Last week the new Maternity Care Standards were published by Health Improvement Scotland. These are to be used to establish appropriate care in all settings across Scotland. Jaki Lambert, Director of RCM Scotland explains how they came about, explores what they are and highlights potential challenges
What do the Health Improvement Scotland Maternity Care Standards mean to Midwives in Scotland?
Key Points
- The Maternity Care Standards were commissioned by the Scottish government in 2024 and published by Health Improvement Scotland on the 23rd of March
- The standards cover maternity care delivered in all settings and apply to all NHS Scotland staff who are involved in maternity care in any way.
- The Standards provide leverage to advocate for the workforce, skill mix, resources and services needs for high quality care.
- The standards were shaped by a high level of engagement throughout
- Without sustained investment there is a real risk that these cannot be implemented in full.
Introduction
While there has been no shortage of policy, regulatory and recommendations published regarding maternity care in Scotland, it is 21 years since Scotland had Standards for Maternity care in Scotland (QIS 2005). In a busy landscape why are the new Maternity care Standards (HIS 2026) important to the Midwifery community in Scotland and why do we need them?
Background
The Chief Midwife for Scotland Justine Craig had advocated strongly for Maternity Standards to be developed and in 2024 it was announced that Healthcare improvement Scotland (HIS) had been commissioned to develop them. For context, In the same year it was also announced that Maternity inspections would also be developed based on the Safe delivery of Care inspections that Healthcare Improvement Scotland (HIS) undertake. At the time, the RCM in Scotland had raised concerns that, while we welcomed a focus on maternity care, undertaking inspections before the standards were developed appeared counterintuitive. Indeed, Professor Mary Renfrew very clearly challenged Healthcare improvement Scotland’s (HIS) intention to undertake inspections, only in acute maternity services, at the RCM Scotland SMiLe conference in 2024 , stating plainly that, as one of the indicators of high quality maternity care, how integrated it is across the continuum of care their approach was, in her own words, ‘wrong’! Therefore, the publication of the standards is essential to informing inspections moving forward along with informing the new Maternity and Neonatal taskforce in Scotland.
So how were the Standards developed?
HIS have a standard methodology for developing standards that is set out in appendix 1 with the aim that any standards are evidence based and fit for purpose, define what to expect from a service and can be used for quality assurance purposes. However, that methodology meant that the initial draft that met the multidisciplinary and multiagency development group felt a very long way from relationship-based care that meets the holistic needs of every person seeking maternity care. Rather it appeared a risk-based series of interventions with no mention of a midwife to be seen! However, the standards and indicators lead in HIS, Fiona Wardell was a star throughout who listened and engaged constructively and without losing her cool. This was also helped by some great chairing by Directors of Midwifery Cheryl Clark and Isla Barton. The development group, on which RCM Scotland had a professional and a partnership seat, continued to meet throughout 2025 and before and after the consultation period which included a session at the 2025 SMiLe conference among the many engagement sessions that were facilitated.
What are the final Standards?
The standards that were published on the 23rd of March reflect the wide engagement including the voices of families, midwives, third sector and various groups and professions across the Multidisciplinary team. The standards are not care pathways or policy; these already exist and are referenced throughout. What they are however is a set of standards that can support the current and future care provision in Scotland. Each standard sets out what it means for women and babies, what it means for midwives and the MDT and what it means for health boards. There are 11 standards covering principles of care, leadership and culture, service planning and facilities and high performing and functioning teams as well as all main aspects of care. (The standards do not sit in isolation but align with the HIS Clinical governance standards.)
The standards are, like maternity care, complex and non-linear. Reading them front to back, it is easy to think there are things missing to find that it is covered in another section. This means that things can be missed. In trying to meet everyone’s needs there will be gaps from everyone’s perspectives, however there is much to welcome.
- The need for boards to have the right staff and skill mix.
- The need to support time to learn, to reflect and develop and to access clinical supervision are really important as they give leverage for what is missing.
- The fact that care is described across home, community as well as acute supports advocating for care to be suitably resourced.
- Importantly the key role of Midwifery across the continuum of care.
These are just snapshots of much in the standards that can help to leverage for what is needed.
Are there any concerns?
As with all standards they are there to raise expectations and drive improvement, however it is essential that that means creating and resourcing an enabling environment so that midwives can thrive and provide the care that families want and need. These cannot be implemented fully without the investment in maternity services that have been sadly lacking.
Another real concern is that the inspections underway continue without taking a real account of these new standards. Why is this a concern? As the inspections are focused only on acute, in hospital care, they are not taking account of the integrated nature of care and a systems approach as set out in the standards. This is an issue on two counts: first, in the current financial climate, any improvement required by an inspection risk drawing resource from already under resourced parts of care that sit outside acute settings. The second issue is that the scoping for a review of maternity services in Scotland, currently being undertaken by the Scotland taskforce, is focusing on the current inspections, again, not giving the full integrated nature of maternity care.
That may have been rationalised before the standards were published but how can that be acceptable when the standards now exist?
So overall, I welcome the standards, any leverage that we can use to drive forward investment in evidence based maternity care is very welcome, but it is up to all of us to advocate for their implementation and resourcing.
Healthcare Improvement Scotland (HIS) 2026 Maternity Care Standards accessed 290226 HIS-Maternity-care-standards-March-2026.pdf
Healthcare Improvement Scotland (2025) Clinical Governance standards accessed 290326 20250609-Clinical-Governance-Standards.pdf
Healthcare Improvement Scotland (2026) Safe Delivery of Care Maternity hospital Inspections accessed 29th March 2026 Safe-delivery-of-care-maternity-hospital-inspection-methodology-February-2026.pdf
Quality Improvement Scotland (2005) Clinical Standards for Maternity Services QIS Scotland (no longer available online)
Jaki Lambert
Director of RCM Scotland
April 2026