Vaughan Gething, Cabinet Secretary for Health and Social Services
On the 9 October 2018 I provided an Oral Statement to Assembly Members on the concerns relating to current maternity care provision in Cwm Taf University Health Board. I committed then to update members on progress, which I will provide within this Written Statement.
As a parent myself, I understand the concern and anxiety that this will have caused parents who are currently using, and those who have previously used these services. I am absolutely committed to ensuring a full investigation of the causes that led to this situation and the potential improvements that are needed. I also appreciate that this is a very difficult time for staff and I would like to commend them for their hard work, especially in the support they are providing to families at this time and the flexibility they are exhibiting in ensuring appropriate staffing levels across the service.
In order to ensure a full, transparent investigation into these adverse outcomes, I committed to commission an external review of maternity services in Cwm Taf to be undertaken by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives. This review will commence in the next few weeks and the findings will be published in the spring of 2019. The purpose of the review is to provide assurance to Cwm Taf University Health Board and Welsh Government that the maternity service provides safe and effective care for mothers and babies.
Building on the review work the health board has already undertaken the review team has been asked specifically to provide advice on further actions needed to ensure high quality, safe care is provided to mothers and babies and improve systems of governance and assurance in line with national standards and best practice.
The review will include assessment of the performance and structure of the maternity service in line with national standards and appropriate benchmarks to identify key areas for improvement. It will also involve reviewing the changes to systems and processes already brought in by the health board to ensure the timely identification, reporting, investigation and learning from serious incidents, and advise on actions to further improve fitness for purpose. It will also advise on any requirements for extension of the retrospective case reviews (prior to January 2016). A review of the actions contained within the health board’s local Maternity Services Improvement Plan will be undertaken, and advice is sought on any additional requirements to strengthen or accelerate delivery as appropriate. The review also provides an opportunity to identify key opportunities for further improvement in clinical systems and practice to improve quality and outcomes, and will look at any practical or cultural barriers within the service, or the wider organisation, that might inhibit progress.
Looking to the future, the review will consider those actions required to strengthen current service delivery as well as the opportunities for further improvement once consultant-led obstetric services are consolidated on one site from March 2019. Welsh Government officials have been working closely with health board leads to ensure that the terms of reference for the review build on the work already undertaken locally and ensure sustainable quality service provision both currently and within the future model for Cwm Taf.
A key focus of the work to date has been on ensuring safe staffing levels and strong clinical leadership. The health board has been working tirelessly over the last few weeks to ensure appropriate staffing levels, including: one band 7 patient experience midwife and 6.56 wte (whole time equivalent) band 5 midwives started employment in October; 2.26 wte band 6 midwives who will be starting December/January; and a further 5.8 wte band 6 midwives who are currently progressing through pre-employment checks and will be starting as soon as these checks are complete. They are continuing to advertise for midwives and obstetricians. Bank and agency staff have also been used as a short term measure to improve staffing levels. At a leadership level we have ensured that additional senior midwifery and medical management support is in place to provide oversight and advice. Experienced midwifery support continues to be provided by neighboring health boards, including a head of midwifery providing additional support and a governance midwife.
Welsh Government officials continue to work closely with the health board and weekly monitoring meetings are in place to provide assurance of safe services and progress with review process. The health board has developed a Maternity Improvement Board with key stakeholders to monitor progress in action plan implementation and is also working closely with the Welsh Government Delivery Unit to review governance processes and ensure full investigation of incidents and transfer of learning.
To ensure compliance with the need for robust reporting mechanisms for adverse events across NHS Wales, the Chief Nursing Officer wrote to each health board Chief Executive requesting assurance on reporting mechanisms and governance processes. All health boards have provided these assurances, and Heads of Midwifery have committed to review current reporting measures to ensure consistent and comparable reporting measures.
Women using maternity services rightly expect to receive good quality, safe care. Childbirth can be stressful, but also an experience that brings great joy. The welfare of mothers and their babies must be our main and immediate concern. I have been given assurance that clear actions are in place to ensure that women receiving care within Cwm Taf maternity services can expect safe and compassionate care. The review will provide additional assurance and learning to further improve services, and I commit to update members when the report is published in the next year.