The head of the General Medical Council has warned that harm to mothers and babies risks becoming normalised because of a toxic culture of cover-up within the NHS. GMC chief executive Charles Massey will address delegates at the Health Service Journal patient safety congress in Manchester, saying that something must have gone badly wrong when trainee doctors fear speaking up. He will describe a tribal culture in which staff are pitted against one another, potentially silencing concerns and preventing admissions of mistakes. “That doctors are making life and death decisions in environments where they feel fearful to speak up is profoundly concerning,” he will say, adding that such conditions foster cover-up and obfuscation and cause the greatest patient harm. He will emphasise that maternity care is among the most high‑risk areas of medicine where the consequences can be tragic and far‑reaching for families. GMC data shows 27% of obstetrics and gynaecology trainees say they have hesitated to escalate a patient to a more senior clinician — higher than in other areas of medicine. The specialty also reports above‑average workload stress, bullying and a sense of being unsupported by colleagues.