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.