3. Workforce and workforce culture

Most trusts we spoke to highlighted significant challenges in building and retaining their maternity workforce, especially within midwifery teams. Concerns were raised in relation to workforce shortages, lack of diverse workforce representation, and skills or capacity gaps within teams – all of which can undermine efforts to improve maternity services and can contribute to safety concerns. National inquiries and other reports have highlighted concerns about the culture within maternity services, highlighting examples of poor multidisciplinary team working, ineffective mechanisms for speaking up, and a lack of oversight to support team working (CQC, 2022).

In our conversations, burnout within maternity services was attributed to high caseloads, increasing administrative responsibilities and the growing complexity of patients, alongside declining morale. We know that the way staff feel impacts upon the quality of care provided to patients, which can risk ‘compassion fatigue’ setting in for staff that are experiencing burnout (NHS Employers, 2025).

This is largely reflective of broader trends within the NHS. The latest staff survey data revealed that 40% of staff have reported feeling unwell due to work-related stress in the last 12 months (NHS England, 2025b). However, there are specific concerns within maternity services, with the prospect of external scrutiny contributing to a sense of apprehension among teams.

Trusts are also aware that their maternity workforce is not always diverse or representative of the communities they serve. They acknowledge the negative impact this can have both on the cultural awareness of the workforce and in wider efforts to tackle inequalities in care and experience. A diverse workforce can provide improved quality of care for patients alongside improving the efficiency of services (NHS Employers & Nuffield Trust, 2021). We heard examples of good practice in this area, including one trust putting in place local level community hiring initiatives.

While trusts have recognised this as an area for improvement, many noted challenges to recruitment, especially given descriptions and perceptions about the culture of a maternity ward. A small number of trusts have increased the diversity of their teams through international recruitment but acknowledged this did not always reflect the demographics of the local population.

Call to action: Take innovative and co-ordinated action on recruitment and retention within maternity services to close staffing and skills gaps (for example, consideration of alternative routes to midwifery training) and provide guidance for increasing the diversity and community representation of midwifery teams.