Report Details Harm to Mothers and Babies at Edinburgh Maternity Unit

A whistleblowing investigation, reviewed by BBC News, indicates that mothers and newborn infants experienced harm due to insufficient staffing and a “toxic” environment within Edinburgh’s maternity unit. Following concerns raised by a staff member in February of the current year, NHS Lothian commissioned a report focusing on the obstetrics triage and assessment unit located at Edinburgh Royal Infirmary. The inquiry either fully or partially validated 17 safety concerns. NHS Lothian stated that an “improvement plan,” developed to bolster patient safety and enhance the staff working environment, was already being implemented in response to the report’s findings. NHS personnel engaged with BBC News subsequent to the death of a mother at the maternity unit in September, which occurred after the whistleblowing investigation had concluded. The health board indicated that a comprehensive review into the death was being conducted to provide the family with essential answers. However, staff members express apprehension that patient risks persist. An anonymous staff member, speaking to the BBC, stated: “We are afraid we can’t provide safe patient care and that women and babies are being harmed.” They added: “The situation has been getting worse over the past five years and it is at its worst now.” The triage and assessment unit provides care for pregnant women needing urgent attention, attending to approximately 1,200 women monthly. The whistleblowing report identified that patient safety was jeopardized by multiple factors, among them staff shortages contributing to delays in women receiving treatment. Furthermore, the report noted that women were being attended to by staff lacking appropriate qualifications and highlighted a “toxic relationship” between management and midwives. The report concluded by stating: “There is no dispute that there have been safety concerns, near misses and actual adverse outcomes for women and babies.” It detailed instances where the support offered was “inadequate” and midwives experienced feeling “professionally compromised” due to a deficit in staffing. Investigators discovered that managers erroneously asserted the unit was adequately staffed, whereas “the majority of midwives said the department was short-staffed on most shifts, with the least experienced staff responsible for ongoing care of a significant number of women at the same time.” Rota analysis revealed a consistent staffing deficit. Midwives recounted instances of actual and “near miss” safety issues when staffing levels were inadequate. The report additionally indicated that sickness levels within the obstetrics triage and assessment unit surged by 200% between April 2023 and April 2024, reaching 15.2%. Accounts emerged of staff members feeling undervalued, disrespected, and operating under significant pressure and stress. A witness characterized the dynamic as an “abusive relationship between management and staff,” while other reports cited a deficiency in kindness and compassion from managers toward staff following a colleague’s suicide. Certain witnesses stated that managers minimized concerns, with one manager being described as “insensitive at best and bullying at worst.” Multiple staff members expressed fears that speaking out would lead to negative repercussions, such as managers creating difficulties in their work lives, for instance, by denying annual leave. Senior nursing staff authored the report, having interviewed a total of 30 witnesses, encompassing individuals currently working or having previously worked in the obstetrics triage department. Their conclusion was that staffing deficits and absences due to sickness would compromise midwives’ capacity to provide safe care. They further observed increased pressure on the department, with attendances rising by a quarter since January 2022, resulting in overcrowding and delays. Jim Crombie, deputy chief executive of NHS Lothian, confirmed that the death of the mother in the unit in September was under review. He stated: “A Significant Adverse Event (SAE) panel, made up of a number of experts including an external clinician, will carry out the careful review using the normal processes and the report will be shared directly with the family and the service to ensure that all necessary steps are taken.” Crombie added: “We need to wait on the outcome of the SAE and address any recommendations from that, as well as continuing to implement actions in relation to the whistleblowing concerns.” He further explained: “Since concerns were raised, an improvement plan designed with staff to enhance patient safety, quality of care and improve the working environment and experience for our teams of dedicated staff is already under way.” Crombie concluded: “All aspects of patient care and workforce have been reviewed as well as staff working patterns, training and environment, as part of an open and transparent plan to work with teams.” Beginning in January, maternity units across Scotland will undergo routine unannounced inspections by Healthcare Improvement Scotland, the NHS safety watchdog. This initiative follows several increases in newborn deaths observed in recent years.