Staffing shortages and a "culture of mistrust" have led to significant harm for mothers and newborns at one of the United Kingdom’s busiest maternity units, according to a damning new report by Healthcare Improvement Scotland (HIS). The Royal Infirmary of Edinburgh’s maternity services, already under scrutiny following a series of complaints and whistleblower revelations, now face 26 urgent requirements for improvement after an unannounced inspection in June 2025 revealed a host of safety and cultural failings.
The HIS inspection, which was triggered by mounting concerns and an earlier internal review by NHS Lothian, found that delays in care, incomplete patient monitoring, poor communication, and a negative workplace culture had all contributed to adverse outcomes for women and babies. Inspectors escalated their “serious concerns” to both NHS Lothian and the Scottish Government, prompting immediate calls for action at the highest levels of Scotland’s health system.
“During the course of this inspection, we escalated serious concerns within NHS Lothian to senior staff and the Scottish Government,” said Donna Maclean, HIS’s chief inspector, as reported by The Scotsman. “These concerns related to culture, oversight of patient safety and staff wellbeing within Edinburgh Royal Infirmary maternity services.”
The investigation uncovered that some women waited more than 24 hours to be induced, with delays of between seven and 15 hours for an obstetric review in the triage department. In some cases, the induction of labour process was delayed by up to 29 hours. Only 13% of patient charts for essential observations—such as blood pressure and heart rate—were fully complete at the time of inspection. In a particularly alarming instance, an inspector had to alert staff that a patient’s vital signs indicated potential deterioration, a situation that could have been avoided with proper monitoring.
These delays and lapses in care were not isolated incidents. The report found that delays in escalating care led to “significant adverse outcomes” for women. Errors resulting from poor communication between different care areas were also documented, including missed medication and incomplete handovers. The inspection team noted that five of the six single rooms within maternity triage had no call bell system available, leaving women unable to summon help when in pain or distress. One woman told inspectors she had been in pain but had no way to get staff attention, a scenario that underscores the gravity of the unit’s shortcomings.
Behind these clinical failures lay a deeper problem: a pervasive culture of mistrust and negativity among staff. The majority described feeling overwhelmed, unsupported, and not listened to, with many expressing “overwhelming feelings of helplessness, frustration and worry for not only patient, but staff safety,” according to the HIS report. The reluctance to submit safety or incident reports was widespread, driven by fears of reprisal and a lack of faith that concerns would be addressed. “Our inspection has highlighted gaps in incident reporting and a reluctance to submit incident reports, with staff describing a culture of mistrust,” Maclean said, as quoted by BBC Scotland News. “These are concerning issues that may have significant impact on the learning from adverse events in the system and reduce opportunities to improve safety.”
This toxic workplace culture was not a new revelation. NHS Lothian’s own internal review in 2024 had already upheld or partially upheld 17 concerns about safety, concluding that mothers and newborn babies had come to harm due to staffing shortages and high patient complexity. The review found “there is no dispute that there have been safety concerns, near misses and actual adverse outcomes for women and babies.” The findings of the HIS inspection echoed those earlier conclusions, but added new urgency and detail to the picture of a unit in crisis.
Specific clinical risks were also identified. The leading cause of maternal death in the UK is venous thromboembolism, and HIS found that errors in risk assessments and medication related to this condition were the second most common reason for patient safety incident reports in the six months preceding the inspection. Some stillbirth reports were delayed by as much as 11 days after the death, further highlighting failures in the reporting and learning process. Student midwives reported feeling pressured to “just get on with it” without adequate support, a dynamic that contributed to additional medication errors.
Staffing levels were found to be dangerously inconsistent, with midwife availability reduced by up to 50% on some shifts. At times, there were simply no staff available to meet care needs. The lack of visible senior management and support was a recurring theme, with staff describing a negative culture where bad behaviours were tolerated and their own safety—and that of patients—was compromised. The emotional toll was evident, as many staff members were described as “emotional and tearful” during interviews with inspectors.
In response to the report, NHS Lothian’s chief executive, Professor Caroline Hiscox, issued a public apology to women, families, and staff. “I know these reports are concerning and I apologise to women and their families and can reassure them that these issues are being taken extremely seriously,” she told BBC Scotland News. “An improvement plan is ongoing in NHS Lothian after whistleblowing concerns were raised in 2024 and we have been very clear that wider ranging matters, such as staffing, recruitment and working culture within the department, will take time to resolve. Significant investment and improvements have already been made.”
Professor Hiscox detailed that more than 70 additional midwives have been recruited and will be in post by the end of December 2025, with 30 already on the job and the remainder set to provide “additional resilience and to future-proof our maternity services.” She also reiterated the apology made to staff earlier in the year regarding their concerns over staffing numbers and a difficult working culture: “That is not acceptable in any workplace. We know there is still more to do to ensure our staff feel supported at work, safe to raise concerns and able to thrive.”
Scotland’s Health Secretary, Neil Gray, expressed similar concerns and a commitment to rapid action. “I have sought direct assurances from NHS Lothian’s chief executive that the health board are providing support to women and families using their maternity services, and to staff,” Gray told the BBC. “We will not tolerate these issues in our NHS services, and they must be addressed immediately.” While acknowledging that maternity services across Scotland remain safe for most families, Gray emphasized that “the safety and wellbeing of mothers, babies and staff is our absolute priority.” He announced record funding for NHS boards and the establishment of a new minister-led oversight group to strengthen services across Scotland.
As the Royal Infirmary of Edinburgh’s maternity unit moves to implement HIS’s 26 recommendations, the eyes of Scotland—and indeed the UK—will remain fixed on its progress. For the families affected and the staff struggling under immense pressure, the hope is that these apologies and promises will finally translate into lasting, meaningful change.
