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The next item of business is a statement by Neil Gray on ensuring safe maternity services in Scotland. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.
14:45
I am grateful to the Presiding Officer for the opportunity to make this statement. Members will be aware of Healthcare Improvement Scotland’s report into acute maternity services at the Royal infirmary of Edinburgh in NHS Lothian, which was published this morning, as well as the BBC’s “Disclosure” programme that aired last night.
I know that people will be concerned, but from the outset I 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 places for women to give birth, and they ensure that mothers have access to the best possible care.
Any death or injury in maternity and neonatal services is a tragedy for a family. I found it incredibly difficult to read and listen to the experiences of people who were excited to be extending their families but are instead mourning the loss of their loved ones. I take this opportunity to extend my deepest condolences to Lori Quate—the husband of Jacqui Hunter and father of their 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 families who have lost cherished loved ones while in the care of NHS Lothian maternity services.
This is an incredibly sensitive and emotive issue, and it is one whose effects will be felt across the chamber. I have not spoken about it before, but my family knows personally what it is like to suffer pregnancy loss. Indeed, at that time I also very nearly lost my wife due to inaccurate assessments of ectopic pregnancy symptoms, which is an experience that stays with me every day. Our family’s experience differs from those of the families featured in the “Disclosure” programme and the HIS review, but I can absolutely understand the pain, grief and trauma that they went through. That makes me even more grateful to the families who have come forward. I share their personal determination to ensure that urgent improvements are made.
I acknowledge 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 the wider national health service 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, the most anxious times in their lives, witnessing the miracle of birth every day. I also recognise that there are deeply challenging times when something does not go to plan. Our NHS maternity staff are there to offer families compassionate and supportive care. I know that many other members across the chamber will have deep personal gratitude for the support that maternity care staff have provided to their families.
Before I turn to the substantive content of the HIS report, I want to provide members, and the public, with some important points of assurance. First, in the past 20 years, Scotland has made significant progress in reducing the risks associated with childbirth. Infant mortality has significantly reduced and, in 2024, stillbirth reduced to its lowest level. Although neonatal deaths have also reduced, we commissioned a review of neonatal mortality to understand what more needs to be done to reduce it further. The review was chaired by Dr Helen Mactier and published its findings last year, which led Healthcare Improvement Scotland to announce the commencement of its “safe delivery of care” inspections into acute maternity units across Scotland. The Scottish Government fully supported and backed that decision.
Those inspections started earlier this year. The first report, into NHS Tayside’s Ninewells maternity unit, was published in May. The second, into the Royal infirmary of Edinburgh, was published today. Although I know maternity and neonatal services are safe and the vast majority of women and their families have good experiences, the work done by HIS will help to ensure that we address issues such as those that have been found in Lothian.
It is also important that expectant parents have accurate information available to them. 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 the latest report, particularly those relating to the experiences of women giving birth. I 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 who use 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 those issues in our NHS. I appreciate the bravery of the nurses who spoke out both in the BBC’s “Disclosure” programme and to HIS. That is how change and improvement happen.
On Monday night, I met NHS Lothian’s chief executive to discuss those 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 also recognise that the report highlights some positive points, including respectful and responsive care, good teamwork and improvements in maternity triage. It illustrates the dedication, hard work, and compassionate care that are provided by staff working in very challenging circumstances. I thank the staff at Edinburgh royal infirmary for their commitment and tireless efforts to support mothers and babies, often in difficult circumstances.
In December, I directed the chief medical officer and chief nursing officer to work directly with NHS Lothian on the issues that I became aware of at that time. HIS undertook an unannounced visit in March and an inspection visit in June. The board has since made some improvements, in particular to maternity triage, and NHS Lothian has told me about its £1.5 million investment in additional staff, which it says 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 by the appointment of a dedicated associate medical director for women’s services, and a range of cultural improvement initiatives, including the development of a culture charter.
However, I still have significant concerns about the pace and momentum of change, and I am clear that 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. That intervention will provide significantly enhanced support and scrutiny of the improvement activity that NHS Lothian has outlined in its 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 the handling of adverse events.? I will meet 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. Although the Healthcare Improvement Scotland inspection reports will, in some cases, make for difficult reading for Government and health boards, I fully back the programme, which 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, that 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. The process is holding services to account. The NHS Tayside and NHS Lothian reports demonstrate that.
Local improvement action plans are already delivering change on the ground. NHS Tayside has already delivered the vast majority of its improvement actions following its inspection, with the remainder due to be completed by the end of the year. That is the sort of positive improvement that we want to see happening everywhere.
As we get further into the inspection schedule, we are seeing themes emerge, which means that we can now focus on actions to improve those areas. We have commissioned HIS to develop a set of detailed maternity standards that will describe the level of service that we expect to be delivered in every maternity unit, and those standards will inform future inspections.
Our Scottish patient safety programme’s perinatal programme, which has been operating for more than 10 years, has also delivered a range of improvements in maternity services, such as safety huddles, perinatal care bundles and stillbirth care bundles. The 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 that 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 will 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 such reviews.?
To further strengthen our national oversight, I can announce today the establishment of a new Scottish maternity and neonatal task force. It 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 and third sector and advocacy organisations. It will report to me and will complement the existing audit and inspection system that is in place in Scotland. I want women’s voices and their experiences of maternity services, as well as the voices of front-line midwives, to be heard, and I will make sure that they are part of the task force and that we listen to them.
Furthermore, I will meet Scotland’s new Patient Safety Commissioner in November, and I will take the opportunity to discuss maternity services with her then.
Finally, members will be aware that I have also reached out to health spokespeople from across the chamber to invite them to meet me and the chief executive of NHS Lothian to discuss the findings of the HIS report in more detail.
Fulfilling our commitment to continuous improvement across our NHS is vital. We must empower our services and our staff to make the necessary changes that we need to ensure the safest and highest-quality maternity services in Scotland. I know that members will support me in that vision, and I welcome the opportunity to answer any questions that members might have at this time.
The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will move on to the next item of business. I would be grateful if members who wish to put a question were to press their request-to-speak buttons.
As I am a father of two young children and a practising NHS general practitioner who works closely with NHS staff and patients, this issue is particularly close to my heart.
I welcome Neil Gray’s urgent statement today. Like all members in the chamber, I am sickened, appalled and, to be frank, terrified to read the findings of the report. My thoughts are with new mothers and families who have experienced such trauma at first hand and with the staff who have suffered.
This traumatic report highlighted a number of serious issues in our health service, including dangerously low staffing levels, a culture of fear, cover-ups, a failure to listen to families and a refusal to learn from mistakes that have been made—with pure luck seeming to get staff through sometimes.
Staff and mothers have been raising the alarm for years, but those warnings were silenced, which has shamefully put mothers and babies in harm’s way. Let us be clear: two out of four hospitals in the Highlands have not been inspected for almost a decade.
We cannot rely on the BBC to show our problems. The buck stops with the cabinet secretary. After nearly two decades of Scottish National Party mismanagement, our health service is in permanent crisis mode. Until the SNP fixes the dire workforce planning, nothing will change. Surely, with the new task force, the cabinet secretary will halt the downgrading of maternity services under the best start model.
Given the severity of the report, why have NHS board members not been held accountable? What is the timeline to implement the 26 recommendations in full?
First and foremost, as I said in my statement, my thoughts are with all the families who have been impacted and with the staff who have come forward. I made that clear in my statement, so I share the sentiments that Sandesh Gulhane sets out.
In my statement, I addressed the steps that NHS Lothian has taken to recruit more staff. The staffing complement for midwifery and nursing in Scotland has gone up under this Government, but I am not complacent about that, which is why it is important that we keep the matter under review and why the safe staffing legislation is so important to ensure the continued safety of our services.
I will not under any circumstances tolerate a culture of fear for staff who seek to raise concerns or report poor standards of behaviour. I have made that plain in the time that I have been in office and in the discussions that I had with the chief executive of NHS Lothian. I have made plain to all board chief executives and chairs that I expect there to be a speak-up culture in the NHS. The “Disclosure” programme serves as a reminder of why such a culture is so important.
In my statement, I have set out the position on neonatal services, which has been underscored by midwives at NHS Tayside and, indeed, by Bliss, which says that it is the right model for us to follow.
On accountability, I cannot go into detail about human resources or employment matters, as Dr Gulhane will understand, but changes have been made and leadership has been strengthened at NHS Lothian.
For years, midwives have issued warnings about the sustainability of services, but it seems that the cabinet secretary has not fully listened. The cabinet secretary has been told many times by the profession that our hard-working, dedicated staff face mounting pressures and an increasing workload. Junior midwives are being forced to enter the profession with limited mentorship and support. The Government mentioned an increase in midwife numbers, but what about the numbers of whole-time equivalent staff, the unfilled shifts and the changing complexities of cases, all of which have been raised by the profession? Staff on the ground are burned out, and it is clear that urgent action is needed.
Today, the cabinet secretary announced a new Scottish maternity and neonatal task force, but, after months, many of the nursing and midwifery task force recommendations have not actually been implemented—some of the work has not even been started. How can the Parliament be confident that the new task force will ensure the delivery of better outcomes for staff and patients on the ground? Has the cabinet secretary ensured that tight timeframes are in place for reporting on that?
On the point about listening and hearing, when I became aware of concerns about NHS Lothian in December, I instructed the chief medical officer and the chief nursing officer to support NHS Lothian. When the report from HIS was shared with me last week, I made plain to NHS Lothian my expectation that there be an immediate response and that the recommendations in the report be set out. I am satisfied that the Government has done and is doing everything possible to ensure that there is public confidence and staff confidence in maternity services, not only in NHS Lothian but—as we heard in last night’s important BBC “Disclosure” documentary—across Scotland.
It is for boards to employ staff and to ensure that the right staff skill mix is available, but I hear Carol Mochan’s concerns about the need to ensure that the level is appropriate, given the concerns that have been raised in the HIS report on NHS Lothian. On Monday night, I raised those concerns directly with the chief executive of NHS Lothian, and I received assurances on her commitment to ensuring that staffing is increased to safe levels and that the right skill mix is put in place. I expect that to be the case across all boards, not only because of a report from HIS.
On the nursing and midwifery task force, I expect the recommendations to be implemented at pace. I will work with the new chief nursing officer, who comes into post in the next couple of weeks, to ensure that that is the case. On reporting, I set out in my statement my expectation of immediate action from NHS Lothian, and I will follow up with the chief executive by the end of November.
I thank the cabinet secretary for his statement and for recognising the concerns of maternity services, families and staff across the country. He has outlined his empathy with the situation and his interest in maternity services, particularly neonatal services.
The issue is of interest to my constituents. As a fellow MSP from the area that NHS Lanarkshire covers, the cabinet secretary will know the concerns that have been raised about the best start plan. However, misinformation means that many of my constituents are concerned that the neonatal unit is closing. As we know, that is not the case. It is the specialist services that will now be centralised, with the nearest one for my constituents being in Glasgow. Neonatal surgery, which is currently unavailable at Wishaw, is already performed in Glasgow.
Given that that is the case, will the cabinet secretary clearly outline the decisions that are set out in the best start plan, and how parents and families will be supported if their baby is transferred? Will he again reassure us that the neonatal unit in University hospital Wishaw is not closing?
I made reference to that in my statement, because I have been concerned about misinformation that has been reported. I thank Clare Adamson for her question, and I thank the incredible staff at the neonatal unit in Wishaw general hospital for their life-saving work.
I am aware of the recent press and social media coverage about the neonatal units at both Wishaw general hospital and Ninewells hospital, and I state my concern about that misinformation. My utmost priority, and that of ministers, will always be the families in Scotland, and the fear and alarm that that misinformation could cause is distressing.
No neonatal units are closing. We are consolidating care for the smallest and sickest babies in three specialist units at the Queen Elizabeth university hospital in Glasgow, the Royal infirmary of Edinburgh and Aberdeen maternity hospital, so that they have the best chance of survival.
I will make clear the reasons why the decision has been made to improve the model of neonatal care in Scotland. The model, which is set out in the 2017 report “The Best Start”, follows clinical evidence that providing specialist care in units that care for higher numbers of very pre-term babies gives the best survival chances and clinical outcomes.
Very pre-term babies are those babies who are born at less than 27 weeks’ gestation, who weigh less than 800g and who need multiple complex intensive care interventions or surgery. In Scotland, that will mean that only 50 to 60 babies who are born at the extremes of prematurity and a small number of the very sickest babies who require, for example, neonatal surgery will receive care through the model, with the vast majority of more than 4,500 premature babies continuing to receive care in the units closest to their home.
I fully appreciate the sensitivity of the issues. I am keen to enable as many members as possible to take part in the session, and I would be grateful if we were succinct, as that would enable more members to be involved.
Following the BBC “Disclosure” programme last night, which highlighted the harrowing experience of a patient from 2020, I was approached by a constituent who experienced similar issues with her maternity care at Ninewells hospital. Her baby was dropped by a doctor, she was given drugs, which were later described as unsafe in her condition, and she was told to remove a surgical bandage herself in the toilets 24 hours after birth rather than getting the correct support from staff.
Given that the cabinet secretary mentioned in his statement the progress that has been made through NHS Tayside’s local improvement action plan, what reassurances can he give to my constituent and other women that those improvements will be sufficient to ensure safety? I note his comments about accountability for NHS Lothian, but how will the Scottish Government ensure that NHS boards are held accountable, especially as we are talking about one of the most vulnerable moments in a woman’s life?
Roz McCall is absolutely right. That is why it is so important that we get this right. My apologies to the constituent who contacted her with those details. That is clearly a very distressing situation, and I would appreciate being furnished with those details so that I can follow up with NHS Tayside to ensure that the necessary response to that and the on-going care needs of that family are in place.
Healthcare Improvement Scotland has carried out an inspection of Ninewells. The recommendations have not just been accepted—their implementation is in train, and I expect them all to be completed by the end of this year.
On the back of Roz McCall’s information, I will make sure that that case is also highlighted and that lessons can be learned.
The cabinet secretary will be aware of the issues that local people, and we as local MSPs, have raised in Wigtownshire regarding the provision of rural maternity services.
Safety has always been my primary concern when addressing these matters. What assurances can the cabinet secretary give to our constituents in rural and more remote areas, such as the south-west region, regarding the provision of safe maternity services, and can he provide some feedback on the Government’s recent meeting with the local Galloway community hospital action group?
I fully recognise the importance of those issues for the people of Wigtownshire whom Emma Harper represents, and I know that my ministerial colleagues share that understanding. All women, irrespective of where they live, should receive high-quality, safe maternity care that is tailored to their individual needs and circumstances. The implementation of continuity of midwifery care through our best start programme is a key part of that and we are confident that, overall, maternity services in Scotland are safe and that the system of unannounced inspections gives us real-time assurance of quality and safety.
As Emma Harper highlights, I visited Dumfries and Galloway earlier this month and met service leaders and community groups on 15 October, including the Galloway community hospital action group, to hear directly about those issues. Following that meeting, I have asked NHS Dumfries and Galloway for further information, and I will share that with the Galloway community hospital action group.
The risks to mothers and babies that were outlined in the HIS report and on the BBC’s “Disclosure” programme are incredibly worrying. The cabinet secretary is reducing specialist neonatal provision at Wishaw and elsewhere, and mothers and the sickest babies from that area could have to travel for three hours to Aberdeen because Glasgow is regularly full—in fact, Glasgow sends its overspill to Wishaw. Mothers in Caithness and Stranraer are having to travel hundreds of miles to give birth, and I met some of them recently.
I ask the cabinet secretary, therefore, to include provision for remote and rural areas in the task force work and to review the best start programme, as we could have five specialist neonatal units and not the three that the Government has settled for.
I am happy to consider Jackie Baillie’s ask for the task force to look specifically at rural and island community midwifery services. However, I do not accept her characterisation of the best start model—it is not true. Ensuring the safest possible care that has been recommended by clinicians and supported by Bliss and by midwives, including at Ninewells, is the model that we should be following to ensure the best outcomes for these babies.
At the outset, I should say that I hear a lot of positive stories about maternity care, and my family and I have had three very positive and happy experiences in Lanarkshire, at the Wishaw maternity unit.
However, although this is not directly related to the situation in Edinburgh, I met a constituent this week who reported having had very difficult maternity experiences at all stages, including pre-birth, birth and aftercare. I have written to the cabinet secretary about that, so I will not go into the full details just now. However, at the heart of my constituent’s complaint is that she did not feel heard in relation to the treatment and care that she received.
What more can be done to ensure that the services learn from such experiences, as well as from the experiences in Lothian, so that all mothers feel that they are an integral part of the care and decision-making process when they are pregnant and giving birth?
I know that Fulton MacGregor wrote to me yesterday, and I will ensure that he gets a full response to that correspondence. He is absolutely right that women deserve answers, transparency, honesty and openness with regard to the care that they receive. That was the theme of concern that came through from the HIS report in NHS Lothian, and I have been absolutely clear with the board’s chief executive that that must change and improve.
Fulton MacGregor is absolutely right that women must receive information that is appropriate to their needs and that they must, when they have questions about their care, including when there have been mistakes or failures, have those properly investigated and fully resolved.
NHS Lothian has responded to the HIS inspection report, citing its improvement plan and apologising to staff for the working culture and staff shortages. Although I am sure that we all welcome the recruitment of 70 new midwives, that is a staggering level of understaffing—NHS Lothian was short of more than 70 midwives, and whistleblowers had to sound the alarm about patient and staff safety. How did the Scottish Government not know what was happening in our maternity services? How will the minister take us from an NHS culture of reacting to bad news, to a culture of proactively assessing and evaluating the state of our NHS services so that we do not end up in this situation again?
I appreciate the concern that Lorna Slater has set out regarding the revelations in the HIS report about staffing levels in NHS Lothian. I share those concerns and I said as much to the chief executive of NHS Lothian on Monday night—I said that I expect the staffing complement to be resolved and the skill mix in that staffing complement to be properly addressed.
On ensuring that we respond rather than react to the situation, I have been clear about the inspection regime that is in place with Healthcare Improvement Scotland, which is part of the reason why I am stood here today taking questions about these matters. We are uncovering areas where there is challenge and we are finding areas of success and sharing experience of both to ensure that we can learn and provide safer services going forward.
I have been working with Lori Quate for some time. As we saw in the programme last night, he lost his wife and daughter within 24 hours of each other. That was a traumatising experience. I welcome the cabinet secretary’s statement, because it does not ask whether there is a problem; it acknowledges that there is a problem. These are not isolated cases; there is a problem with the system as a whole. We have seen from the inspections in NHS Lothian and NHS Tayside that that is the case.
The question now is how we deliver change. I accept that the cabinet secretary has set out a series of procedures and processes and a new task force. However, if he finds through that task force that a national investigation is required to stimulate adequate change across the country, will he agree to such an investigation? It is important that we learn the lessons from this, rather than its being forgotten as a one-time episode. Will the cabinet secretary consider a national investigation if that is what the task force finds?
I very much appreciate Willie Rennie’s testimony. I again offer my condolences to Lori Quate for the unspeakable and unimaginable pain and torture that he must be experiencing. I am grateful to Willie Rennie for his support and representation on Lori Quate’s behalf.
In my statement, I set out the steps that I believe we can and are taking regarding the HIS inspection regime. However, I remain open-minded. Should further information come to light, or should any of the discussions that I have with the Patient Safety Commissioner, or the information that comes through the HIS reviews, require us to have more national oversight, I will consider that. It is important that we act now rather than wait for the outcome of a review. The HIS inspection regime allows us to operate live to ensure that we are addressing concerns and problems where they arise on a localised basis.
Midwives in Edinburgh have told me that they often feel like they are landing planes, with expectant mothers being told to sit in car parks or to go home. In one case, an expectant mother told me about giving birth on a bathroom floor. That trauma meant that the family has decided not to have any more children. This seems to be happening too often. What reporting of such incidents will take place under the reviews that the cabinet secretary has outlined to ensure that the task force takes into consideration the situations that are often not being reported?
I absolutely recognise that a traumatic experience such as the one that Miles Briggs put on the record and the ones that were put on the record in the “Disclosure” programme can lead to families making very difficult choices about their family composition. I cannot imagine the challenge that is at play in those situations. There are significant adverse event review processes in place in the NHS across Scotland. As I said in my statement, I have written to all health board chief executives to set out my expectations regarding the speed, timeliness and robustness of those processes. As Miles Briggs has pointed to, I expect the task force to be able to look at some of those processes to ensure that it is informed about the actions that need to be taken, should they need to be taken.
Any negative childbirth experience can have short-term and long-term adverse consequences for women and their babies. It has been linked to difficulties with breastfeeding, poor self-rated health, post-traumatic stress and post-natal depression. What assurance can the cabinet secretary provide that support is available to women who, due to feeling fearful or being in physical distress, have had a negative experience of childbirth?
Ruth Maguire is right. That is why, in February this year, we published our pathway of maternity care, to set out the core care that all women and their babies should receive during the antenatal, intrapartum and postnatal periods. The pathway provides that all women
“should be given the opportunity to discuss their maternity journey with their midwife”
prior to their discharge from maternity services, and that
“any appropriate referrals to other services should be made at this time.”
I encourage any women with any worries or concerns about either their current pregnancy or their previous birth experience to speak to the midwife in the first instance, to ensure that they receive the appropriate care and support, tailored to their individual needs and circumstances.
We have known about these issues for more than a year. In August 2024, new mother Louise Williamson spoke about her “horrific” labour after she was “repeatedly ignored”.
In December, in a verbal briefing given to Lothian MSPs and MPs on women’s services concerns, NHS Lothian advised that action was under way. Further assurances on progress were given to the same group on 20 June 2025, yet, three days later, on 23 June, an unannounced HIS inspection confirmed that nothing had changed.
Women deserve to know that their maternity services are safe. Today, NHS Lothian told MSPs that the issues
“will take time to resolve.”
What confidence can families have that, this time, there will be real, tangible changes?
It is not true to say that nothing has changed. The HIS report explicitly goes into detail about the improvements that have been made in maternity triage processes, which have improved and have been given a good score.
However, as I set out in my statement, I share the concern about the pace of progress. That is why NHS Lothian has been escalated to level 3 of the NHS support and intervention framework for its maternity services—it is because I share the concern that the member outlines about the speed of progress. To provide Sue Webber, her constituents and other members across the chamber with reassurance about the completion of all the recommendations, that is also why I will be meeting the chief executive of NHS Lothian by the end of November to ensure that that progress is being made.
The report that was published following the HIS inspection in June states that staff were
“working hard to provide compassionate and responsive care in very challenging circumstances.”
It made 26 requirements for improvement and escalated serious concerns to NHS Lothian and the Scottish Government. One of the main issues that were mentioned in the report was
“delays in escalation of care”,
which
“resulted in significant adverse outcomes for women.”
What can the cabinet secretary say to reassure pregnant women in my area of East Lothian and in NHS Lothian about that particular area, and what actions are being taken now—and have been taken since the inspection—in relation to that?
I thank Paul McLennan for raising those points, which will be incredibly important to the constituents he represents in East Lothian. As I said in my statement, I know that people will be concerned—I am concerned—and, from the outset, I want to reassure every pregnant woman and their families 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 to ensure access to the best possible care.
When I met NHS Lothian’s chief executive earlier this week, she outlined the extensive package of work that the board has already put in place to address the findings of the report, recognising that some of the issues will take time to resolve. I impressed on her my direction that this must be resolved as quickly as possible. She also outlined improvements that have already been made. Those include the investment of £1.5 million in staffing, which has led to the recruitment of more than 70 additional midwives, 30 of whom are already in post and the rest of whom will be in post by the beginning of December. Leadership has been bolstered through the appointment of a dedicated associate medical director for women’s services, and the board has invested in staff training. NHS Lothian published its externally commissioned review of culture in May, and maternity teams are now developing their own culture charter.
I assure Paul McLennan that I take the concerns to which he referred extremely seriously, and I expect NHS Lothian to act immediately to implement the 26 requirements.
I am keen to take all members who have indicated a desire to ask a question, so I would be grateful if people could be succinct.
I know from personal experience, when our first daughter died, how much care and love was given by the maternity unit here, in Edinburgh.
It is clear that there is an on-going issue, and I welcome the cabinet secretary’s statement. Will he commit to coming back to the chamber early next year to give us an update on how things are progressing in Lothian? I am afraid that many of us in the city of Edinburgh are not confident that the changes that he outlined in his statement will be made quickly or efficiently.
I thank Jeremy Balfour for sharing his very sad loss, and I offer my condolences to him for the pain and trauma that he experienced in those circumstances.
I have set out clearly to NHS Lothian my expectation that it must come forward with improvements, and I have set a timeline—by the end of November—for when I expect to hear more. I am more than happy to ensure that Parliament is kept informed of progress, whether through a statement, a Government-initiated question or a letter to committee.
I express my gratitude for the courage of whistleblowing NHS staff, because it is their willingness to speak up that is key to having a transformed culture of continual improvement.
I know that the cabinet secretary knows that, too often, families who are affected by maternity tragedies are left in the dark, while HIS and NHS boards appear to pass responsibility for transparency and accountability between each other. What assurance can he give that health boards will not go on managing reputational risk but will instead ensure that significant adverse event reviews in maternity cases are published, learned from and acted on?
Stephen Kerr has a long-standing interest in supporting whistleblowers, for which I am very grateful. I share his desire for us to have a speak-up culture in our health service. I have made that abundantly clear on numerous occasions publicly, in Parliament and to our NHS board chairs and chief executives. I share Stephen Kerr’s view that we need to have a speak-up culture, because that is how we will achieve progress, improvement and learning. I also share his concern about the need to ensure that information is shared transparently with families.
As I said in my statement, I have written to NHS board chief executives to set out my expectations on the timeliness and robustness of significant adverse event reviews. Mr Kerr will understand why it is challenging to have those published, but I am more than happy to have further conversations about how the process is working.
The cabinet secretary will be aware that I, alongside other colleagues in the Parliament, have campaigned to stop the downgrading of Wishaw general’s neonatal department. The Scottish Government might wish to use the term “centralisation”, but the removal of specialist services from a neonatal department is downgrading. That is not misinformation—it is a fact.
I have also campaigned to secure overnight accommodation for parents of babies in neonatal wards, as there are not enough beds at present. That is another area in which the Scottish Government has not acted quickly enough.
Will the cabinet secretary confirm that the new task force will—as Jackie Baillie called for it to do—undertake a review of the best start model, with a view to having five specialist neonatal units as opposed to three? Can he give an update on the number of beds that are available for parents who need to stay with their babies in neonatal departments across Scotland?
In response to Jackie Baillie and Clare Adamson, I set out the Government’s position on neonatal services in Scotland, which is based on expert clinical advice and on ensuring that we provide the best possible care to the sickest babies—the most vulnerable babies in Scotland—who need access to the most specialist care. I was clear in setting out our position in that regard.
I am sympathetic to and willing to look at Meghan Gallacher’s request with regard to overnight accommodation in neonatal settings, and I will respond to her in writing with more detail on that.
I should declare an interest, because I have a daughter who is a midwife.
Listening to the cabinet secretary’s statement today, and to the questions and answers, spins me back to the start of my political career, nearly 10 years ago, when one of my first cases was a constituent who, tragically, had lost a child in childbirth. Over an extended period, we worked out that Crosshouse hospital was nearly 24 neonatal staff short, and that of course was addressed, but here we are, nearly a decade later. My colleague raised the issue of reputational management. How do we get past that? How do we get NHS boards to bin the idea of protecting reputation and reputational management, so that we can learn from mistakes that are made?
I thank Brian Whittle for that. I understand that his constituent spoke to and gave evidence to the patient safety commissioner on those issues.
As I said to Stephen Kerr, I am absolutely clear in my expectations for the culture of the NHS and, indeed, wider public services around candour, disclosure and transparency. I am not interested in the protection of reputations. I am interested in ensuring the safe delivery of services and ensuring that our staff feel confident that they can raise concerns where they have them, and that they can go about their jobs to deliver the incredible, world-leading, compassionate and professional care that they do in the NHS here in Scotland.
That concludes the urgent statement.
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Urgent Question