challenged and separated. Those who undermine others should not be tolerated but challenged and supported to change !!

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  • Shame they didn't listen when 2 midwives raised concerns...instead we were all told that they were liars and persecuted by a senior manager and hospital directors..they weren't liars. What they were, was brave. Need more of these guts people instead of vile bullies.

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