4. Race equality and cultural competency

A cultural shift is needed within maternity services to counteract the structural racism, discrimination and bias that exists within the NHS and broader society (NHS Race and Health Observatory, 2021). While trusts are not solely responsible for tackling structural racism, which will require national policy changes and directives, there are steps that can be taken to increase awareness and understanding of the issue amongst those working in the NHS. Trust leaders told us that improving the culture among the maternity workforce takes time and proactive effort, but without it there are significant implications on the quality and inequalities seen within maternal care.

Most trusts have prioritised their focus on providing training for staff in areas including cultural competency, anti-racism and inequalities. Cultural competency training was noted as being important for minimising pre-existing biases and assumptions, particularly where maternity teams are predominantly from a white British background. One trust, now in its second year of delivering cultural competency training, has found a positive change in the language used by staff.

However, concerns were raised by a number of trusts around the non-statutory nature of such training. Taking frontline staff away from their direct patient care responsibilities can have implications on safe staffing levels of maternity wards, representing a challenging dilemma for trust leaders. One trust had overcome this by embedding a race equity lens into existing compulsory training offers. Trust leaders told us that additional resource is required to provide additional study days and backfill time to safely staff units. Some trusts also called for national guidance on training in this area, to help provide consistency and reduce variation in training offers.

Board leadership and support is also crucial for achieving cultural change. Boards must champion the provision of safe, equitable, and high-quality maternity services, signalling that addressing inequalities in maternal care is embedded within the trust's values, goals and operational plans. A number of trusts we spoke to have set up steering groups or committees to oversee their work on addressing inequalities. One trust would welcome guidance on what roles are needed within teams to support improvements, such as equality, diversity and inclusion (EDI) leads and quality leads. It was also flagged that not all systems or ambulance trusts have dedicated lead midwifery roles. Trusts that had access to these roles highlighted their benefit in taking forward interventions and recommendations for improving safety and reducing inequalities.

Call to action: Demonstrate a national and system-wide commitment to tackling racism and bias in maternity services through actions including a co-produced, evidence-based and standardised framework for training in advocacy, anti-racist practice, cultural competence, and ethnicity data capture. Actions should be measurable to maintain continuous evaluation and improvement.