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We move to the next item, which is a statement by Angela Constance on improving maternity services across Scotland. The cabinet secretary will take questions at the end of her statement and there should be no questions or interruptions.
We will have a two-minute break to enable a changeover of members on the front benches.
I ask members who are leaving the chamber to do so quietly, and I call Angela Constance.
14:36
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.
The cabinet secretary will now take questions on the issues raised in the statement. I intend to allow around 20 minutes for questions, after which we will move to the next item of business. It would be helpful if members who wish to ask a question were to press their request-to-speak buttons now.
Thirteen members have indicated that they wish to ask a question of the cabinet secretary. To enable all those questions to be put and answered, questions and answers will require to be brief.
I welcome the cabinet secretary’s statement, and I welcome the appointment of Professor Christine McCourt. She has her work cut out for her. For example, inspections have revealed the significant delays for women who are waiting to be induced in Glasgow. Others are forced to travel 100 miles to give birth in Caithness, and there are shortages of midwives in Lothian.
Parents who have lost babies are frustrated by the lack of transparency. Promises were made previously that parents such as Julie Keegan, who lost her baby boy, and Lori Quate, who lost both his wife and unborn child, would be part of the task force. Why have they not been involved?
Only this week, we learned of further delays to the opening of the Baird family hospital, which provides maternity services. It is seven years late. There is also the downgrading of the award-winning Wishaw neonatal unit. Consideration of neonatal services appears to have been dropped, and it would be helpful to know whether the cabinet secretary would reconsider that.
In my constituency, midwives and expectant mothers are concerned by reports that triage calls that are currently dealt with by their local hospital, the Vale of Leven, could be centralised. What steps will the minister take to ensure that women who are giving birth receive safe, high-quality care, wherever they are in Scotland?
I will do my best to answer those points in turn while also trying to achieve brevity.
Jackie Baillie said that Professor McCourt has her work cut out for her. I suggest that we all have our work cut out for us, because time does not stand still for any of us. Where there are issues, I hope that the chamber and Ms Baillie know that I will always be candid and direct. If I need to lift the lid on something, I will do that.
Transparency for families is absolutely crucial. I have been concerned by reports that I have read with respect to serious adverse reviews. At the very heart of those reports are issues around quality and timing. Those reports have to be done timeously, they must involve families and they must be of good quality, because they facilitate learning for the future.
On Baird and ANCHOR—Aberdeen and north centre for haematology, oncology and radiotherapy—issues, we want those services to be open as soon as possible. However, they need to be safe before they are open. I think that we have all learned those lessons.
With regard to Wishaw neonatal, if someone has a very sick baby and that wee baby is not being cared for in the hospital closest to them, I well and truly understand the tension and distress that will cause. However, I also understand what we have to do to save young lives. On the basis of clinical advice, and with the support of organisations such as Bliss, we are moving to a model that has safety at its heart. I am happy to discuss that further.
The terms of reference have still to be published. We would, of course, not publish the terms of reference before a chair was appointed, as a chair has a crucial role in drafting those, because they are, indeed, independent.
I thank the minister for her statement and I welcome the independent review. As someone who has stood for this Parliament once before, in relation to saving local hospitals in Dunfermline, Perth and Stirling, I am interested to see how things have progressed in 20 years.
The key issue of the workforce remains the same. In Caithness and other areas, it is often a case of death by 1,000 cuts. First, you do not have the medical staff—there is no housing for them, so they do not want to come. Then you have a problem with midwives and you maybe do not have midwives. Then you say that anybody who is anything other than a low risk has to be moved—and so it goes on.
I will not speak about the problems, as Jackie and others have often mentioned them, but what specific steps is the Scottish Government taking to increase the recruitment and retention of midwives?
Members must refer to other members by their full names.
For the record, over the past 10 years there has been a 13 per cent increase in the number of qualified midwives, which equates to just under 318 whole-time equivalents. Nonetheless, there are significant workforce issues to be addressed.
As I said, I will meet the Royal College of Midwives later today, and Maree Todd will continue to be involved in the nursing and midwifery task force, which has been designed specifically to look at those workforce issues. Recruitment can be a challenge, particularly in rural areas, and we need to retain those who join that very important vocation. There is work to do, but I assure Ms McDade that we are well and truly on the journey.
The cabinet secretary will be aware that it is now eight years since NHS Grampian downgraded maternity services at Dr Gray’s hospital. Restoration of a consultant-led service has been supported by the Scottish Government, and the project team is now undertaking the most challenging phase of work to recruit key clinicians to restore our full obstetric service.
I welcome the reference to Elgin in the cabinet secretary’s statement. I ask that she confirm that the review will not impact the Scottish Government’s commitment to a consultant-led service in Moray and that the Government will do all that it can to support the project team as it continues its work to rebuild services at Dr Gray’s hospital.
As I said in my statement, we remain committed to supporting the return of obstetric maternity services to Dr Gray’s hospital. Since 2023, we have invested with NHS Grampian to support that return. In this financial year, there is a further £6.5 million of investment.
Since 2024, NHS Grampian has made progress on obstetric day care and antenatal scanning services, and it is also performing elective daytime caesareans. Of course, there is further work to be done, which hinges on ongoing recruitment.
I echo the cabinet secretary’s appreciation of, and sincere thanks for, the exceptional dedication of midwives. When they start their journey as midwifery students, there are often barriers to their staying in the sector due to the costs of living and studying. Will the cabinet secretary confirm whether the review will also look at paying midwifery students while they learn?
The purpose of the midwifery and nursing task force is to look at those issues, and I mentioned the work that Maree Todd will be leading on apprenticeships. Kayleigh Kinross-O’Neill raised an interesting point about earn-as-you-learn routes into the profession. In a former ministerial role, I was the Minister for Youth Employment, so I am committed to vocational learning and models that are otherwise adapted with regard to what we have learned from the success of apprenticeship-type models.
Over the past 10 years, there have been three reviews of maternity and neonatal services. I do not believe that there is any joined-up thinking in this Government about its approach and how it will improve those services for mums and their babies.
I want to raise an issue about the number of beds that are available for parents in neonatal wards. The work that was undertaken by Bliss Scotland shows that, for every 10 children who need specialised care, there is only one bed for parents who want to stay overnight. I worked with the previous minister on the issue and I am willing to work with the cabinet secretary. Will she give an update today on the number of beds that are currently available for parents? Will she ensure that there is a positive change in the number of those beds, to ensure that parents can stay with their babies who need specialised care?
Ms Gallacher makes an important point about the need to keep mothers with their babies, irrespective of the health needs of the children. We want to ensure that that happens as much as is conceivably possible, and I would be delighted to work with Ms Gallacher on that. I will follow up on the specific question that she has asked about the number of beds, their availability and where they are.
What will be different about this review is that it will be on the back of seven Healthcare Improvement Scotland maternity inspections, and there are broad themes in relation to those. The work of the nursing and midwifery task force and the midwifery and neonatal task force will be important in ensuring that the review can build on those inspections. I am confident that we have an excellent and outstanding chair to lead that work and that she will be open to engaging with parliamentarians and, most importantly, all the communities that we seek to represent.
The Liberal Democrats have long called for an independent review, so I welcome the appointment of Professor McCourt as an independent chair. It is imperative that local campaigners and those who have lived experience are fully engaged, including Willie Rennie’s constituent Lori-Mark Quate, who was previously given a commitment on involvement in the task force, although that has not happened to date.
Will the cabinet secretary recommend that Professor McCourt meet the Caithness Health Action Team and experience at first hand the 100-mile-plus journey that mums in the far north are forced to make? Will she also clarify whether the review will examine restoring consultant-led maternity services in Caithness?
It will be an independent review with an independent chair, but I hope that the principles that have been published today will give at least some reassurance until the review has been set up and established.
On the point about the existing midwifery and neonatal task force, some of that work will be paused. The proposition, which is subject to consultation with the chair, is that there will be a panel to advise her.
I am clear that, as well as being independent, any review must engage with the affected communities, which specifically includes Caithness and other rural communities. Members will note from my statement that, as well as maternity triage, clinical pathways will be important. This is a comprehensive, independent review for all of Scotland, and it is inclusive of the communities that many of the members who are here today represent.
It is vital that everybody planning for a family in Scotland should feel confident that they will have a positive and safe experience of maternity care, whereby their choices are respected and supported. Therefore, I was delighted to hear the cabinet secretary talk about equity of access, particularly in rural areas, including many communities in my constituency. Will the cabinet secretary say more about the plans to improve equity of access for expectant families across the country?
Alex Kerr raises a crucial point about equity, which is an issue with regard to access. We have heard about very long journeys, travelling across Scotland, that birthing mothers have taken. Equity is also important in considering the impact of deprivation. I will give one or two examples. Women from the most deprived communities are more likely to have complex health issues, including diabetes; they are more likely to have a pre-term baby; and their baby is more likely to be small for its gestational age. This is a comprehensive, independent review, and inequity in all its forms will be at its heart.
Western Isles hospital maternity care service received an excellent report following an inspection earlier this year, showing that staff are doing a great job of providing compassionate and responsive care to women and their families. However, the report from Healthcare Improvement Scotland also stated that recruiting and retaining staff is a concern, with housing being a key issue. What role does the Scottish Government see the key worker housing fund having in ensuring that maternity care in our islands remains excellent?
Donald MacKinnon makes an important pragmatic point. That is why we need all our services and every portfolio in Government to be joined up. The housing fund for key workers is absolutely imperative. We all know of the recruitment and retention challenges, particularly in our rural communities, and I appreciate that there are additional challenges with our island communities.
I, too, associate myself with the cabinet secretary’s comments with respect to the staff who work in maternity services, especially those in Argyll and Bute.
This is a follow-on question from Donald MacKinnon’s. To ensure that the current 24-hour midwife-led community service is maintained in places such as Argyll and Bute, staffing levels cannot be reduced. What discussions is the Scottish Government having with health boards and health and social care partnerships to ensure that there is appropriate staff funding to improve maternity services across Scotland, especially in rural constituencies such as Argyll and Bute? How are the very important rural and island voices being included in the maternity review?
I am grateful to Ms Minto for her question. She has done, and will continue to do, great work in championing the healthcare needs of women, and she will continue to be a strong voice for rural Scotland.
I am sure that Ms Minto will be aware that local authorities and health and social care partnerships are responsible for planning and delivering services that meet local needs. I want to be clear that safe and effective care for women using maternity services is of the utmost importance. I recognise the challenges that women face in rural areas of Scotland, including in Argyll and Bute. With another hat that I used to wear, I was the minister with responsibility for resilience, so I have become intimately familiar with the weather challenges, whether in Argyll and Bute or in Caithness, and I appreciate the logistical challenges for public services and, indeed, emergency services. However, I would point out that we have provided a record £17.5 billion to health boards and that, since 2018, we have provided more than £34 million to invest in maternity and neonatal services alone.
I thank the cabinet secretary for her statement. I appreciate the attempts, which she outlined, to address the issues that maternity care in Scotland faces. While we wait for the outcome of the new national review of maternity services, will action be taken to help the expectant mothers who, since the Galloway community hospital maternity wing was shut down, have had to travel 75 miles to access maternity care?
I am becoming aware of the history of the range of local issues in different parts of Scotland, including the south-west. We cannot turn back time, so we must look forward and address the issues that are being wrestled with in relation to choice, safety, access and equity—equity irrespective of where a woman stays and in relation to the other challenges that women might face in their lives.
The purpose of the review is to build on the previous work that has been done—we are not going to reinvent the wheel—and to get some impetus, rather than waiting until the cycle of Healthcare Improvement Scotland reports has been completed. The eighth report is due to be published soon, and there will be 18 in total.
We need those Healthcare Improvement Scotland reports, because they shine a light on the good practice, the compassionate care and the value of midwives in this country. They also shine a light on where improvements must be made. The job of the task force will be to work at pace to implement change that, I hope, we can all get behind.
I remind members of my entry in the register of members’ interests: I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
The Queen Elizabeth university hospital in Glasgow was recently ordered by Healthcare Improvement Scotland to make 26 improvements. Many of my Rutherglen and Cambuslang constituents access maternity care at or from the hospital. What reassurances can the cabinet secretary give my constituents that those improvements will be made and that their maternity care will be safe?
We must reassure women, especially those who are currently expecting a baby, that they should be confident in accessing care and that—in recognition that that is a special time but that it can be worrying—if things do not operate as planned, there will be absolute transparency around that. With that in mind, we always want to encourage women to access the care that they need.
In my statement, I intimated that I quickly met the chief executive of NHS Greater Glasgow and Clyde and, separately, Healthcare Improvement Scotland. That was my way to cross-check what the chief executive had relayed thoroughly to me about the progress that was being made with the published action plan, the additional investment in midwives and the work that was being done to engage with the workforce, address issues of culture and address access to interpretation services. I specifically raised access to interpretation with the chief executive, because I can imagine that, if English is not your first language, it must be frightening to be unable to communicate your needs. Being able to communicate your needs and have them be understood is fundamental to care.
I also took the opportunity to engage with Healthcare Improvement Scotland, which confirmed the proactive leadership and ownership by the chief executive and the board.
I assure Clare Haughey, so that she can reassure her constituents, that I and other ministers will follow through on that with further meetings. A range of options are available to us if the current progress does not continue.
I thank the cabinet secretary for her statement, and I welcome the commitment to work with black and Asian women to inform the review.
I am sure that the cabinet secretary will be aware of the shocking statistic that black women are more than twice as likely as white women to die in pregnancy, childbirth or the postnatal period. As some of the women who engage with the review might have experienced significant trauma as a result of being racialised by maternity services, how will the cabinet secretary ensure that the review is trauma informed and that sufficient emotional support is available for those who take part in it?
I am acutely aware of the very sobering MBRRACE-UK maternity mortality stats, which show that there is a threefold difference between maternal mortality among black women and maternal mortality among white women, and that the maternal mortality rate for Asian women is a bit higher than that for white women. We must recognise the disparities in outcomes that the audits and confidential inquiries that have been carried out across the UK show.
It is therefore crucial that racialised health inequalities are tackled. Work has been ongoing in that area—a maternal care action plan was published in February 2025—and I want that work to proceed as a priority. In addition, Cara McKee will note that racialised health inequalities are an important part of the brief for the chair of the new independent review.
I welcome the cabinet secretary’s statement and the manifesto commitment to an independent report on the maternal mortality that is faced by Scotland’s black and Asian communities. It is essential that communities that face systemic barriers and bias are properly supported to ensure the best outcomes for everyone in Scotland. Can the cabinet secretary say any more about the Government’s expectations for that work and what it hopes to achieve as a result of its commitment?
I will not repeat what I said to Cara McKee, other than to reinforce that tackling racialised health inequalities is a priority. The matter is one on which I have engaged with the Minister for Equalities and International Development, Simita Kumar. I have also made it clear to my health officials that it is not just an issue for the health department and that we need to reach out to different communities.
As I intimated, last year we published our action plan on tackling racialised health inequalities in maternity care, which contained 14 actions to be addressed in the first instance. Activity is under way on all the actions that were identified in the action plan for local delivery by NHS boards. I assure Mr Ghani that I will continue to monitor the implementation of those actions through NHS board updates.
I apologise to the members I was unable to call. Before we move on to the next item of business, I will allow a moment for front-bench teams to change over.
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