Mothers came to harm at maternity unit says report

Mothers and newborn babies came to harm because of staffing shortages and a "toxic" culture at Edinburgh's maternity unit, according to a whistleblowing investigation seen by BBC News.

NHS Lothian commissioned a report into the obstetrics triage and assessment unit at Edinburgh Royal Infirmary after a member of staff raised concerns in February this year.

The investigation upheld or partially upheld 17 concerns about safety.

NHS Lothian said an "improvement plan" designed to enhance patient safety and improve the working environment for staff was already under way as a result of the report.

NHS staff spoke to BBC News following the death of a mother in the maternity unit in September - after the whistleblowing investigation had already been completed.

The health board said a detailed review was taking place into the death in a bid to give the family much-needed answers.

But staff say they fear the risks to patients remain.

"We are afraid we can't provide safe patient care and that women and babies are being harmed," one staff member said, speaking to the BBC anonymously.

"The situation has been getting worse over the past five years and it is at its worst now."

The triage and assessment unit looks after pregnant women requiring urgent care and sees about 1,200 women each month.

The whistleblowing report found that patient safety was being compromised by a series of factors, including staff shortages which were leading to delays in women accessing treatment.

It also said women were being seen by inappropriately qualified staff and that there was a "toxic relationship" between managers and midwives.

The report concluded: "There is no dispute that there have been safety concerns, near misses and actual adverse outcomes for women and babies."

It describes situations where the support provided was "inadequate" and midwives felt "professionally compromised" because of a staffing shortfall:

• One woman who was in labour waited several hours in triage, then called St John's Hospital in Livingston herself to see if there was space in its maternity ward
• On another day, 10 women were waiting to be triaged and 17 were in the department when the night shift began. The unit has capacity to treat nine people at a time.

Investigators found managers incorrectly claimed the unit was well staffed, while "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".

An analysis of rotas found that there was regularly a staffing shortfall. Midwives described actual and "near miss" safety concerns when staffing levels were compromised.

The report also found that levels of sickness had gone up 200% in the obstetrics triage and assessment unit between April 2023 and April 2024 to 15.2%.

There were accounts of staff feeling undervalued, disrespected and working under high levels of pressure and stress.

One witness described an "abusive relationship between management and staff", while others reported a lack of kindness and compassion from managers towards staff after a colleague took their own life.

Some witnesses described managers downplaying concerns, with one accused of being "insensitive at best and bullying at worst".

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

The report was written by senior nursing staff who interviewed a total of 30 witnesses, including staff who work or have worked in the obstetrics triage department.

They concluded that staffing shortfalls and sickness absence would impact on the ability of midwives to deliver safe care.

They also noted an increase in pressure on the department, with attendances up by a quarter since January 2022, leading to overcrowding and delays.

Jim Crombie, the deputy chief executive of NHS Lothian, said the death of the mother in the unit in September was being reviewed.

He said: "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.

"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.

"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.

"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."

Maternity units in Scotland will routinely face unannounced inspections by the NHS safety watchdog, Healthcare Improvement Scotland, from January. It comes in response to a number of spikes in newborn deaths in recent years.