Scrutiny of NHS Lothian maternity services escalated after 'concerning' report

The Scottish Government has escalated its support and scrutiny of NHS Lothian maternity services after inspectors raised “serious concerns”.

Staffing shortages and a “culture of mistrust” has led to delays and patients being harmed at the Royal Infirmary of Edinburgh, a review by Healthcare Improvement Scotland (HIS) found.

Inspectors found 26 areas where required standards had not been met.

Scottish health secretary Neil Gray told MSPs on Wednesday that he was “deeply disappointed and concerned by the findings in the report”.

He said the Government has escalated NHS Lothian maternity services to level three of the NHS support and intervention framework to set things right.

“We are taking these concerns extremely seriously, and I expect NHS Lothian to act immediately to implement all 26 requirements from the report,” Gray said.

The health secretary said NHS Lothian has already made “some improvements” to its maternity triage services, and invested £1.5m in staffing, which has been used to recruit 70 new midwives since June, 30 of whom are already in place.

According to Grey, the health board has also made “necessary staffing changes” and bolstered leadership with the appointment of a dedicated associate medical director for women’s services alongside culture improvement initiatives.

The health secretary said he still has “significant concerns” about the pace and momentum of change.

The decision to escalate will provide “significant enhanced support and scrutiny”, according to Gray.

He expects to see evidence of improvements before the end of the year, particularly in relation to staff recruitment, training, development, and handling of adverse events.

The framework provides five stages for support and intervention by the Scottish Government, and stage three is for “enhanced monitoring and support”.

What did inspectors find?

Inspectors raised “serious concerns” after carrying out an unannounced inspection of one of the country’s largest maternity units.

Staff spoke to inspectors about their “overwhelming feeling of helplessness, frustration and worry for not only patient, but staff safety”.

The inspection said some women waiting for labour to be induced had experienced delays of more than 24 hours.

Inspectors also spoke to women who “described being left alone in a triage room for long periods of time following their initial assessment”.

A review of incident reports showed “evidence of medication errors occurring involving student midwives”, the report revealed.

Donna Maclean, chief inspector at HIS, said: “During the course of this inspection, we escalated serious concerns within NHS Lothian to senior staff and the Scottish Government.

“These concerns related to culture, oversight of patient safety and staff wellbeing within Edinburgh Royal Infirmary maternity services.”

Scotland

Health inspectors raise ‘serious concerns’ over maternity services

A team from Healthcare Improvement Scotland visited the maternity services at the Royal Infirmary of Edinburgh.

Health secretary ‘nearly lost’ wife ‘inaccurate assessments’

The health secretary told MSPs he “nearly lost” his wife during pregnancy after “inaccurate assessments” were carried out.

The father-of-four told MSPs: “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.”

Although his experience is different from those detailed in the HIS report, Gray said he “can absolutely understand” the pain, grief and trauma that women and families have experienced.

‘Scottish maternity services are safe’

The health secretary sought to assure both MSPs and pregnant mothers that Scottish maternity and neonatal services are “safe”.

“I know people will be concerned, but from the outset 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,” Gray said in his ministerial statement.

“Our hospitals are the safest possible place to give birth and ensure access to the best possible care.”

He added: “I know maternity and neonatal services in Scotland are safe, and that the vast majority of women have good experiences. The work by HIS will help ensure we address issues as have been found in NHS Lothian today.

“I want to reassure MSPs that I have sought and received direct assurances from the NHS Lothian chief executive that it is providing packages of support to women and families, including a helpline which will be available today.”