Healthcare Improvement Scotland: Edinburgh Royal Infirmary – safe delivery of care inspection October 2025

Summary

This report summarises the outcome of an unannounced maternity services inspection to the Royal Infirmary of Edinburgh, NHS Lothian on Monday 23 and Tuesday 24 June 2025. This inspection resulted in five areas of good practice, two recommendations and 26 requirements.

Content

Healthcare Improvement Scotland summarised their key findings as follows:

• Throughout the inspection they observed staff working hard to provide compassionate and responsive care in very challenging circumstances. The multidisciplinary team within maternity services spoke highly of the clinical working relationship.
• In some areas staff were complimentary and described their line manager as supportive. However, the majority of the multidisciplinary team they spoke with expressed feeling frustrated at staffing levels which they believe left areas short staffed and staff unsupported. Staff told them this presented a safety risk for women, babies and families within their care which they raised on multiple occasions with managers.
• The majority of the staff they spoke with shared their concerns and feelings of being overwhelmed, described feeling unsupported and believed they were not being listened to. Staff informed inspectors this has impacted staff confidence to escalate staffing concerns due to lack of feedback and resolution when concerns are raised.
• They observed delays to the induction of labour process of up to 29 hours and other delays to women who required ongoing care within the labour ward due to lack of staff availability, capacity and increased acuity.
• Staff they spoke with described suboptimal skill mix, low staffing levels and high acuity resulting in challenges in providing and maintaining one-to-one care for women within the labour ward. Staff also described staffing impacting on timely care such as delays in undertaking maternity early warning score (MEWS) observations or escalation of clinical concerns.
• Women told them of mixed experiences within Royal Infirmary of Edinburgh maternity services. In some areas women were highly complimentary of the care they experienced, describing it as exceptional; however, other women described their experience leaving them feeling alone and vulnerable. Whilst some women were complimentary of their care, they also informed inspectors of poor communication, leaving them feeling uninformed and with no ‘voice’ in their care.
• Their inspection has highlighted gaps in incident reporting and what appears to be a reluctance to submit incident reports with staff describing a culture of mistrust. These are concerning issues that may have significant impact on the learning from adverse events within the system, reducing opportunities to improve safety.
• During the course of this inspection, Healthcare Improvement Scotland escalated serious concerns with NHS Lothian through the Healthcare Improvement Scotland and Scottish Government Operating Framework. These concerns related to culture, oversight of patient safety and staff wellbeing within Royal Infirmary of Edinburgh maternity services.
• Other areas for improvement have been identified within maternity services within Royal Infirmary of Edinburgh. These include fire safety requirements, safe storage of cleaning products and required improvements to the environment.