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Flu activity continues to increase in Scotland
With case numbers for flu rising sharply this week, Public Health Scotland (PHS) is continuing to encourage those who are eligible to come forward to receive their vaccine.
New figures published today show that laboratory-confirmed cases of flu more than doubled in the past week, rising from 845 to 1,759.
Hospital admissions due to flu also increased by 70% in the past week, rising from 426 the previous week to 724.
Those aged 65 and over, pregnant women, and those with underlying health conditions are most at risk of serious flu illness, hospitalisation, and in some cases, death. This is why the flu vaccination programme is focussed on protecting those who are most vulnerable to becoming seriously ill with flu.
Early evidence from UKHSA shows that this year’s vaccine does a good job preventing severe disease, as measured by hospital admissions due to flu for the strains currently circulating in the UK.
Children are around 70-75% less likely to attend or be admitted to hospital with flu if vaccinated, and adults are around 30-40% less likely to attend or be admitted.
Dr Kim Marsh, Viral Respiratory Pathogens lead at Public Health Scotland, explains: “Flu can seriously disrupt anyone’s life but, for some people, flu hits harder. With case numbers of flu having risen again in the past week, we’re continuing to encourage those who are eligible to come forward to receive their flu vaccine. Vaccination remains the best way to help protect yourself against serious illness from flu.
“NHS Boards in Scotland are working at pace to deliver the winter vaccination programme and look forward to welcoming you for your appointment.
“For more information regarding eligibility and to book, or rearrange, your appointment visit nhsinform.scot/flu”
Pregnant women are strongly recommended to take up the vaccines, which will give them and their babies the best possible protection against serious illness from the viruses.
Everyone who works in the NHS and all frontline social care workers are also eligible for the flu vaccine this winter.
The flu vaccine is also being offered to all children from 2 years old to the end of secondary school, as well as children aged 6 months to 2 years old with a condition that puts them at increased risk of flu.
Look out for your invitation or book your appointment
Most people who are eligible for this year’s vaccination will now have received their invitations by text, email or post, in a white envelope with clear NHS Scotland branding.
Pregnant women can book an appointment online or via the national vaccination helpline, with further information available from midwives.
Those who work in the NHS and frontline social care workers may not receive an invitation and are encouraged to check local arrangements for eligible staff and book their appointment now.
Parents and carers should have received appointment letters by post, or consent forms in their child’s school bag, and are encouraged to take up the flu vaccine offer this winter.
What to do if you suspect you have flu
To prevent the spread of flu, we continue to recommend regular handwashing and advise people with symptoms of respiratory illness to stay off work or school and away from hospitals until you’re feeling better. Advice on how to recognise and manage flu-like symptoms is available at NHS Inform.
Additional information
To find out if you’re eligible for a flu vaccine this year visit www.nhsinform.scot/flu
For more information about the child flu programme visit www.nhsinform.scot/childflu
Some people may also be eligible for other vaccines, including RSV and COVID-19 this year. More information about the coronavirus vaccine, including who is eligible, is available on www.nhsinform.scot/covid19vaccine
More information about the RSV vaccine is also available on NHS Inform RSV vaccine for adults | NHS inform and RSV vaccine during pregnancy | NHS inform
More information about the early start to this year’s flu season and the influenza A(H3N2) strain which is currently circulating is available in our recent blog With this year’s flu season starting early, find out how to stay protected – Our blog – Public Health Scotland
More information on UKHSA’s study is available on their website: Flu vaccine providing important protection despite new subclade – GOV.UK
Lothian Nurses Honoured with Prestigious Queen’s Nurse Title
NHS Lothian is proud to announce that two of our community nursing leaders have been awarded the prestigious title of Queen’s Nurse, a mark of excellence in community nursing across Scotland.
Ashley Lawrence, Health Visiting Team Manager in East Lothian, and Leigh Williams, Clinical Team Lead for District Nursing and the Bladder and Bowel Service in West Lothian, were among 18 nurses celebrated at a ceremony in Edinburgh on 28 November after completing a nine-month development programme run by the Queen’s Nursing Institute Scotland (QNIS).
The Queen’s Nurse Award recognises exceptional community nurses who demonstrate leadership, innovation, and a commitment to improving health equity. Originally introduced in the late 19th century, the title was reintroduced in 2017, with around 20 nurses selected annually to undertake the Queen’s Nurse Development Programme.
There are now almost 200 contemporary Queen’s Nurses working across Scotland.
This achievement highlights the outstanding contribution of our community nursing teams in Lothian. Ashley and Leigh’s success reflects their dedication to delivering high-quality care and making a real difference in the lives of the people they serve.
Pat Wynne, Nurse Director for Primary and Community Care for NHS Lothian, said: “I’m delighted to see both Ashley and Leigh being awarded the Queen’s Nurse title. This is a significant achievement for community nurses across Lothian.
“It reflects their dedication to delivering outstanding care and their commitment to improving health and wellbeing in our communities. We are incredibly proud of their success and the positive impact they continue to make every day.”
Pictured TOP: Leigh Williams (left) and Ashley Lawrence (right).
Pictured above from the left is Debbie Marklow, CNM HV East Lothian, Ashley Lawrence Health Visiting Team Manager, Pat Wynne Nurse Director for Primary and Community Care, Leigh Williams, Clinical Team Lead for District Nursing and the Bladder and Bowel Service, and Leanne Grant CNM DN West Lothian.
Exhibition shines light on Scotland’s first Renal Young Adult Service
At the end of October the Royal Infirmary of Edinburgh opened a moving and inspiring art exhibition created by young adults living with kidney conditions, marking a milestone moment for NHS Lothian’s pioneering Renal Young Adult Service.
The exhibition, held in OPD4, showcased a vibrant collection of artwork produced by patients aged 16–35 who are supported by the service.
Euan Flannigan (above) is a patient of the service and has taken part in the exhibition by creating a piece of work that represents his personal healthcare journey. He explains: “I decided to take part in this art project because it was not only a cool idea, it was also a great way to show my experience as a transplant patient.
“Being a transplant patient is unpredictable – one day you’re fine, the next you’re not. It’s also surreal in other ways; you might be in a busy street and think, ‘I’m probably the only person here who’s had a transplant.’ That feeling can be strange, but also uplifting and motivational. You’ve survived something extraordinary, and that makes you strong.
“Embrace that feeling and keep living a great life. We’re all special, and ambassadors for transplantation – so share your story and keep moving forward like the wind.”
The exhibition gave participants a creative outlet to explore and express their emotions, experiences, and identities through various artistic mediums.
Sharlene Taylor, Renal Young Adult Support Worker and lead for the service (above), reflected on the exhibition’s impact: “The thought behind the exhibition was, when you make choices in art—such as picking a colour, the composition and layout, it empowers you to make decisions and create your vision.
“This gives individuals a sense of confidence in their ability to express and choose.
“This not only applies to their art but allows them to express in other areas of their lives, particularly around their healthcare. Bringing people together who can relate to each other’s journeys and hearing them chat and learn from one another has been the most powerful thing to watch and listen to.”
The Renal Young Adult Service, launched in May 2023, is the first of its kind in Scotland. While other health boards are exploring similar models, NHS Lothian remains the only provider currently offering dedicated support for young adults with kidney conditions.
Thanks to the support of NHS Lothian Charity, the service was set up and designed to address the unique challenges faced by this age group, many of whom had never met peers with similar experiences prior to joining.
Monthly peer support groups at the Royal Infirmary have become a cornerstone of the service, offering a safe space for connection, discussion, and shared learning. The emergence of art as a common interest among participants led to the development of the exhibition project, which has proven to be both therapeutic and empowering.
“Art helps process emotions, reduces anxiety and stress, builds confidence and encourages mindfulness,” added Sharlene. “It’s been incredible to see how creativity has opened up new ways for these young adults to engage with their health and with each other.”
The exhibition not only celebrates the artistic achievements of the participants but also highlights the importance of holistic, person-centred care in long-term health management.
All the artwork was developed while attending a series of workshops led by a local artist at the Edinburgh Printmakers and curated by NHS Lothian Charity’s Tonic Arts for their exhibition space.
Len McCaffer, Tonic Arts Manager at NHS Lothian Charity: “The ‘My Journey’ exhibition showcases the strength, resilience and talent of these incredible young people.
“These artworks tell stories that go beyond treatment – they show the strength and creativity of these individuals who are navigating complex health journeys.
“We’re proud to support initiatives like these that not only enhance patient care but also give people a voice and a platform to share their experiences in a way that inspires others.”
NHS Lothian’s Renal Young Adult Service and exhibition has been funded by NHS Lothian Charity.
To read more about the charity go to: https://nhslothiancharity.org/
NHS Lothian staff recognised in prestigious Scottish Health Awards
NHS Lothian staff celebrated success at the Scottish Health Awards, taking home four accolades during a ceremony at the Edinburgh Corn Exchange.
The Scottish Health Awards celebrate the extraordinary achievements of those individuals and teams who go above and beyond to deliver compassionate, high quality health and social care to the people of Scotland.
Among the winners was Lucy Duns, Community Midwife, NHS Lothian, who received the Midwife award for going far beyond routine maternity care, providing life-changing support to a pregnant patient experiencing domestic abuse.
She recognised subtle signs of distress, offered private, compassionate conversations, connected her to specialist services, and safeguarded both mother and baby.
Through extra visits, advocacy, and empowering guidance, she restored the patient’s sense of control and safety. Her dedication, empathy, and courage transformed a dangerous situation into a path toward security and wellbeing for her patient.
Laura Jess, Head of Paediatric Respiratory and Sleep Physiology at NHS Lothian, has been awarded the Healthcare Scientist Award in recognition of her transformational leadership in healthcare science.
Laura has pioneered innovative, patient-centred services, influenced national policy, and significantly advanced respiratory and sleep physiology across Scotland.
A passionate advocate for education and workforce development, she mentors the next generation of healthcare scientists and promotes evidence-based practice.
Her leadership, dedication, and excellence continue to inspire colleagues, elevate clinical care, and shape the future of the profession.
Winner of the Allied Health Professional Award, Claire Yerramasu is a highly accomplished physiotherapist and Advanced Practitioner leading the Midlothian Community Respiratory Team at NHS Lothian.
With over 26 years of experience, Claire has revolutionised respiratory care, reducing hospital admissions, enabling earlier discharges, and establishing a multidisciplinary, patient-centred model now recognised across Scotland.
A champion of innovation, she integrates digital tools, service evaluation, and independent prescribing into practice. Claire also leads cutting-edge research, including a PhD Fellowship focused on co-developing data-driven risk stratification dashboards.
As an educator and national contributor, she is deeply committed to workforce development, patient engagement, and service excellence, cementing her reputation as a leader in respiratory physiotherapy and community care.
Steven Swanson, Senior Biomedical Scientist and Team Leader at Western General Hospital, NHS Lothian, was named joint winner of the Leader of the Year Award.
Steven transformed the Biochemistry Department into a centre of innovation, collaboration, and patient-focused excellence, achieving over 16 awards for clinical and quality improvements.
Steven mentors and empowers his team, fostering resilience, trust, and professional growth. Under his guidance, service delivery has improved through faster turnaround times, reduced errors, and advanced technologies, all while prioritising staff wellbeing and patient care, embodying NHS Scotland’s core values.
The winners were joined by another 6 finalists from NHS Lothian including:
Sophie Wardrop, Pharmacy Support Worker – Support Worker Award
FND Specialist Practitioner Team – Innovation Award
Laura Jeffrey – Team Lead, Adult Complex and Exceptional Needs Service – Integrated Care Award
Dr Ruth Brotherstone, Jody Forster and Samantha Stredwick, were also finalists.
Tracey Gillies, Executive Medical Director of NHS Lothian, said: “I’m incredibly proud of all our staff who were shortlisted for this year’s Scottish Health Awards. To be recognised among peers from across NHS Scotland is a tremendous achievement in itself.
“I would like to offer my special congratulations to our winners for their well-deserved awards and the recognition of their exceptional contributions to patient care and innovation.”
NHS Lothian: Bring your Meds
Coming to hospital for an inpatient appointment? Remember to bring any meds you’re taking into hospital with you.
This includes prescription/non-prescription medication such as inhalers, tablets, eye drops etc.
Royal Edinburgh Hospital: Mental health safe delivery of care inspection report
Healthcare Improvement Scotland yesterday (Thursday 13 November) published a report relating to a Safe Delivery of Care inspection of Acute Adult In patient services at Royal Edinburgh Hospital, NHS Lothian. The inspection took place between 17 – 19 June, 2025.
Our safe delivery of care inspections of adult mental health services aim to take account of the changing risk considerations and sustained service pressures currently across NHS Scotland.
During our inspection of Royal Edinburgh Hospital, we inspected wards, spoke to staff and patients and reviewed policies and procedures. Throughout July and August we held several discussion sessions with key members of NHS Lothian staff to discuss the evidence provided and findings of the inspection.
Speaking of the Royal Edinburgh Hospital report, Donna Maclean, Chief Inspector, Healthcare Improvement Scotland, said: “During our inspection we saw good multidisciplinary team working to provide person-centred care and treatment and kind and respectful interactions between staff and patients.
“Staff were open and transparent about the current challenges they face in relation to the use of non-standard care areas throughout the hospital. During our inspection we raised several concerns with senior managers relating to the care of patients within non-standard care areas.
“We also raised concerns with senior managers around risk assessments, a lack of approved process to support staff decision making and lack of privacy for patients in non-standard care areas. Issues around unassessed ligature points, environmental challenges and the ability of staff to be able to carry out continuous observations were also highlighted.
“We also raised concerns relating to the fire risk assessments and the lack of appropriate fire doors.
“Several requirements have been given in relation to a lack of effective systems in place to support the delivery of safe care within non-standard care areas. We will return to carry out a follow-up inspection to assess and monitor improvement in response to these concerns.
“Other areas identified for improvement include staff training in areas such as life support and fire safety as well as improving communication with patients and families.”
Eddie Docherty, Director of Quality Assurance and Regulation at Healthcare Improvement Scotland, said: “Our previous mental health inspection programme was focused on infection prevention and control.
“It was agreed with Scottish Government to widen the inspection focus from infection prevention and control to a broader assurance function, creating a new and revised ‘safe delivery of care’ assurance model in NHS adult mental health units.
“We believe it is important to provide public assurance that adult mental health units in Scotland are safe for patients and staff, provide quality person-centred care, with clear leadership and a focus on improvement.”
The Royal Edinburgh Hospital inspection resulted in six areas of good practice, four recommendations and 21 requirements.
An improvement action plan has been developed by NHS Lothian to meet the requirements.
NHS Lothian says it is continuing work to improve Adult Mental Health services after accepting a report published by Healthcare Improvement Scotland (HIS) yesterday (Thursday 13 November).
Significant work has been ongoing since March 2025 to meet the considerable increase in demand for beds, which regularly exceeded capacity, and address system pressures.
A detailed improvement plan to address the requirements from the HIS report is also well underway, with many of the actions already complete or in progress.
The HIS inspection took place in June during efforts to meet demand. While it identified many areas of good practice within teams and the care provided, it highlighted more needs to be done.
Jim Crombie, Deputy Chief Executive, NHS Lothian said: “We take patient safety extremely seriously and took immediate action to address many of the concerns raised in the report.
“A structured plan to reconfigure wards to add extra permanent beds where needed is almost complete. This will end the use of temporary, non-standard areas and the divert suite, which were set up in response to demand.
“Additional leadership oversight and staff training are in place to improve the quality and consistency of ligature inspections, assessments and observations to further reduce the risk of patient self-harm or suicide.
“We have also recently recruited 97 newly qualified nurses, and 30 healthcare support workers. This will allow us to meet increasing service demand and provide more resilience, while significantly reducing the use of bank and agency staff.
“We are committed to providing safe, effective care for patients and ensuring staff are well supported. We are grateful to HIS for their guidance and will continue to work with them and other professional bodies to improve our services.”
Since the initial improvement work began, considerable progress has also been made in reducing delayed discharges. This includes working closely with the health and social care partnerships and other specialist care providers to ensure patients can return to the community with appropriate support.
Improvements are also underway to enhance patient and carer communications, building on the positive work noted in the report of proactively obtaining their feedback. More widely, an ongoing programme of work to transform mental health services to meet the changing needs of mental health care and future proof services also continues.
The full inspection report is available to view at:
https://www.healthcareimprovementscotland.scot/publications/royal-edinburgh-hospital-mental-health-safe-delivery-of-care-inspection-november-2025/
ADDITIONAL INFO:
We carried out an unannounced inspection to Royal Edinburgh Hospital, NHS Lothian, on Tuesday 17 June to Thursday 19 June 2025 using our safe delivery of care inspection methodology. We inspected the following areas:
- Balcarres
- Braids
- Caanan
- Craiglockheart
- Cramond
- Divert suite
- Fairmile
- Harlaw
- Hawthorn
- Hermitage
- Margaret Duguid unit
- Meadows
- Merchiston
- Myreside
- Orchard
During our inspection, we:
- inspected the ward and hospital environment.
- observed staff practice and interactions with patients, such as during patient mealtimes.
- spoke with patients, visitors and ward staff.
- accessed patients’ health records, monitoring reports, policies and procedures.
This inspection resulted in six areas of good practice, four recommendations and 21 requirements.
Additional £25.5 million for planned care
Delivering extra appointments and procedures for patients
Health boards will receive an additional £25.5 million this year to allow them to deliver more planned care appointments and procedures to reduce long waits for patients, First Minister John Swinney has announced.
The additional funding will support the delivery of more outpatient appointments and inpatient/day case procedures across a variety of specialities including orthopaedics, dermatology, general surgery and gynaecology. Cardiology and paediatrics will also get extra funding.
This new support takes total additional investment to £135.5 million in 2025-26 to help the National Health Service maintain progress on reducing waiting lists.
Recent figures show the total list size and longest waits are coming down. There has also been an increase of more than 31,000 appointments and procedures from April to September this year compared to same period in 2024.
Speaking during a visit to Queen Elizabeth University Hospital in Glasgow, the First Minister said: “The latest figures show our plan to support Scotland’s NHS is working, delivering real benefits for patients.
“We have already provided £110 million of additional targeted funding this year to tackle the longest waits. Now we are providing a further boost to deliver more appointments and procedures, taking the total additional funding to £135.5 million for 2025-26.
“I am determined to build on the progress being achieved by hardworking staff in our health service, like those I met today at Queen Elizabeth University Hospital. We want to help them provide the care and treatment patients need and expect – and we are already seeing results.
“Not only are the total list size and longest waits coming down, but we are treating more people than last year. There is still work to be done, but these are very welcome improvements.
“Under my leadership, the people of Scotland can expect a strong National Health Service delivering patient care of the highest possible quality.”
The additional £25.5 million will be shared between the following health boards:
- Ayrshire and Arran
- Fife
- Grampian
- Greater Glasgow and Clyde
- Highland
- Lanarkshire
- Lothian
- Shetland
- Tayside
In NHS Greater Glasgow and Clyde, as at 30 September 2025, new outpatient ongoing waits over 52 weeks had decreased by 17.6% and inpatient/day case ongoing waits over 52 weeks had decreased by 5.7% compared to the previous month.
RIE Maternity staff ‘Overwhelmed, unsupported and not listened to’
Healthcare Improvement Scotland: Inspection report Royal Infirmary of Edinburgh, NHS Lothian
Healthcare Improvement Scotland today (Wednesday 29 October) published a report relating to a Maternity Services Safe Delivery of Care inspection visit to the Royal Infirmary of Edinburgh, NHS Lothian.
We carried out the unannounced inspection of maternity services at the hospital on 23-24 June 2025.
Speaking of the report, Donna Maclean, Chief Inspector, Healthcare Improvement Scotland, said: “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.”
Other areas for improvement identified included fire safety requirements, safe storage of cleaning products and improvements to the environment.
Speaking of our expansion of Safe Delivery of Care inspections into maternity services, Eddie Docherty, Director of Quality Assurance and Regulation, said: “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.”
The maternity services inspection at the Royal Infirmary of Edinburgh resulted in five areas of good practice, two recommendations and 26 requirements.
An improvement action plan has been developed by NHS Lothian to meet the requirements for maternity services.
The full Lothian maternity inspection report is available to view at:
Pre-empting the report, NHS Lothian issued a statement yesterday:
KEY MESSAGES FOR PATIENTS
You are likely to read or hear some stories in the media this week about maternity services in NHS Lothian.
A new BBC documentary will air on Tuesday and will explore challenges in maternity services across Scotland. It is looking at situations and cases in the bigger units of Glasgow and Edinburgh and is following up on the improvement work that is already underway in NHS Lothian.
Then on Wednesday, Healthcare Improvement Scotland (HIS) will publish a report into Women’s Services following two unannounced visits in June.
You might understandably have some questions or concerns about what is going on. It is also to be expected that you may feel more anxious than normal.
We can reassure you that your health, and that of your baby, is our main priority.
If you have any questions at all, please raise them. If your expert midwife can’t answer them, they will be able to find someone else who can help.
A phoneline has also been established to help answer any questions or concerns. It will be manned by our Patient Experience Team with a local contact in Women’s Services for any specific issues.
You can make contact on: Tel 0131 536 3370 (open Mon-Fri, 9am to 2pm) and on email: LOTH.Feedback@nhs.scot
Many of the things to note are:
- We know these reports will be concerning and we apologise to women, people who use the service, and their families and can reassure them that these issues are being taken extremely seriously.
- A major improvement programme began last year and is already underway across women’s services in NHS Lothian.
- Many of the points we expect to be mentioned in the BBC documentary and many of the findings in the HIS report actually reinforce the work that is already underway and serve to strengthen the improvement plan.
- The issues are being taken extremely seriously, and we have always been clear that wider ranging matters, such as staffing, recruitment and working culture within the department, will take time to resolve.
- Significant investment and improvements have already been made, and many new posts have been filled, but there is still more to do to ensure our staff feel supported at work, safe to raise concerns and able to thrive.
- We are working to enhance patient safety, quality of care and improve working conditions for our teams.
- The first and ongoing phase of improvement work focussed on patient care. The second phase is focussed on staff working culture, training and environment.
- As part of the programme, we have improved triage and escalation increased staffing, boosted training, altered placement rotation and created robust patient pathways.
- The report highlighted some areas of good practice, particularly our maternity triage system which is one of areas already targeted by the ongoing improvement programme.
Report on Melville Unit highlights need to strengthen safety and wellbeing of young people
The first in a series of visits to Child and Adolescent Mental Health Services (CAMHS) Inpatient units has found a mix of concerns for the safety and wellbeing of young people, alongside committed staff and positive initiatives at the Melville Unit in Edinburgh.
The joint unannounced visit was carried out in May 2025 by the Mental Welfare Commission for Scotland together with Healthcare Improvement Scotland, following a commitment from the Minister for Social Care, Mental Wellbeing and Sport to address national concerns about the care of young people in mental health units.
The Commission listened to the experiences of the young people in the unit during the visit. While young people reported feeling listened to by staff and staff were praised for their clear commitment and passion, the visit identified several critical areas requiring immediate action.
Key findings on safety and wellbeing of young people
The report presents a mixed picture of the care provided at Melville. On one hand, the Commission observed positive interactions between staff and young people, who reported feeling listened to by dedicated and passionate staff.
However, there were concerns for the safety and wellbeing of young people. A significant issue was the use of restraint. The report calls for urgent improvement when this highly restrictive response is used, noting a lack of detailed care plans and incomplete records.
Of particular concern is the practice of nasogastric tube feeding under restraint, which requires immediate review to ensure it follows best practice and respects young people’s involvement in decisions about their care.
The unit has also yet to ensure all care is lawful under the Mental Health Act, as our previous recommendations have yet to be fully acted on and embedded. The quality of care planning and communication with parents also requires improvement.
Young people and their families reported a lack of activities, especially in the evenings and on weekends. Some young people said this meant they spent “too much time thinking their own thoughts,” which directly impacts their recovery.
The physical environment was also noted as requiring attention to ensure the safety of both staff and patients.
Julie Paterson, Chief Executive of the Mental Welfare Commission and Robbie Pearson, Chief Executive of Healthcare Improvement Scotland said: “Inpatient care provides intensive support for children and young people experiencing acute mental health crises and it is crucial such care meets both legal requirements and standards for the safe delivery of care.
“This report has identified areas for improvement as well as good practice. It is important the NHS Lothian addresses the recommendations and requirements with appropriate urgency.”
Claire Lamza, Executive Director (Nursing) of the Mental Welfare Commission for Scotland, said: ““The safety and wellbeing of vulnerable young people in specialist inpatient mental health units is a key priority for the Mental Welfare Commission. Several findings from our visit to Melville were concerning as they did not provide the quality of lawful care and treatment every young person has a right to.
“We recognize the dedication of staff at Melville who genuinely advocate for young people. However, decisive action from NHS Lothian is needed to address the issues identified in this joint report and in previous Commission visit reports. This must include honest reflection on why previous action plans and intentions have yet to deliver meaningful change for young people and their families.”
Nicola Killean, Children and Young People’s Commissioner Scotland, said: “I’m deeply concerned about the findings from the Mental Welfare Commission into the care of children at Melville Unit, which highlight potential rights breaches including the safe and lawful use of restraint.
“This is further worrying evidence about the use of restraint on children living in some of the most vulnerable situations. Alongside partners I have been raising my concerns with the Scottish Government about the use of restraint on children in mental health provision for over two years.
“Following my recent letter before action, I am pleased that the Scottish Government has now confirmed that it will revise the statutory code of practice to include human rights-based guidance and put in place mandatory recording and reporting of restraint and seclusion.
“I have also been given assurances that it will designate the Mental Welfare Commission as the appropriate monitoring body. These steps must be taken urgently to protect children from harm.”
NHS Lothian says it is working to improve services for young people at the Melville Inpatient Unit after it accepted a joint report published today (Thursday 23 October) by Healthcare Improvement Scotland (HIS) and the Mental Welfare Commission (MWC).
A robust action plan is already well underway to address the report recommendations and improve care in the specialist Child and Adolescent Mental Health Service (CAMHS) unit which supports up to 12 young people with complex needs.
CAMHS has made significant progress in recruiting and retaining more skilled staff and developing new care pathways, with the report also highlighting positive staff interactions and their commitment and passion for working with young people.
However, Jim Crombie, Deputy Chief Executive for NHS Lothian, said that wider improvements were continuing across the unit. He added: “We want to reassure young people and families that we are committed to delivering safe, high-quality and effective care and we take the findings of the report extremely seriously.
“The safety and care of young people and staff is always our top priority. Restraint is only ever used in the unit as a last resort to prevent harm for young people or to staff or other patients.
“We introduced an initiative to reduce the use of restraint further, which was observed by HIS during the inspection, and has shown positive results. Systems are also in place to improve the recording, monitoring and auditing of restraints.
“We want to thank staff for their ongoing dedication and HIS and MWC for their expertise and guidance in shaping improvements to the mental health care of young people. We will welcome any forthcoming national guidance or best practice from these essential reviews.”
The action plan also includes work underway to improve multidisciplinary team dynamics through enhanced meeting structures, communication, collaboration and decision making to work more effectively with young people.
Since May 2025, a system has been in place to monitor legal authority for treating young people under the Mental Health Act, with enhanced managerial oversight and daily checks by registered nurses to ensure documentation is in place before administrating care.
Work also continues to expand meaningful evening and weekend activities for young people with regular reviews planned. Nurses will also receive refresher training to strengthen their therapeutic skills in individual and group settings.
A review of the physical environment of the Melville Unit, including looking at options for how best to provide care safely while meeting the needs of young people, is also well underway.
A copy of the report is available from Healthcare Improvement Scotland.