SafeCare in Maternity: How Scotland is Delivering Safer Midwifery Services
Scotland has something distinctive among the UK nations: legislation that mandates real-time staffing assessments, risk escalation and evidence-based workforce planning across multiple clinical professions. In this session from the Connected Health & Care Summit 2026, Martin McKelvie from Healthcare Improvement Scotland, Mags Cantley and Kevin Dickson from NHS Lothian, and Karen Swinson, Clinical Lead at RLDatix share how the Health and Care Staffing Act works in practice, how bespoke maternity staffing tools were built by midwives using observation studies for inpatients areas and for community areas with approximately data gathered from 700-clinicians, and how SafeCare is being used from chaplains to delivery wards.
Watch how NHS Scotland built maternity staffing tools from scratch with midwives, deployed SafeCare across every inpatient area in Lothian at 85% compliance, and is using legislation to drive consistent, transparent staffing decisions nationally.
What the session covers and how the legislation works
This session covers Scotland’s distinctive legislative framework for safe staffing and its practical application in maternity. The key points were:
- The Health and Care Staffing Act 2019 went live in April 2024 and covers multiple clinical professions, including chaplains
- Healthcare Improvement Scotland monitors compliance, reviews the common staffing method and has power to request information from any health board
- Bespoke maternity staffing tools were developed by an expert working group of heads of midwifery, the Royal College of Midwifery and the chief midwifery officer, using observation studies and data from 700 midwives entered through a bespoke app
- The tools cover inpatients, outpatients, triage and community, and for the first time include baby care alongside mother care in the acuity descriptors
How NHS Lothian deployed SafeCare and what maternity staff are saying
Mags Cantley describes Lothian’s journey from procuring the system in 2015 to achieving 85% SafeCare compliance across every nursing and midwifery inpatient area. She is candid that SafeCare was a slow burn initially because staff were already learning electronic rostering.
In 2023, the executive nurse director mandated use across all inpatients. Weekly compliance reports sent to all areas created competitive momentum. Mags Cantley personally visits 5 to 10 areas that require support each week. SafeCare is now used by healthcare scientists, AHPs and chaplains, not just nurses.
On maternity, staff feedback since April 2026 has been positive. Midwives use SafeCare in morning huddles, value the ability to redeploy staff in real time, and are learning that staffing problems are sometimes about skill mix rather than numbers. Lothian invested £1.5 million and hired 70 additional midwives.
What this means for other organisations and who it is relevant to
Kevin Dickson describes how SafeCare supports annual compliance audits against the legislation. The audit asks staff what systems and processes are in place. Over successive years, a positive compliance trend has emerged, with SafeCare increasingly used in huddles and a shift from bespoke measures toward standardisation. He provides assurance to the board and Scottish Government where robust, evidence-based processes are in place.
Martin McKelvie explains the technical architecture: 22 instances of Optima and SafeCare across Scotland, data pulled through RLDatix Data Hub into NHS Scotland’s own environment, with Healthcare Improvement Scotland controlling all calculations and publishing reports nationally. National reporting includes recommended whole time equivalents by ward, 75th percentile demand measures, compliance checks and census period completion rates.
An audience member asked whether Scotland shares its multipliers with other nations. Martin McKelvie confirmed they are published but require discussion, and noted conversations with NHS Northern Ireland are underway.
The session closes with the vision: daily use across all maternity services, year-round data replacing two-week snapshots, and exploration of delayed inductions as the next use case for SafeCare.
This session is relevant to directors of nursing, heads of midwifery, SafeCare leads, workforce planners, compliance teams and anyone responsible for safe staffing, acuity measurement or legislative compliance across the UK.
Frequently asked questions
The session features Martin McKelvie, Information Systems Consultant at Healthcare Improvement Scotland, Mags Cantley, Health and Care Staffing Lead and SafeCare Lead at NHS Lothian, Kevin Dickson, Health and Care Staffing Lead at NHS Lothian, and is moderated by Karen Swinson, Clinical lead at RLDatix who introduces the legal framework. The session covers both national policy and local deployment.
The Health and Care Staffing (Scotland) Act 2019, which came into force in April 2024, covers multiple clinical professions. It mandates real-time staffing assessments, risk escalation, processes to address severe and recurring risk, and use of the common staffing method. Healthcare Improvement Scotland monitors compliance across all health boards and has power to request information. The legislation requires clinical leaders to have protected time to lead and boards to follow nationally standardised staffing tools.
An expert working group of heads of midwifery, directors of midwifery, the Royal College of Midwifery and the chief midwifery officer met at least monthly for two years. They defined levels of care, scope and quality thresholds. Observation studies were conducted in areas meeting quality standards. For community, approximately 700 midwives entered data through a bespoke app. The tools cover inpatients, outpatients, triage and community, with baby care included alongside mother care for the first time.
Every nursing and midwifery inpatient area in Lothian uses SafeCare with 85% average compliance. Weekly reports are sent to all areas, creating competitive accountability. Mags Cantley visits 5 to 10 areas requiring support each week. Professional judgment is mandated for every census period. Annual compliance audits survey staff on systems and processes and show a positive trend. SafeCare provides evidence for board and government assurance against the legislation.
Scotland has legislation mandating safe staffing, a Once for Scotland approach with nationally agreed values, and bespoke multipliers developed through observation studies rather than using the Safer Nursing Care Tool from Imperial. The maternity tool includes baby care in acuity descriptors. Currently, the Maternity and Mental Health Staffing Level Tools are hosted in SafeCare, with plans for all Staffing Level Tools to be incorporated into the platform in the future. Scotland has 19 adult inpatient specialties, 12 mental health subspecialties and dedicated maternity multipliers, all with independent values.
Healthcare scientists, AHPs and chaplains all use SafeCare in Lothian. Non-inpatient areas use SafeCare One, comparing staffing against demand templates and raising professional judgment. Mags Cantley argues professional judgment is the most powerful tool because it gives clinicians a recorded voice. Even chaplains, who have on-call requirements, use the risk escalation functions.
Scotland has 22 instances of Optima and SafeCare across individual health boards. Data flows through RLDatix Data Hub into NHS Scotland’s own environment. Healthcare Improvement Scotland accesses national data via a Snowflake instance, controls all calculations, and publishes reports back to every board. This ensures consistent, standardised results. Reports include recommended WTE, compliance rates, census completion and future red flag dashboards. This work is still in progress; however an interim reporting solution is in place whereby Health Boards extract the patient data report from Optima, submit it to a centralised area which is then loaded into a PowerBI dashboard where users can review their results.
