Hansard

This Government is determined to ensure that the maternity services that are provided across our country meet the highest of standards, for all women and their families. The core principles of safety and choice must remain at the heart of what we do.

I know that members will share my deep concern about recent reports on maternity services, including last week’s Healthcare Improvement Scotland inspection report on the Queen Elizabeth university hospital’s maternity services. My statement will respond to those findings and set out the further action that we will now take nationally, including through an independent review of maternity services.

I know that, for women and their families, pregnancy and birth can be both exciting and worrying. Giving birth in Scotland is, in the vast majority of cases, very safe, and our national health service staff are highly skilled. Any woman who is pregnant should always access care.

Women generally report positive experiences. The National Childbirth Trust’s recent study, “From expectation to reality”, found that 87 per cent of surveyed new mums in Scotland said that they received good-quality care, and an audit report on perinatal deaths of babies born in the United Kingdom in 2024, published today by MBRRACE-UK—mothers and babies: reducing risk through audits and confidential enquiries across the UK—shows that Scotland had the lowest rate of all four UK nations.

That said, I have heard the concerns that have been shared by women, their families and members of this Parliament, and one poor experience is one too many. Care must be safe, compassionate and of the highest quality, regardless of where or when women give birth.

Ministers have already laid some important groundwork that is needed to address the challenges facing maternity services, but it is clear that much more remains to be done.

Last year, Healthcare Improvement Scotland began a rigorous programme of inspections of maternity units, instigated by this Government. Those inspections are independent of Government and are conducted wholly unannounced.

Last week’s HIS report into the Queen Elizabeth university hospital identified serious issues, particularly in relation to women’s experiences of birth and access to timely, personalised care. Inspectors reported delays in triaging to labour wards and instances of failures to provide interpretation services where they were needed. I find those issues unacceptable, and I have made that very clear to the chief executive of NHS Greater Glasgow and Clyde. I expect all of Healthcare Improvement Scotland’s 26 requirements to be taken forward urgently, and ministers will be meeting the board’s chief executive again before recess to review progress.

Although the report identifies failures, it also highlights kind care delivered to women, babies and their families, demonstrating the dedication of maternity staff. I will shortly meet Jaki Lambert, director of the Royal College of Midwives, to discuss the concerns of the workforce and to reiterate my thanks for the exceptional dedication of midwives.

Members might also recall last year’s HIS inspection of the Royal infirmary of Edinburgh maternity unit. Progress within NHS Lothian is positive: 24 of the 26 HIS requirements have been delivered, with the board launching a maternity culture charter and recruiting new staff. However, NHS Lothian maternity services remain escalated under the framework that we have for supervision, and we will continue to work with the board to ensure that it meets all of HIS’s requirements and recommendations.

With seven of the 18 HIS inspections completed, common themes are emerging. These include inconsistent approaches to maternity triage, delays in induction of labour, workforce pressures, concerns around governance and culture, and failures to consistently meet core mandatory training requirements. Each of the boards inspected by HIS has submitted a detailed action plan setting out how it will address the issues identified, and they will be held to account for delivering on those commitments.

It is clear, nonetheless, that decisive national action is needed to tackle the issues that we are seeing again and again in different parts of the country. That work has already begun. First, we commissioned HIS to develop standards that describe the level of service expected in every maternity unit. Those were published in March, and HIS will incorporate the new standards into its inspection programme from September. Last year, we published an action plan to address racialised health inequalities. This provides boards with clear actions to improve the care provided in perinatal services. We have developed a delivery framework for miscarriage care to make sure that women and their families receive the compassionate care that they need, at the right time, in settings that meet their needs. Our triage working group is producing a target operating model that describes how maternity triage services should look in small, medium and large units, and in rural and urban communities. Work is also being taken forward to support the sustainability of the maternity workforce through our nursing and midwifery task force, including improving recruitment pathways, retention and workforce wellbeing. Minister Maree Todd will take forward work to develop rural midwifery apprenticeships.

Although those actions are important, they will not be sufficient. That is why we have committed to an independent review of maternity services in Scotland. This review will draw on inspection findings, but we cannot wait for HIS’s programme of inspections to conclude next year before it gets under way. That is why, today, I have published the core principles of the review, and I will outline these to members now.

First, the review will consider whether we have the right maternity services in place to meet the changing needs of women and families. Women are increasingly having children later in life, and more women are entering pregnancy with complex health needs. These factors can have a significant impact on the care required during pregnancy and birth. This review will provide a strategic assessment of need that will help us match our services to our population. The review will be forward looking and consider service sustainability, taking account of workforce, culture, safety, quality and equity of access.

The review will consider maternity services in rural and island areas and the experiences of women living there. I have heard very clearly—particularly from Maree Todd, David Green, Finlay Carson and Laura Mitchell—of the strength of feeling in Caithness, Wigtownshire and Elgin. I know that progress has been made in meeting our commitment to Dr Gray’s hospital in Elgin, and I want to ensure that progress continues. This review will look at the experiences of women in Caithness, Wigtownshire and Elgin, and in other rural and island communities.

The review will consider inequalities and outcomes, including the higher maternal mortality rates experienced by black and Asian women, and will assess whether current work to tackle racialised inequalities is achieving the required impact. That will be informed by the voices of black and Asian women.

Lastly, the review will consider how NHS boards engage with their local communities on the decisions that they make about maternity services. I know that that has been a key issue that has been raised by the Patient Safety Commissioner for Scotland.

This work will demand an experienced and trusted chair, and I am therefore very pleased to announce that the review will be chaired by Professor Christine McCourt, who is professor of maternal and child health at City St George’s, University of London. Her wide-ranging expertise includes focusing on the experience of women, informed choice in care, place of birth, induction of labour, group care and continuity of carer, and on approaches to improve equity, quality and safety in care. She is a trusted leader in the UK in maternal health and is well placed to lead the transformation that we need to see.

Professor McCourt will engage with women, families, patient groups, clinicians, midwives, nurses and the wider maternity workforce across Scotland, including in Caithness and Wigtownshire. It is essential that the voices of those receiving and delivering care are heard directly through the process.

I will also ask Professor McCourt to examine service models and make robust evidence-based recommendations on the best possible clinical pathways to ensure that women are safe when they give birth and that their needs and those of their families are met.

Pace is essential, and I expect the review to be commenced after summer and completed within nine months. We will publish a more detailed scope and terms of reference in due course. To ensure that the Parliament is fully involved in that work, I will ask Professor McCourt to host a cross-party meeting before she begins the review.

I close by providing reassurance to women that they will be heard. Welcoming a new arrival to the world is the most precious and special moment, and women must be able to trust the services that are being provided to them. The independent review is about ensuring that women can have the confidence that the Government will take swift action where it is needed. That not only delivers now on our 100 days commitment but, importantly, will deliver real and tangible change for women, their babies and their families.