Media Release: Inspection report Royal Infirmary of Edinburgh, NHS Lothian

“During our inspection of the maternity services we saw staff working hard to provide compassionate and responsive care in very challenging circumstances.  All interactions observed during inspection between women, babies and families were positive and respectful.

“We saw good teamwork and innovation within the maternity triage department involving extended members of the multidisciplinary team including obstetricians, midwives and the healthcare support team.

“However, during the course of this inspection, we escalated serious concerns within NHS Lothian to senior staff and Scottish Government. These concerns related to culture, oversight of patient safety and staff wellbeing within Edinburgh Royal Infirmary maternity services.

“Some staff were complimentary and described their line manager as supportive. However, the majority of the multidisciplinary team we spoke with were frustrated at staffing levels and told us this presented a safety risk, which they’d raised on multiple occasions with managers. They shared their concerns and feelings of being overwhelmed, unsupported and not listened to. They said this has impacted staff confidence to escalate staffing concerns.

“During the inspection we observed delays to the induction of labour process of up to 29 hours and other delays to women who required ongoing care within the labour ward due to lack of staff availability, capacity and the complexities of patient conditions.

“Staff described suboptimal skill mix and challenges in providing and maintaining one to one care for women within the labour ward, as well as delays to observations or escalation of clinical concerns.

“Our inspection has highlighted gaps in incident reporting and a reluctance to submit incident reports, with staff describing a culture of mistrust. These are concerning issues that may have significant impact on the learning from adverse events in the system and reduce opportunities to improve safety.

“Women told us of mixed experiences within the hospital, whilst some were complimentary of their care, they also informed inspectors of poor communication that left them feeling uninformed and with no ‘voice’ in their care.”

“In response to Healthcare Improvement Scotland’s Neonatal Mortality Review in 2024, we made a commitment to expanding our Safe Delivery of Care inspection approach to include inpatient maternity services. The maternity inspections will provide women, and families with an assessment of the quality of care provided by their local maternity service and an independent review of any required improvements.

“Our organisation is also producing a set of standards for maternity services, which will in time support our inspection process for maternity services.”