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.
