A “clique” of midwives at Arrowe Park Hospital's 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 the hospital also found senior managers were aware of the clique but had “reinforced” its behaviour rather than challenging it.

The review by Robertson Cooper, a business psychology company, was conducted at the request of the hospital trust after concerns were raised in a Care Quality Commission report last year.

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 devalued when raising concerns.

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

According to the NT, the review said: “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.

“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.

“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.”

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 devalued.

“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.”

The maternity unit handles more than 3,300 births a year and employs 119 whole-time equivalent midwives.

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

Gaynor Westray, director of nursing and midwifery, said: “As the newly-appointed director...I am pleased this commissioned report confirmed to me the many positive responses from staff during the review.

Wirral Globe:

Gaynor Westray, director of nursing and midwifery

"It is encouraging how passionate our maternity staff are about the care they provide and furthermore how much they enjoy their job.

“Regrettably the report uncovered some communication issues between a small number of staff and these are now being addressed.

"High quality patient care and strong staff welfare is of absolute paramount to the Trust and I would like to offer my personal reassurance that any concerns flagged within the report will be addressed and dealt with in the appropriate way."

Ms Westray continued: "I have been open and transparent with my maternity colleagues, all of whom have had full access to these findings.

"It is pleasing that the general feedback is of a positive nature, confirming to me a really strong patient focused department which continues to achieve great results both internally for staff and externally for our mothers and babies.

“Staff satisfaction levels - as highlighted in the latest NHS staff survey - show very strong engagement within the maternity department.

"This further cements our overall organisational achievement as being one of the most improved trusts in the country for staff engagement, and something we must not lose sight of here.”