6th October 2026
There must be a point when a government stops reviewing a problem and starts solving it.
For women and families in Moray, that point may feel a very long way away.
Full consultant-led maternity services at Dr Gray's Hospital in Elgin were withdrawn in 2018 because of staffing shortages. Most women requiring hospital births have since had to travel to Aberdeen or Inverness.
In 2023, the Scottish Government approved a plan to restore consultant-led obstetric care at Dr Gray's, backed by up to £6.6 million of funding.
The original plan was for a phased restoration, with full consultant-led services returning in 2026.
Now, in October 2026, that deadline has slipped again.
NHS Grampian says the return of full services will happen "as soon as is safely possible" next year.
For a community which has already waited seven years, that is another delay.
And on exactly the same day, the Scottish Government has announced yet another development in the wider maternity debate.
A new independent national review of Scotland's maternity services has begun.
Another review
The new review will take nine months and report in July 2027.
It will examine maternity services across Scotland, including workforce, leadership, capacity, patient flow, safety and the choice of where women can give birth.
It will specifically consider rural and island maternity services.
And the Government has explicitly named Caithness, Elgin and Wigtownshire as areas requiring particular attention.
That will be welcomed by communities which have been arguing for years that a maternity service designed around the Central Belt cannot necessarily be applied to remote and rural Scotland.
But it also raises an uncomfortable question.
How many times can a service be reviewed before somebody has to decide what the future actually is?
Caithness has been through this too
Caithness knows something about maternity uncertainty.
The local service has been subject to repeated debate over what can safely and sustainably be provided locally, with women sometimes having to travel considerable distances for care.
The Scottish Government's own records show how the process has evolved.
In December 2025, an FOI response stated that there was no planned independent review specifically of Caithness maternity services.
Instead, Caithness was to be considered through the Scottish Maternity and Neonatal Taskforce and wider work on rural maternity services.
That taskforce was already discussing how a national review should be designed.
Now, in October 2026, there is indeed a national independent review, and Caithness is specifically included within its remit.
That may ultimately produce a better answer.
But it also illustrates the frustration.
The process seems to move from review to taskforce to inspection to another review.
Meanwhile, families have to live with the service as it exists today.
The Government has a difficult problem
It would be unfair to pretend that this is simply a case of ministers refusing to provide the service communities want.
There is a genuine problem.
Maternity services require specialist staff. Obstetricians, anaesthetists, midwives, neonatal specialists and other professionals must be available around the clock.
A small rural maternity unit cannot necessarily recruit and retain the same number of specialists as a major city hospital.
And safety has to come first.
Nobody would seriously argue that a maternity service should be maintained in a form that cannot safely staff it.
That is the Government's strongest argument.
But it doesn't answer the whole question.
Safety and accessibility are both important
There is another side to the equation.
For a woman living in Caithness or Moray, travelling to Aberdeen or Inverness is not the same as travelling across Edinburgh.
It can involve hours on the road.
It can mean additional accommodation costs for families.
It can mean partners being further away.
It can be particularly difficult in winter.
And there is the simple psychological issue of giving birth a long way from home.
The debate therefore cannot sensibly be reduced to:
local service = good
or
centralised service = safer.
The real question is:
What maternity service can Scotland provide that is both safe and reasonably accessible to women wherever they live?
This is where the new review matters
The Government says the new review will take a "whole-system" approach and will listen to women, families and staff as well as examining the evidence.
That is important.
It is also encouraging that the review will specifically examine rural and island maternity services rather than treating them as a footnote to the Central Belt.
But the test will be what happens afterwards.
Scotland has had reviews before.
It has had taskforces.
It has had inspections.
It has had consultations.
It has had plans.
It has had funding announcements.
And it has had deadlines that subsequently moved.
The public is entitled to ask whether this latest exercise will finally produce decisions that can actually be implemented.
What would success look like?
Perhaps the answer is not necessarily to restore every maternity service exactly as it operated in the past.
Perhaps the future will involve different models.
More community midwifery.
Better early assessment locally.
Stronger links between smaller hospitals and major centres.
Guaranteed emergency transport.
More use of technology.
Better accommodation for women who have to travel.
Or a properly staffed consultant-led service where the population and workforce make it viable.
But whatever model is chosen, communities need to know what it is, why it has been chosen and when it will be delivered.
That is what has been missing from too much of the debate.
The danger of consultation fatigue
There is another problem which governments should not underestimate.
People eventually become tired of being asked for their views.
They attend meetings.
They respond to consultations.
They tell their stories.
They read reports.
They listen to politicians promise action.
Then another review appears.
At some point people reasonably ask:
"Didn't we already tell you this?"
That is particularly important in places such as Caithness.
Communities have experienced years of discussion about health services, schools, transport and economic development.
If every difficult issue becomes another consultation, another review or another taskforce, confidence in the process can gradually disappear.
Scotland needs a decision-making process as well as a review process
The Scottish Government may be right that maternity services need fundamental examination.
The independent review may identify problems which previous reviews did not solve.
It may also find new solutions.
But there needs to be a clear final stage.
Review → evidence → decision → funding → implementation → monitoring.
Not:
review → report → consultation → taskforce → another review.
The people of Scotland do not expect governments to solve every problem immediately.
They do, however, expect a government eventually to make decisions.
And when those decisions have been made, they expect them to be delivered.
Elgin is therefore about more than Elgin
The latest delay at Dr Gray's is disappointing for Moray.
But it is also a test of something much bigger.
Can Scotland develop a health service which recognises that one size cannot fit every part of the country?
Can it balance safety with accessibility?
Can it recruit the specialist staff required?
Can it give rural communities a service which is genuinely sustainable rather than one which works only when every staffing vacancy happens to be filled?
And perhaps most importantly:
Can the Scottish Government eventually move from discussing these problems to making decisions that people can actually see and rely upon?
The new national review will report in July 2027.
By then, some people will have been discussing the future of maternity services for nearly a decade.
That is a very long time in the life of a family.
The Government may argue that getting the answer right is more important than getting it quickly.
That is reasonable.
But there is another principle which matters too.
After seven years, people are entitled to ask when the waiting is going to end.
Independent review of maternity services begins
Published 05 October 2026 10:30
Topic Health and social care
Improving care for women and babies across Scotland.
A nationwide review of Scotland’s maternity services begins today, examining how care can be improved for women, babies and families.
Chaired by maternal and child health expert Professor Christine McCourt, the independent review will take a whole-system approach, drawing on data, evidence and the direct experiences of women, families and staff at every level of care.
The review will pay particular attention to how care is provided in rural and island communities, with specific focus on services in Caithness, Elgin and Wigtownshire. It will also examine disparities in maternal outcomes, including higher rates of maternal mortality by Black and Asian women.
The review will run for nine months and will also take account of the unannounced inspections of all 18 of Scotland's acute maternity units currently being carried out by Healthcare Improvement Scotland.
Prof McCourt is due to submit her findings and recommendations in July 2027.
Health Secretary Angela Constance said:
"I want every woman and baby to receive the high-quality care they deserve.
“That is why I announced this independent review, which will sit alongside the inspections already underway of every acute maternity unit in Scotland, to identify the systemic changes needed to strengthen services and improve outcomes.
"While the vast majority of mothers receive good care, I have heard from families who were let down, and from those who have bravely shared their experiences of loss – these are powerful stories. Their experiences must shape improvement.
"While the vital work of the review is underway, we will continue to take action to improve services, through implementation of the Miscarriage Framework and HIS Maternity Standards, the Scottish Patient Safety Perinatal Programme, improved bereavement care through the National Bereavement Care Pathway, and new work to improve triage services. HIS will also continue its programme of maternity inspections, driving improvement locally in every acute maternity unit in Scotland, and informing the review."
Professor Christine McCourt said:
"The review team is committed to engaging with women, families, healthcare staff and organisations across Scotland to understand both the challenges facing maternity services and the examples of excellent care that can inform future improvements.
“We want to hear from people with a wide range of experiences and perspectives. We encourage anyone with relevant insights to visit the website, learn more about the review and engage with the process as our work progresses."
Background
www.citystgeorges.ac.uk/scotland-maternity-review
Christine McCourt is Professor of Maternal and Child Health at City St George’s, University of London, where she leads the Centre for Maternal and Child Health Research. Her research focuses on care experience, service organisation and approaches to improving equity in maternity services.