Ensuring safe maternity services in Scotland: Ministerial statement

Presiding Officer, Members will be aware of the publication this morning of Healthcare Improvement Scotland’s report into acute maternity services at Royal Infirmary of Edinburgh in NHS Lothian, and also of the BBC Disclosure programme that aired last night 

I know that people will be concerned, but from the outset today I want to reassure every pregnant woman and their family in the strongest possible terms, that our maternity and neonatal services in Scotland are safe. Our hospitals are the safest possible place to give birth and ensure access to the best possible care.  

Any death or injury in maternity and neonatal services is a tragedy for a family, and I found it incredibly difficult to read and listen to the experiences of people who were excited to be extending their family but are instead mourning the loss of their loved ones.   

I want to take this opportunity to extend my deepest condolences to Lori Quate, Jacqui Hunter’s husband and father of baby Olivia, and to the families of baby Freya Murphy and baby Mason Scott McLean, who so bravely shared their stories for last night’s  BBC Disclosure programme.  

I also wish to convey my deepest condolences to those families who have lost cherished loved ones in the care of NHS Lothian maternity services.  

Presiding Officer this is an incredibly sensitive and emotive issue and one that will be felt across the chamber.

I haven’t spoken about this before but my family knows personally what it is like to suffer pregnancy loss. Indeed during that experience I also very nearly lost my wife due to inaccurate assessments of ectopic pregnancy symptoms and that stays with me every day.

Our family’s experience differs from the families featured on the Disclosure programme and the HIS review, but I can absolutely understand the pain, grief and trauma they experienced. This makes me even more grateful to the families who have come forward and I share their personal determination to ensure urgent improvements are made.

Presiding Officer, I acknowledge today the commitment of our staff in maternity services across Scotland who continue to provide kind and caring support to families. I thank our hard-working midwives, nurses, doctors, clinicians and wider NHS support staff who dedicate their lives to maternity care and who perform such an important role in our NHS.  

They care for families during the most exciting, and indeed anxious time in their life, witnessing the miracle of birth every day. But I recognise there are also deeply challenging times when something does not go to plan, It is our NHS maternity staff who are there to offer families that compassionate and supportive care. 

I know that myself, and many others across this Chamber, will have a deep personal gratitude for the role that maternity care staff have provided to their families.  

Before I turn to the substantive content of the HIS report today, I want to provide members and the public with some important key points of assurance. 

Firstly, Scotland has made significant progress in the last 20 years in reducing the risks associated with childbirth. Infant mortality has significantly reduced, as has still birth to its lowest level in 2024. 

And while neonatal deaths have also reduced, we commissioned a review of Neonatal Mortality, chaired by Dr Helen Mactier, which published last year to understand what more needs to be done to reduce this further.  The findings of that review led Healthcare Improvement Scotland to announce the commencement of their Safe Delivery of Care inspections into acute maternity units across Scotland.  A decision which the Scottish Government fully supported and backed.  

These inspections started earlier this year, with the first report into NHS Tayside’s Ninewells Maternity Unit, which published in May and the second report, into Royal Infirmary Edinburgh, which published today. While I know maternity and neonatal services are safe and the vast majority of women and their families have good experiences, the work by HIS will help ensure we address issues as have been found in Lothian today. 

It is also important that expectant parents have accurate information available to them and members will be aware of some misinformation circulating both in the media and on social media in recent weeks regarding Scotland’s neonatal services model. To be clear, no neonatal units are closing, we are consolidating care for the smallest and sickest babies in three specialist units so that they have the best chance of survival. Pregnant women can access accurate information and advice on services available to them via NHS Inform. 

I am deeply disappointed and concerned by the findings in this report, particularly those relating to the experiences of women giving birth.  

I want to reassure Parliament that I have sought and received direct assurances from NHS Lothian’s Chief Executive that the health board is providing a package of support to women and families using its maternity services, including a helpline which will be available from today. 

The report highlights a number of concerning findings, specifically related to oversight of patient safety, staffing levels leading to delays in care, staff feeling overwhelmed, unsupported and not listened to, gaps in incident reporting, and poor communication with women.  

I am also greatly concerned about the findings relating to poor culture. Every member of staff deserves to feel valued, respected, and supported at work, and their wellbeing should never be compromised. We will not tolerate these issues in our NHS. I appreciate the bravery of the nurses who spoke out both in the BBC Disclosure Programme and to HIS. This is how change and improvement happens. 

On Monday night I met with NHS Lothian’s Chief Executive to discuss these issues and the wider concerns around patient safety oversight, leadership, staff wellbeing and delays in care. We are taking these concerns extremely seriously and I expect NHS Lothian to act immediately to implement all 26 requirements from the HIS report.  

I do also recognise the report highlights some positive points, including respectful and responsive care, good teamwork and improvements in maternity triage.  

It highlights the dedication, hard work, and compassionate care of staff working in very challenging circumstances – I thank those staff in Edinburgh Royal Infirmary for their commitment and tireless efforts to support mothers and babies, in often difficult circumstances.  

In December I directed the Chief Medical Officer and Chief Nursing Officer to work directly with Lothian on the issues that I became aware of at that time. HIS undertook an unannounced visit in March and their inspection visit in June 

The Board has since made some improvements in particular to maternity triage, and NHS Lothian have told me about their £1.5m investment in additional staff, which has recruited 70 new midwives into the service, 30 of whom are already in place. I have also been assured that necessary staffing changes have been made and that leadership has been bolstered, for example with appointment of a dedicated Associate Medical Director for Women’s Services, and a range of cultural improvement initiatives, including development of a culture charter. 

However, I still have significant concerns about the pace and momentum of change. I am clear we must see urgent improvements.  

That is why the Scottish Government has taken the decision to escalate NHS Lothian Maternity Services to Level 3 of the NHS Support and Intervention Framework.   

This intervention will provide significantly enhanced support and scrutiny of the improvement activity that NHS Lothian have outlined in their Action Plan.  

In escalating to stage 3, I expect to see evidence of improvement before the end of the year, particularly in relation to staff recruitment, training and development and handling of Adverse Events.  I will be meeting with the Chief Executive of NHS Lothian again before the end of November to discuss progress on improvements.  

Looking at the wider context, I have been asked to consider whether we should initiate a review of maternity and neonatal services.  

Our utmost priority will always be the safety and wellbeing of mothers and their babies. And our staff must always be a priority for our NHS.   

In Scotland, we are working towards our shared vision of continuous improvement in maternity services. Whilst the Healthcare Improvement Scotland inspection reports are in some cases going to make for difficult reading for Government and Health Boards, I fully back the programme and it is working exactly as intended.  

This intelligence-led, independent inspection programme for acute maternity services allows us to take a ‘real time’ and local approach, ensuring that lessons are learned quickly, improvements are made without delay and that good practice is shared widely.  

The inspections are giving us vital insight into what is working in our maternity hospitals and what needs to change. It is holding services to account.  The NHS Tayside and NHS Lothian reports demonstrates this. 

Local improvement action plans are already delivering change on the ground. NHS Tayside have already delivered the vast majority of their improvement actions following their inspection, with the remainder due to be completed by the end of the year.  This is the sort of positive improvement we want to see everywhere.  

As we get further into the inspection schedule, we are seeing themes emerging. This means we can focus now on actions to improve these areas.   

We have commissioned HIS to develop a set of detailed maternity standards that will describe the level of service we expect to be delivered in every maternity unit, and these standards will inform future inspections.  

Our Scottish Patient Safety Perinatal Programme which has been operating for over ten years has also delivered a range of improvements in maternity services, such as safety huddles, perinatal care bundles and stillbirth care bundles.  This Programme will also be used to mobilise improvements that emerge from maternity inspections.  

On adverse events, when things go wrong we expect Boards to investigate fully. They must be open and honest with families about what happened, and make sure lessons are learned to improve care.  Last month I wrote to every Health Board Chief Executive in Scotland to make clear my expectation that all Boards work with Healthcare Improvement Scotland to improve the timeliness and quality of significant adverse event review investigations and reporting, and to provide regular reporting to HIS that strengthens oversight and scrutiny of these.  

And to further strengthen our national oversight, I can announce today the establishment of a new Scottish Maternity and Neonatal Taskforce.  

This will provide strategic, national leadership and will be chaired by the Minister for Public Health and Women’s Health. The Group will include senior figures from across our Health System, independent bodies, third sector and advocacy organisations. It will report to myself and will complement the existing audit and inspection system in place in Scotland. I want the voices of women’s experiences of maternity services to be heard, as well as the voice of frontline midwives and will make sure that they are part of the Task Force, and that we listen to them. 

Furthermore, I am meeting with Scotland’s new Patient Safety Commissioner in November, and I will take that opportunity to discuss maternity services with her.  

Finally, Members will be aware I have also reached out to Health spokespeople from across this Chamber inviting them to meet with me and the Chief Executive of NHS Lothian to discuss the findings of the HIS report in more detail.   

Presiding Officer, our commitment to continuous improvement across our NHS is vital. We must empower our services and our staff to make the necessary changes we need to ensure the safest and highest quality maternity services in Scotland.  I know Members will support me in this vision and I welcome the opportunity for any questions the Chamber may have at this time.