Maternity Alerts - Edinburgh's Royal Infirmary Fails Key Safety Checks Amid Staff Shortages

29th October 2025

A recent unannounced inspection by Healthcare Improvement Scotland (HIS) into maternity services at the Royal Infirmary of Edinburgh has uncovered multiple serious issues around safe delivery of care. The findings raise concern about the risk to both mothers and babies and call for urgent improvement. The report was released today 29 October 2025.

Key Findings

Inspectors noted that the unit has had persistent safety concerns, including near-misses and actual adverse outcomes for women and babies.

There are significant staffing shortfalls and skill mix problems: midwives reported that the unit was short-staffed on most shifts, and that newly qualified staff were expected to supervise others with minimal experience.

Training and supervision were found wanting: the least experienced staff were responsible for ongoing care of large numbers of women, and staff felt under-prepared and unsupported.

Escalation of deteriorating patients was delayed in some cases, and risk assessment (for example for blood clots) was inconsistently applied.

The incident-reporting system appears unreliable: for example, the rate of severe perineal tears was shown to be above national average but internal incident reporting was much lower, suggesting under-reporting of safety incidents.

Culture of the unit: many staff reported feeling unable to raise concerns safely, with fear of repercussions and lack of faith that issues would be addressed.
The Times

Context & Consequences

The report describes services under pressure: large numbers of patients waiting, staff stretched beyond safe capacity, and a mismatch between management assurances and on-the-ground reality.

Although frontline staff were repeatedly commended for their dedication and compassion, the system failures identified place mothers and newborns at elevated risk. The findings do not reflect isolated incidents but systemic concerns requiring board-level oversight and swift action.

Recommendations & Next Steps

The inspection team has required the health board to deliver a robust improvement plan, with measurable timelines and responsible leads for actions around staffing, training, supervision, governance, escalation protocols and incident-reporting. The Scottish Government and HIS will monitor progress. The board already acknowledges the need for improvement and says an action plan is in motion.

Implications for Expectant Parents

For women and families preparing for birth at the Royal Infirmary of Edinburgh, the inspection report underscores the importance of:

Understanding who will care for you (midwife, obstetrician), their level of experience and how supervision is structured.

Asking about how the unit monitors and reports safety issues (such as perineal tears, blood-clot prophylaxis, escalation of care).

Knowing where you stand with support if things don't go to plan: what are the escalation pathways? How quickly would deterioration be recognised and acted on?

Checking whether the unit offers updated assurances on staffing levels, training compliance and patient-safety culture in the wake of the inspection.

Five key recommendations from the inspection findings of the Healthcare Improvement Scotland (HIS) report into maternity services at the Royal Infirmary of Edinburgh (RIE) under NHS Lothian — aimed at addressing the serious safety and governance issues identified:

Urgently review and ensure safe staffing levels and appropriate skill-mix
The report highlights shortfalls in both staffing numbers and senior/mid-experience supervision in the maternity unit. An improvement plan must define minimum staffing ratios, include contingency for absences, and ensure newly-qualified or less-experienced staff are appropriately supported and supervised.

Strengthen training, supervision and escalation protocols
Staff reported feeling under-prepared and unsupported, and the inspection found delays in escalation of deteriorating women and infants. The recommendation is to implement robust training programmes (including for newly qualified staff), clear escalation pathways, regular supervised practice, and audit of compliance with these processes.

Improve incident-reporting, investigation and learning culture
The inspection found that incident reporting did not reflect the known number of adverse events (for example, higher rates of perineal tears but low internal reporting). The board is recommended to overhaul its incident-reporting system: ensuring all adverse events/safety issues are reported, investigated, lessons learned, and changes tracked and fed back to staff.

Foster an open, transparent safety culture where staff feel able to raise concerns
There were reports of a "toxic" relationship between some management and midwifery staff, and that staff were reluctant to raise concerns for fear of repercussion. The inspection recommends establishing mechanisms (e.g., a "freedom to speak up" guardian), regular safety huddles, anonymous feedback and visible senior leadership to promote psychological safety and responsiveness to staff concerns.

Strengthen governance, assurance and oversight of maternity services
Given the systemic nature of the concerns, the report recommends that NHS Lothian ensure board-level oversight of maternity service safety, with clear measurable improvement targets, regular audits of performance (clinical outcomes, staffing, training compliance, incident trends), and public reporting of progress. External assurance and follow-up inspections should be part of the accountability framework.

What are people saying in the media

"There is no dispute that there have been safety concerns, near-misses and actual adverse outcomes for women and babies."
Edinburgh News

"Women were being seen by inappropriately qualified staff and ... staff shortages which were leading to delays in women accessing treatment."
Edinburgh News

"Student midwives described feeling under-prepared and isolated, ‘often having to make decisions they felt they did not yet have the experience to make about women and babies due to limited supervision and available support from qualified staff'."
The Times

"The incident-reporting system ... did not correlate with other data on patient-safety issues ... the rate of obstetric anal sphincter injury ... had been above average" but "incident reports ... were significantly lower than expected".
The Times

"Management didn't listen to our concerns. We'd say we were short-staffed, and they'd say it's fine. If your staffing is down ... you can't give the same care to a larger number of patients."
STV News

"High levels of burnout, absences and people leaving."
STV News

"Newly qualified staff were expected to supervise others with minimal experience."
The Times

"Delays in escalating the care of women who were deteriorating during labour were flagged ... documents showed this problem had resulted in ‘significant adverse outcomes for women'."
The Times

“Inspectors raised a number of serious concerns about the safe delivery of care ... we remain concerned that the immediate actions ... did not lead to significant improvements.” (on broader hospital inspection context)
The Edinburgh Reporter

“The Scottish Government and Healthcare Improvement Scotland are ‘aware of the whistle-blowing concerns raised by staff in NHS Lothian'.”
Edinburgh News

The full report can be read HERE
Pdf 39 Pages

Source