Ann Porter

The problem now is that false beliefs about natural childbirth have infiltrated the training, regulation and supervision of midwives- all of which have been considerably weakened from the time in the 1990s when power shifted from doctors to midwives. Childbearing is perceived to be an incidental, ‘natural’ business when in fact it is inherently dangerous and risky.

In 2007, Leeds Teaching Hospitals were joint winners of a national award for "Practices to promote the normality of childbirth". 🧵 1/8

@mancunianmedic @Tristan27856485 @Anisocyte @DrSteveTaylor @kcisc In reality, boards probably don‘t have the first clue about this. The challenge is to work out how to raise awareness of this issue in a way that makes sense to whomsoever you are selling the idea-not from your perspective. One method is to excite fear of consequences.

Whistleblowers have claimed an investigation into a botched lumbar puncture at Newport's Royal Gwent hospital was marked as "closed" 2 months ago despite serious allegations against PA involved walesonline.co.uk/news/wales-new…

@Tristan27856485 @mancunianmedic @Anisocyte @DrSteveTaylor @kcisc Some NHS organisations certainly don’t take risk registers too seriously but others do. Highlighting the risks of ACP type roles wherever possible within existing administrative systems is worthwhile. Apart from anything else when things go wrong, there is a paper trail.

@mancunianmedic @PorterRend69501 @Anisocyte @DrSteveTaylor @kcisc And risk registers are essentially pointless

@19MW98 @ExMomentum_NHS Agree

@PorterRend69501 @ExMomentum_NHS Same goes for unions

The Nursing and Midwifery Council claims on its website that it rejects 90% of complaints about nurses and midwives. Over 100 working days ago, we made a Freedom of Information Request to the NMC to find out if they record themes, issues, patterns of negligence/incompetence concerning midwives, even when complaints are rejected. Given midwives play a central role in the UK's failing maternity care system, this is important information. Despite a reminder and despite the target for response being 20 working days, we have had no reply. As a consequence, we have made a complaint to the Information Commissioner's Office.

@ExMomentum_NHS @19MW98 Agreed. The incentives are skewed. It’s really disappointing when midwife representative bodies are not truly motivated by the greater good for mothers and babies.

@PorterRend69501 @19MW98 They've been encouraged to form separate midwife-led businesses by NHS England, haven't they. So much of what's been done to the service has been achieved by making sure those involved gain from its destruction. As the father of NHS privatisation Alain Enthoven put it:

This wouldn’t be enough in itself. After years of working in the NHS where I parachuted in at very senior level from a commercial/social enterprise background, I came to the conclusion that all you can do is chip away at problems on as many fronts as possible, sometimes over years. An insight…to achieve change, the first thing you have to do is unfreeze the status quo and the best way to do this is to excite negative emotion such as fear. Find the people with power and work out what will cause them concern - which is not necessarily what causes you concern. Then work out how to exploit the business processes of what is the second largest administrative system in the world. Business disciplines in the N H S are opaque and unlike anything in other sectors. Worthwhile learning how it works.

@PorterRend69501 @mancunianmedic @Anisocyte @DrSteveTaylor @kcisc @iDrSunny @medicalmodelbri @DrAsifQasim @DrLKVaughan @parthaskar - would this work?

@Montyburnout123 @mancunianmedic @Anisocyte @DrSteveTaylor @kcisc No one initiative changes things but I suppose I see it like lots of dripping taps. You just keep at it with persistence on as many fronts as possible, often over years.

Not impossible at all. I devised and ran a course for medical students called entrepreneurial competencies for doctors and explained exactly how to achieve change in a complex administrative system. Students went on to challenge dysfunctional systems in the NHS in all sorts of remarkable ways. It can be done.

The problem is indeed systemic but from the time ideas about flat systems became popular in the UK thirty years ago, the training, supervision, and regulation of midwives have been diluted. And while all of this has been going on, midwife unions, representative and regulatory bodies have gained in power. It has been within the gift of these organisations to lead fundamental change but they haven’t. Instead they have power of veto to protect their own interests and avoid accountability.

@PorterRend69501 Surely the target should be the restructured, americanised systems which are the cause not the individual midwives?

After 100 days, the Nursing and Midwifery Council replied to my freedom of information request. The NMC states on its website that 90% of complaints about midwives and nurses are rejected because of eligibility rules. I wanted to find out if rejected complaints were recorded and reported in any way. The NMC reported that between 2022 and 2025, 13,558 complaints were rejected. Of these, 558 concerned midwives. The two top ranking rejected complaints about midwives are: 1. Failing to escalate or respond appropriately to the deterioration of women and babies. 2. Monitoring, observation and assessments of women and babies.

I wonder if part of the problem is that politicians, policy makers, managers etc don’t understand the nature of medical education. If people don’t have skin in the game it is quite possible they think a two year physician assistant programme is equivalent to a medical degree and all the years of training beyond that- not that I have skin in the game but I supported my daughter through years of medical education. From the outside looking in, it’s not easy to understand how the whole thing works.

@PorterRend69501 @WiseOwl1730570 @Anisocyte @DrSteveTaylor @kcisc Yes. Instead we have an absurd situation where we're plugging nurses and non-clinical graduates into doctors rotas without any validated national standards or scopes of practice. That is legitimately insane, reckless policy.

When things go wrong in organisations, it is usually down to layers of incompetence across the system. Thirty years ago, matching clinician competencies to patient need wasn't such a bad idea as a cost saving measure but over the years it has completely lost its way endangering patient safety. It seems that politicians, policy makers, managers, regulators and even some doctors have unthinkingly jumped on a bandwagon that should have disappeared over the horizon some time ago.

@PorterRend69501 @WiseOwl1730570 @Anisocyte @DrSteveTaylor @kcisc Unfortunately the policy aim is quite clear in multiple published documents. Whether the intent is malicious is for the birds. The effect IS that doctors ARE being substituted, with death and harm in unknown and unaudited quantities the consequence.

@WiseOwl1730570 @Anisocyte @DrSteveTaylor @kcisc I wonder if the unthinking adoption and dysfunctional management of physician assistant type roles is down to incompetence rather than a malicious scheme to replace doctors??

@PorterRend69501 @Anisocyte @DrSteveTaylor @kcisc It is being misused to enable Doctor substitution.

'Tiered 'care has been a long time in the making. In the beginning (three decades ago) , it wasn't such a bad idea as a cost saving measure. The aim was to more accurately match levels of competence and qualification to patients with different health conditions-some serious, some not. What has happened, however, is that the people responsible for implementing tiered care at all levels in the system don't have the knowledge or experience to see in their mind's eye what it actually takes to execute this idea safely. Rather than considering the resources, activities, systems, structures, training, supervision, and regulation necessary to keep patients safe, it has all become a bit of a free for all. There seems to be no understanding that the implementation of tiered care takes sustained, hard work over years if it is ever going to have any impact.

@DrSteveTaylor @kcisc It’s a recurrent feature in incidents involving PAs across trusts. Eg Pamela Marking & Christopher Tucker cases. In Mr Tucker’s case, the Cons/PA did the investigation and found no issues. In Mrs Marking’s case, it doesn’t even look like it was referred to coroner at first. 1/

There have been 60 official enquiries into the UK's maternity scandal over the last 10 years. They have all failed to achieve change- the opposite in fact. Maternity care continues to deteriorate steadily. This is because the problem has not been diagnosed correctly. The true causes are: -the adoption of industrial business models in the care of pregnant women -the dilution of the training, regulation, and statutory supervision of midwives -the unthinking adoption of ideologies divorced from common sense such as natural childbirth and the shift in power from doctors to midwives -an equality ecosystem that excludes mothers from public discourse.

Transgender rights are human rights but the problem is that the only way the latest version of gender theory can make any coherent sense is to deny the vagaries, complexities and biological functions of female and male human bodies as if we are all character avatars in a computer game. There have been several court cases in the UK about the inclusion of transgender people in single sex facilities and it has been found that it can be both lawful and unlawful to exclude transgender people depending on a whole range of factors. Sport would seem to be a clear cut case for exclusion given the differences in female and male sexed bodies.Thats not to say exclusion is correct in all circumstances.

@BBCBreaking transgender rights are human rights. the olympics committee for this wrong to discriminate against trans women in sports. this is a setback we must all challenge in 2026 and defend inclusivity

Olympic women's events to be limited to biological females only from 2028 games bbc.in/4uRBmnR

750 enquiries, reports, and investigations into failing maternity care in the UK over the last decade have not achieved change- the opposite in fact. Maternity care is deteriorating steadily. What has emerged, however, is a consistent pattern of concerns, summarised by Baroness Amos in her recent interim report. What is required now is an implementation plan produced by people who know how to effect change in the second most complex, administrative system in the world, after the Indian railway system. There is nothing to be gained by further enquiries. We just need to get on with it.

748 reviews, inspections, and enquiries into failing maternity care in the UK over the last decade have not achieved change because the problem has not been diagnosed correctly in the first place. The problem is the dilution of midwifery training, supervision, and regulation combined with industrial business models in maternity care and the power of vested interest groups to avoid accountability.

Also in today’s @PrivateEyeNews, I reflect on the interim report of the Amos review, and how the seemingly endless gravy train of maternity reviews doesn’t appear to be improving maternity outcomes or preventing future scandals.

In any group of employees there are people who sign up to all types of ideologies and have all sorts of psychologies. Many people play out how they perceive the world in their behaviour at work, not just Dr Upton. They have no clue that what they are doing offends or upsets colleagues. The onus here was on NHS Fife to manage and advise Dr Upton sensibly and proportionately, especially when it became obvious that female colleagues were unhappy that a trans woman was accessing female, single sex facilities. It’s not fair to attack Dr Upton personally for NHS Fife’s poor leadership and incompetence.

Indeed. This is the bigger point, If he were able to just do his job, without crossing lines - in changing rooms or patient care, then he wouldn't have ended up named in the tribunal. But he couldn't just be a professional, he had to make it all about his trans identity and that is an issue in patient care.

We have no issue with Dr Upton "existing in public", we have no issue with him doing his job. We do have an issue if this public existence means that he gets to stand in his underpants while unwilling women are made to strip off for him. We don't think life is "unlivable" if you can't engage in what many consider amounts to sexual harassment.