THE chief executive of Worcestershire Acute Hospitals NHS Trust, John Rostill, says the hardest task he faces in turning around Wyre Forest Birth Centre is changing the "culture of entrenched attitudes" among staff.

The final report of the inquiry - set up following the deaths of six babies at the centre between September, 2000 and August, 2003 - described a "defensive culture and a feeling of isolation in the birth centre".

It said morale across Kidderminster had been affected by the downgrading of their hospital in 2000 and "midwives in the birth centre did not identify with the wider agenda of the trust, which they perceived as a threat".

Mr Rostill responded by saying he had already seen a change in the attitude of staff.

He added: "I think 'fortress Kidderminster' or 'siege mentality' are phrases that could adequately sum up the views of this inquiry team and I put that down to recent history.

"I cannot contemplate re-opening the unit until I'm satisfied all the recommendations have been implemented and my uppermost thoughts have to be about the safety of mother and baby and I can't and will not be pressurised into making that sort of decision," Mr Rostill went on.

"The biggest difficulty is getting over this entrenched culture and the need to bring the obstetrics services here into the wider trust services."

He said a "significant recommendation" was to develop and introduce a policy of rotation of all its midwives between maternity units.

"The report talks about an entrenched attitude of people employed in Wyre Forest Birth Centre and difficulties between various members of staff within the centre and other parts of the trust, mainly in Worcester.

"Although there are an awful lot of good comments about treatment at the birth centre, some patients weren't happy about adverse comments made by midwives about services elsewhere in the county.

"There's very much an 'us' and 'them' situation and a unit that not only felt isolated but probably wanted to be isolated from the rest of the services in the county."

Mr Rostill said he and the director of nursing had spent the past year meeting representatives of midwives at the birth centre and he had begun to see a change of approach and attitude.

"At a meeting I had about 10 days ago they demonstrated to me the changes that had been made and they were prepared to make, including agreement to the principle of rotation," he said.

"Now that is a significant move forward - one that this time last year I doubt would have been possible."

The report refers to a readiness to blame management for difficulties in the birth centre and a distrust of managers' motives which were seen as being driven by finance and central targets.

It says there was no sense of partnership or common purpose and "the effect of these poor relationships was to put barriers in the way of seamless care for mothers and babies".

Referring to morale across Kidderminster being affected by the downgrading in 2000, it adds: "The low staff turnover in midwifery meant that most staff in the birth centre had been there through the service changes and merger and still felt a sense of loss and hurt.

"On top of this midwives in the birth centre felt their unit was under threat because of financial pressures and the low number of births there. Many were suspicious of and resistant to change.

"It is perhaps not surprising that this resulted in a culture of entrenched attitudes. Turning this around had not been - and will not be - easy."

Mr Rostill said he was confident the trust's county-wide system would work in future.

"It's a complicated structure and nobody should underestimate this and not recognise the considerable turmoil that Worcestershire has faced in the last five to 10 years," he said.

"It's not surprising that there are pockets of resistance to change and part of my job is to overcome them.

"I'm confident that the system put in place in Worcestershire will work."