Exploring a culture of injustice in NHS maternity services: A Rawlsian perspective

Since the first National Health Service (NHS) inquiry into failing care at Ely Hospital in 1969, more than 120 inquiries have examined recurring failures in the service. Yet, over a decade after the Francis Report (2013) and its 290 recommendations, progress on culture and professional behaviour remains limited. The national responses, Compassion in Practice (DH, 2012) and the NHS Constitution (2025), initiated in 2015, sought to re‑centre care around values of compassion, competence, communication, courage and commitment. The NHS Constitution reinforced an NHS for all—offering a comprehensive service available to all, delivering high-standards of professionalism and excellence, access based on clinical need rather than ability to pay and working across organisational barriers. The Constitution promoted patients placed at the heart of the NHS, providing best value for taxpayers’ money, and maintaining accountability to the public, patients, and communities. Nonetheless, avoidable harm persists.