Damning Report Finds 'culture Of Mistrust' At Maternity Unit

Staffing shortages and a "culture of mistrust" led to delays and patients being harmed astatine 1 of nan busiest maternity units successful nan UK, a reappraisal has found.

An inspection of maternity attraction astatine nan Royal Infirmary of Edinburgh said immoderate women waiting for labour to beryllium induced had knowledgeable delays of much than 24 hours.

It besides said unit were reluctant to taxable information reports and had raised concerns astir being overwhelmed and unsupported.

The damning findings echo those of NHS Lothian's own reappraisal into nan troubled maternity portion last twelvemonth - but nan wellness committee insisted it was making advancement successful improving and investing successful its women's services.

The reappraisal of Edinburgh's maternity portion follows a BBC Disclosure investigation which heard calls for urgent action to amended maternity information across Scotland.

The investigation heard from a number of families who had knowledgeable mediocre and sometimes deadly care.

Concerns astir Edinburgh's maternity portion were raised successful 2024 by whistleblowers, which forced NHS Lothian to clasp an soul information review.

It concluded that mothers and newborn babies had travel to harm because of staffing shortages and a "toxic" workplace culture.

Health Secretary Neil Gray said nan Healthcare Improvement Scotland (HIS) study was "deeply, profoundly concerning".

Gray, who said he had knowledgeable nonaccomplishment successful his ain family, told BBC Radio's Good Morning Scotland he had directed NHS Lothian to present its recommendations "immediately".

An unannounced inspection was carried retired successful June this twelvemonth by information watchdog HIS.

It has now published its report, which recovered that unit were "working difficult to supply compassionate and responsive attraction successful very challenging circumstances".

It made 26 requirements for betterment and escalated "serious concerns" astir nan portion to NHS Lothian and nan Scottish government.

The inspectors found:

• Delays of betwixt 7 and 15 hours for an obstetric reappraisal wrong nan triage section for immoderate women, and that nan induction of labour process had been delayed by up to 29 hours

• Only 13% of nan charts for patients' basal observations, specified arsenic humor unit and bosom rate, were afloat complete astatine nan clip of nan visit. One inspector had to show unit that these observations indicated a imaginable deterioration successful a woman's condition

• Delays successful nan escalation of attraction resulted successful "significant adverse outcomes" for women

• Errors were occurring because of mediocre connection betwixt different attraction areas, resulting successful problems specified arsenic missed medication

• The mostly of unit described a antagonistic civilization pinch a deficiency of visible elder management. Many unit were "emotional and tearful" talking astir nan "overwhelming emotion of helplessness, vexation and interest for not only patient, but unit safety"

• Five of nan six azygous rooms wrong maternity triage had nary telephone doorbell strategy available. One female told inspectors she had been successful symptom but had nary measurement to get unit attention

HIS main inspector Donna Maclean said each interactions observed during nan inspection betwixt women, babies and families were "positive and respectful".

"Some unit were complimentary and described their statement head arsenic supportive," she said.

"However, nan mostly of nan multi-disciplinary squad we said pinch were disappointment astatine staffing levels and told america this presented a information risk, which they'd raised connected aggregate occasions pinch managers.

"They shared their concerns of being overwhelmed, unsupported and not listened to."

There were concerns astir nan operation of skills wrong nan department, challenges successful providing one-to-one attraction for women, and delays to observations aliases nan escalation of objective concerns.

"Our inspection has highlighted gaps successful incident reporting and a reluctance to taxable incident reports, pinch unit describing a civilization of mistrust," she added.

"These are concerning issues that whitethorn person important effect connected nan learning from adverse events successful nan strategy and trim opportunities to amended safety.

"Women told america of mixed experiences wrong nan hospital. Whilst immoderate were complimentary of their care, they besides informed inspectors of mediocre connection that near them emotion uninformed and pinch nary 'voice' successful their care."

BBC Scotland News has spoken to much than a twelve midwives, connected an anonymous basis, who activity astatine Edinburgh's maternity unit.

They explained immoderate of nan challenges they faced successful nan portion erstwhile it came to dealing pinch pressures specified arsenic short staffing and workload.

NHS Lothian's 2024 reappraisal upheld aliases partially upheld 17 concerns astir information and concluded "there is nary conflict that location person been information concerns, adjacent misses and existent adverse outcomes for women and babies".

At nan time, BBC Scotland said to immoderate families pinch experiences of mediocre attraction astatine nan maternity unit.

This included Naomi Robertson, whose boy Roddy was calved location successful August 2023.

A reappraisal of his commencement recovered he suffered a encephalon wounded aft aggregate missed opportunities for study and curen owed to short-staffing and precocious numbers of analyzable patients astatine nan hospital.

The HIS inspection successful June this twelvemonth besides recovered grounds that suggested not each superior commencement tears were being recorded properly, and that nan number of women experiencing a important humor nonaccomplishment could beryllium being under-reported.

Staff besides described an situation wherever staffing numbers varied vastly connected a shift-to-shift basis, pinch HIS watching a reduced readiness of midwives by up to 50% connected immoderate shifts and noting "at times location was nary unit to undertake attraction needs".

The starring origin for maternal decease successful nan UK is venous thromboembolism, wherever a humor clot blocks nan travel of blood.

In nan incident reports provided by NHS Lothian, HIS recovered that errors regarding venous thromboembolism consequence assessments and medicine was nan 2nd starring origin for a diligent information incident study to beryllium submitted by unit successful nan six months anterior to nan inspection.

Elsewhere, inspectors recovered gaps successful incident reporting, including immoderate stillbirth reports not being submitted until 11 days aft nan death, pinch immoderate workers describing a "reluctance to taxable incident reports owed to perceived repercussions and a civilization of mistrust".

And immoderate student midwives astatine nan maternity portion said they felt unit to 'just get connected pinch it' without capable support, pinch immoderate of them past being progressive successful diligent medicine errors.

Health Secretary Neil Gray said he had met immoderate of nan families who had shared their experiences astatine nan maternity portion and was grateful to them for doing so.

He told BBC Scotland News: "They should cognize that it is not conscionable words that I person but an empathy and a individual committedness to seeing improvements being made."

In a connection to Holyrood, Mr Gray announced NHS Lothian's maternity services would beryllium placed nether further Scottish authorities oversight and support.

In Scotland, wellness boards are taxable to nan "NHS Board Performance Escalation Framework" which ranks from 1 to five, pinch 5 being nan worst, and it relates to circumstantial problem areas.

NHS Lothian's maternity services person been moved to shape 3 of this framework.

In addition, a caller Scottish Maternity and Neonatal Taskforce will beryllium formed to oversee improvements successful nan area.

In his statement, Mr Gray issued his condolences to nan families who featured successful nan BBC Disclosure investigation and those who mislaid loved ones successful nan attraction of NHS Lothian maternity services.

He added: "I americium profoundly disappointed and concerned by nan findings successful this report, peculiarly those relating to nan experiences of women giving birth.

"I americium besides greatly concerned astir nan findings relating to mediocre culture. We will not tolerate these issues successful our NHS. I admit nan bravery of nan nurses who said retired some successful nan BBC programme and to HIS."

In May, NHS Lothian issued an apology to maternity attraction staff aft an investigation recovered a toxic workplace civilization crossed its women's services.

Prof Caroline Hiscox, main executive of NHS Lothian, said nan HIS study "effectively endorses" its ongoing programme to amended diligent information and moving culture.

This includes hiring 70 other midwives, who will each beryllium successful station by nan extremity of December.

She added: "I cognize these reports are concerning and I apologise to women and their families and tin reassure them that these issues are being taken highly seriously.

"An betterment scheme is ongoing successful NHS Lothian aft whistleblowing concerns were raised successful 2024 and we person been very clear that wider ranging matters, specified arsenic staffing, recruitment and moving civilization wrong nan department, will return clip to resolve.

"Significant finance and improvements person already been made."

She added: "I want to reiterate nan apology we made to unit earlier successful nan twelvemonth erstwhile they told america astir their concerns complete staffing numbers and astir a moving civilization that was difficult, and wherever bad behaviours were tolerated.

"That is not acceptable successful immoderate workplace. We cognize location is still much to do to guarantee our unit consciousness supported astatine work, safe to raise concerns and capable to thrive."