'Toxic' culture, staff shortages at Scottish hospital maternity unit 'harming' mothers and newborn babies

A leader SNP minister has insisted improvements are being put in place after an investigation found mothers and newborn babies came to harm due to staffing shortages and a “toxic” culture at Edinburgh’s maternity unit.

A new report commissioned by NHS Lothian found 17 separate concerns about safety at the obstetrics triage and assessment unit at Edinburgh Royal Infirmary.

A mother with her newborn in hospital. Picture: Getty Images | Getty Images/iStockphoto

It also comes after the death of a mother at the maternity unit in September, which happened after the whistleblowing investigation ended, and a spike in baby deaths.

Scottish Government ministers have been blamed for leaving health services at “breaking point”, with the Scottish Tories saying the report must be the “catalyst for change” within NHS Lothian.

The health board says an improvement plan to enhance patient safety and improve the working environment for staff is now in place on the back of the investigation. However, staff say they still have fears about the risks to patients.

Edinburgh Royal Infirmary. Picture: Google Maps | Google Maps

Public Health Minister Jenni Minto expressed her “sincere condolences to the family involved” in relation to the mother’s death. Ms Minto said NHS Lothian had told the Government a “detailed review” into the death has been initiated “to give them much-needed answers and establish what happened”.

The minister pledged: “The family will be fully informed as the review is carried out.” Ms Minto added: “They [NHS Lothian] have started to implement the actions in relation to the whistleblowing concerns.”

The whistleblowing report found patient safety at the unit, which treats around 1,200 pregnant women a month for urgent care, was being compromised by staff shortages, which led to delays in being able to access treatment.

Women were also being seen by inappropriately qualified staff and there was a “toxic relationship” between managers and midwives.

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One member of staff told the BBC: “We are afraid we can’t provide safe patient care and that women and babies are being harmed. The situation has been getting worse over the past five years and it is at its worst now.”

Meanwhile the report said: “There is no dispute that there have been safety concerns, near misses and actual adverse outcomes for women and babies”.

The report detailed one incident where a woman in labour waited several hours in triage before calling St John’s Hospital in Livingston herself to see if there was space in its maternity ward.

It also detailed another incident where ten women were waiting to be triaged and 17 were in the department when the night shift began. The unit only has capacity to treat nine people at a time.

Investigators also found managers incorrectly claimed the unit was well staffed despite the majority of midwives saying it was short-staffed on most shifts and the least experienced staff were responsible for the ongoing care of a significant number of women at the same time.

The midwives also said there had been actual and near misses due to staffing levels compromising safety concerns.

Sickness levels amongst staff also increased by 200 per cent in the unit between April last year and April 2024 to 15.2 per cent. There were accounts of staff feeling undervalued, disrespected and working under high levels of pressure and stress, the investigation found.

Several staff also told the investigation they feared the repercussions of speaking up would mean managers making their life difficult at work - for example, by not granting annual leave.

Scottish Conservative Lothian MSP Sue Webber described the report as “deeply alarming”, adding: “It is also deeply concerning that a toxic culture has been reported within the health board, which must be stopped, if new mothers are to always get the highest quality care.

“SNP ministers who have left crucial frontline services at breaking point need to be urgently upfront on this. They need to say if they were aware of these issues and what action, if any, was taken.”

Jim Crombie, deputy chief executive of NHS Lothian, said the death of the mother at the unit in September was under review. He said a significant adverse event panel, which includes an external clinician, has been created to review the incident.

“Since concerns were raised, an improvement plan designed with staff to enhance patient safety, quality of care and improve the working environment and experience of our teams of dedicated staff is already under way,” he said.

“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.”