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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.

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.

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.

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.

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.

On a point of order, Presiding Officer. I wish to clarify whether my no vote was registered.

NHS boards are responsible for ensuring the provision of primary medical services in their area. My officials are working with all health boards to develop a whole-system NHS infrastructure investment plan. A key part of that plan will be the development of an investment strategy for primary care, which will consider both priorities and delivery models.

Spending on primary medical services by the Scottish Government has increased over the past decade, both in cash and in real terms. In cash terms, spending has gone from £763 million in 2013-14 to almost £1.1 billion in 2023-24.

I thank Alex Rowley for setting that out. Yes, I understand it, because I have met local residents in Lochgelly and Kincardine at the request of Ms Ewing and Ms Somerville, the constituency representatives, and the residents highlighted those concerns. We have a capital funding pause, except in the areas that have been set out in the budget, because of the pressure on our capital budget due to decisions that have been taken that are outwith our control and because of inflation in the construction sector. We are in touch with NHS Fife and all other health boards in order to get their capital priorities. We hope that the United Kingdom budget will provide greater capital investment to allow us to do more in the primary care system.

I very much appreciate the work that Annabelle Ewing has done to advance the case for the Lochgelly medical centre. I hear what she has said about NHS Fife’s prioritisation. She will understand that the capital allocation will be determined based on the allocation that we receive from the UK Government in the budget and the work that is being carried out regarding the spending review and the infrastructure investment plan. My wish is for much greater investment to go into the primary care services capital estate and for Lochgelly, Kincardine and other communities to see development happen.

Let me say how sorry I am that I cannot be in the chamber to listen to Mr Mountain’s speech in person. I also want to say how grateful I am that he continues his incredible work in raising awareness of bowel cancer and destigmatising and demystifying the issues before us this evening. I look forward to meeting him following his interventions at First Minister’s question time and to hearing the debate this evening.