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Mothers and newborn babies were being harmed by staff shortages and a ‘toxic’ culture in Edinburgh’s maternity ward, a BBC News whistleblowing investigation has found.

NHS Lothian commissioned a report into the Edinburgh Royal Infirmary’s obstetric triage and assessment unit after a member of staff raised concerns in February this year.

The survey confirmed or partially confirmed 17 safety concerns.

NHS Lothian said that as a result of the report, an ‘improvement plan’ had already been put in motion to improve patient safety and improve the working environment for staff.

NHS staff spoke to BBC News following the death of a mother in the maternity ward in September – after the whistleblowing investigation had already concluded.

The health board said a detailed investigation into the death is taking place in an effort to provide the family with much-needed answers.

But staff say they fear the risks to patients remain.

“We are concerned that we will not be able to provide safe patient care and that women and babies will be harmed,” one employee told the BBC anonymously.

“The situation has deteriorated over the past five years and is now at its worst.”

The triage and assessment unit cares for pregnant women in need of urgent care and sees approximately 1,200 women every month.

The whistleblower report found that patient safety was compromised by a range of factors, including staff shortages that led to delays in women’s access to treatment.

It also said women were being seen by inappropriately qualified staff and that there was a ‘toxic relationship’ between managers and midwives.

The report concluded: “There is no doubt that there have been safety problems, near misses and actual adverse effects on women and babies.”

It describes situations where the support provided was ‘inadequate’ and midwives felt ‘professionally compromised’ due to staff shortages:

• A woman in labor waited several hours for triage and then called St John’s Hospital in Livingston herself to see if there was room in the maternity ward.

• On another day, there were ten women waiting for triage and seventeen were in the department when the night shift started. The unit has a capacity to treat nine people at a time.

Researchers found that managers incorrectly claimed the unit was well staffed, while “the majority of midwives said the unit was understaffed on most shifts, with the least experienced staff responsible for the ongoing care of a significant number of women at the same time”.

An analysis of the rosters showed that there were regular staff shortages. Midwives described actual and ‘near miss’ safety issues when workforces were compromised.

The report also shows that the morbidity rate in the obstetric triage and assessment unit increased by 200% to 15.2% between April 2023 and April 2024.

There were reports of employees feeling undervalued, disrespected and working under high pressure and stress.

One witness described an “abusive relationship between management and staff”, while others reported a lack of kindness and compassion from managers towards staff after a colleague committed suicide.

Some witnesses described managers downplaying concerns, with one accused of being “insensitive at best and bullying at worst”.

Several staff said they feared the consequences of speaking out would lead to managers making their lives at work difficult, for example by not granting annual leave.

The report was written by senior nurses who interviewed a total of thirty witnesses, including employees who work or have worked in the obstetric triage department.

They concluded that staff shortages and absenteeism would impact midwives’ ability to provide safe care.

They also noted increasing pressure on the department, with visitor numbers increasing by a quarter since January 2022, leading to overcrowding and delays.

Jim Crombie, the deputy chief executive of NHS Lothian, said the mother’s death on the ward in September was under investigation.

He said: “A Significant Adverse Event (SAE) panel, made up of a number of experts, including an external doctor, will carry out the careful assessment using normal processes and the report will be shared directly with the family and the service to ensure that all necessary steps have been taken.

“We must await the outcome of the SAE and follow any recommendations from it, and continue to implement actions regarding whistleblowing concerns.

“Since concerns were raised, an improvement plan is already underway and has been designed with staff to improve patient safety and quality of care and improve the working environment and experience for our teams of dedicated staff.

“All aspects of patient care and staffing have been reviewed, as have staff working patterns, training and environment, as part of an open and transparent team working plan.”

Maternity wards in Scotland do are routinely faced with unannounced inspections by the NHS safety watchdogHealthcare Improvement Scotland, from January. It is in response to a number of spikes in newborn deaths in recent years.