After 30 years working in and with rural and coastal maternity services, I have learned that excellence is not always found in the units with the biggest reputations. Sometimes it is found in trusted relationships, community connections and the courage to remain curious when services are under scrutiny.

Thirty years ago, I moved my midwifery career to a rural coastal community.

At the time, it felt very different from the large professorial units that I had previously worked in and were known nationally and internationally for their research, innovation and reputation. Looking back, however, I realise that I have continued to work in a centre of excellence. It simply looked different.

Over the last three decades, practice, education and leadership have taught me that rural and coastal communities demonstrate excellence in ways that are often difficult to measure. The women, families and people we care for become woven into our own lives.

In these communities, healthcare professionals are rarely anonymous. We do not simply work here, we belong here.

That belonging creates a unique form of accountability. Your reputation is built not only through your clinical expertise but through everyday interactions. People come to you with their questions because they see you as someone they can trust.

But what happens when a service is shaken?

This can occur following reviews, inquiries, regulatory investigations, media attention or proposals to downgrade or close local services. In recent years, maternity services across England have been subject to unprecedented scrutiny.

Recent events in North Devon have generated national attention and significant public debate. Public demonstrations and campaigns have reflected the strength of feeling that local people have about their maternity services.

For those working in perinatal services, fear becomes an important consideration about how they can use their voice.

Whilst the Nursing and Midwifery Council recognises the rights of registrants to freedom of expression, individuals working in small communities may still experience uncertainty about how visible they can be when discussing issues affecting their local services.

Too often when services face scrutiny, people retreat into positions of defence or silence, forgetting that as members of the community they may well be service users too. Yet the lessons emerging from maternity inquiries repeatedly highlight the importance of listening, openness and responding honestly when concerns are raised.

For me, this is where professional activism begins.

Activism is about curiosity, championing others, asking questions, supporting colleagues and understanding the standards that underpin our practice.

After 30 years, I remain inspired by the communities I have served and by the professionals who continue to work within them.

So, I would offer a challenge. Be curious, about what can you say, who can you say that to. Listen carefully to those around you and authentically hear their stories. Create opportunities for healthy challenge using evidence. Use every opportunity to learn, grow and share the stories of women, families and colleagues.

Because excellence is not only about reputation. Sometimes excellence is found in having the courage to stay engaged with your community, particularly when the conversation is difficult.

Further reading

• NMC (2018). The Code
• NMC (2006). Freedom of Expression and Fitness to Practise
• GOV.UK (2023). The NHS Constitution for England
• Ockenden Review (2022, 2026)
• Kirkup Reading the Signals (2022) (PDF)
• NHS England (2026). Baroness Amos Independent National Maternity and Neonatal Investigation
• Thirlwall Inquiry Report (2026)
• The Guardian (2026). Doctors at remote Devon hospital get ‘crash course’ after maternity unit shut
• Mirror (2026). Pregnant women being offered classes on how to give birth in a car after nearest Devon maternity ward closes