It’s well over a year since an employee at Edinburgh’s Royal Infirmary blew the whistle about conditions in the maternity unit, and nearly a year since the subsequent investigation revealed staff shortages and a “toxic” management culture.
The report uncovered by the BBC last December upheld or partially upheld 17 concerns about safety, and NHS Lothian claimed work was already under way to improve patient safety and the working environment.
On June 20 this year, I was amongst a group of MSPs who were told in a health authority briefing that the culture was being fixed, but three days later there was an unannounced inspection at the unit Healthcare Improvement Scotland (HIS), which revealed just how much work was still needed.
The depth of the problems revealed in the BBC investigation last year – mums and newborn babies coming to harm because of the poor culture and staffing situation in the unit – was such that an instantaneous reversal was improbable.
We now know from the publication of the HIS report last week that it’s still in the grip of a crisis, and that doesn’t fully explain the “everything’s in hand” message I was given in June. Nor does it give me any faith that the assurances given in the wake of the latest revelations can be trusted.
NHS Lothian was “grateful to HIS for their expertise,” said the chief executive, Professor Caroline Hiscox last week, and that “these issues are being taken extremely seriously,” which didn’t sound too reassuring at all.
In fact NHS Lothian’s statement was a triumph of linguistic gymnastics, trying to turn stinging criticism into a positive.
The inspectors found frustration with staffing levels which presented a safety risk, and staff were “overwhelmed, unsupported and not listened to”. There was a “reluctance to submit incident reports,” and staff described “a culture of mistrust.”
But according to NHS Lothian the report “effectively endorses the plan already underway,” which was quite breathtaking in its confidence.
It was certainly not enough for the Health Secretary Neil Gray, who has put NHS Lothian’s maternity services into special measures, with the formation of a new Scottish Maternity and Neonatal Taskforce to oversee improvements.
Prof Hiscox said that 72 additional midwives will be working by the end of the year, with 30 in position to meet basic legal requirements, which is a staggering admission of previous failure in itself. The others are for “additional resilience,” so by the time the next report comes out there will be no excuse for further dangerous shortcomings.
What is not explained is how such a crucial service came to be on its knees in the first place. Who was responsible for such an appalling situation which put mothers and babies at such risk? Surely they are not still working in health care, or have they just been quietly moved on?
And if it was a resources issue, it’s remarkable how they have been found when this scandal was exposed. Has another department budget been plundered to cover, in a game of NHS whack-a-mole?
It exposes how much inequality there is in women’s health provision, because it’s hard to imagine any other service being allowed to deteriorate in this way. It’s come to something when undercover investigations and spot inspections are needed to prevent a return to conditions which Sir James Simpson might have recognised.
