By, Alex Lopez
A BBC investigation published this week into Nottingham’s maternity services (ahead of the largest maternity inquiry in NHS history) has exposed a culture of callousness, chronic understaffing and dismissed concerns that left families devastated.
For example, one midwife was reported to have advised colleagues to get pregnant women, who had arrived worried they were going into labour, to go home with the advice: “Don’t be too kind, she’ll keep coming back.”
The findings may make for be shocking reading, but for Professor Jeremy Howick, Director of the Stoneygate Centre for Empathic Healthcare at the University of Leicester, they are also entirely predictable.
Do empathetic healthcare organisations deliver better care?
Howick has spent more than a decade researching what empathy does inside healthcare systems and, critically, what destroys it. His most recent study, the first of its kind, built a system empathy index across NHS trusts in England and tested whether more empathic organisations actually deliver better care.
The results are stark. A healthcare trust scoring just 2.5% higher on the empathy index had 76% higher odds of being rated good or outstanding for patient safety, and 46% greater odds of being rated good or outstanding for effectiveness. Higher empathy scores were also associated with lower staff burnout, lower sickness absence, and lower spending on agency and temporary staff – the very pressures that Nottingham’s maternity unit was drowning in.
Furthermore, it found that hospitals with lower empathy scores spent an average of £5.4 million more on temporary agency staff and £760,000 more on external consultancy than higher-scoring institutions.
Rather than continuing an argument about values or culture in healthcare settings, Howick’s research puts measurable numbers on what empathy is worth, and what its absence costs.
The problem, his work argues, is that healthcare systems have consistently treated empathy as an individual quality rather than a structural one. Burned out practitioners working in chronically understaffed environments with unempathic leadership and no safe way to raise concerns do not stay empathic.
Burnout and a lack of wellbeing support
Howick’s research identifies the specific barriers operating at system level: burnout inducing administrative workloads, burdensome protocols, a lack of staff wellbeing spaces, and organisations that simply do not treat empathy as an institutional value.
Other notable research reports into healthcare quality in recent years, such as the Ockenden Report – which exposed failures in leadership, teamwork, and listening to patients, the Francis Report – conducted by the nursing and Midwifery Council, and the Kirkup Report – which explored serious maternity and neonatal service failings in NHS services across East Kent all reached the same conclusion independently: lack of empathy contributed to hundreds of avoidable deaths across NHS hospitals. What those reports did not provide was a mechanism for change.
The standard response to maternity scandals has been to focus on individual failings. Howick’s research shows that approach alone will not work. Training individuals in empathy skills, while valuable, delivers limited results when the system around those individuals actively undermines what they have been taught.
That is the gap his team has spent recent years trying to close. In 2024 and 2025, Howick and colleagues ran the first intervention to combine individual empathy training with structural, system level change inside an NHS maternity unit.
Closing the empathy gap
Working with 177 staff across clinical and non clinical roles, the programme addressed wellbeing provision, team communications and leadership culture alongside clinical skills. 89% of participants rated the programme highly. 76% reported a meaningful increase in empathy. Seven concrete organisational changes followed, three fully implemented within the study period.
Inequality in healthcare
There is an inequality dimension to this that rarely receives sufficient attention. Howick’s work sits alongside evidence showing that women from Black, Asian and socioeconomically disadvantaged communities are disproportionately harmed when empathy breaks down in maternity care. The higher rates of morbidity and mortality in those groups are not explained by biology. They are, at least in part, a consequence of who receives compassion and who does not.
For over fifteen years, the NHS has run programmes to develop compassionate leadership. The tragedies have continued. Howick’s research points to why: compassion on a values poster changes nothing. What changes outcomes is building systems where empathic care can survive contact with reality – adequate staffing, empathic leadership at every level, and cultures where raising concerns is safe rather than career ending.
The Nottingham report will be harrowing. The research to guide a genuine response already exists, published, peer reviewed, and tested inside the NHS itself. What has been missing after every previous inquiry is not knowledge. It is the institutional will to use it.
Alex Lopez
Alex Lopez is an account manager at BlueSky Education. He enjoys writing about higher education and academic research for BlueSky Thinking.
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